The Script - Issue 45 by CJMarketing

Pharmacy Magazine

PHARMACY WEEK

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Claim y tary n complimeining PDA tra le! modu

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TAKE CARE WHEN USING ANTIBIOTICS

SEPTEMBER IS HERITAGE MONTH

ORAL HEALTH AWARENESS MONTH

Issue 45

FEATURE HEADER

SINUTAB® NASAL SPRAY n

Nasal congestion caused by colds, hay fever, allergic rhinitis and sinusitis

Works within 10 minutes for fast relief 1 Lasts up to 10 hours 2

SINUTAB® SALINE NASAL SPRAY n

Daily nasal hygiene

Cleans and moisturises nasal passages

Soothes irritated nasal passages

Supportive treatment for nasal congestion

References: 1. Martindale, The Complete Drug Reference, 32nd Edition, page 1071. 2. R Eccles, K Martensson, Shirley C. Chen, 2010, Effects of intranasal xylometazoline, alone or in combination with ipratropium, in patients with common cold, Current Medical Research & Opinion, Vol. 26, No. 4, 2010, page 889-899.

Xylometazoline Hydrochloride

Sinutab® Nasal Spray. 1 mg per ml (0,1% w/v). Reg. No. P/16.1/184. For full prescribing information, refer to the package insert approved by the Medicines Control Council. ® Trademark © Johnson & Johnson (Pty) Ltd 2014. Talk to us on sharecall 0860 410032 or email jnjza@its.jnj.com. 08/SINU/05/14/P/PRT.

Nr. 12, 4th Street, Delmas PO Box 186, Delmas 2210 Tel: 013 665 1011 Fax: 013 665 4713 Registered: CJ Pharmaceutical Enterprises (PTY) Ltd. VAT Reg. 409 0205 909 Reg: 2001/009972.06 Telesales Anette, Beauty & Secci [fax] 086 697 9506 email: telesales@cjpharm.co.za

Customer Care Lila, Maria & Brenda [fax] 086 589 5983 email: customercare@cjpharm.co.za

Operations Egon Sellner (COO) email: esellner@cjpharm.co.za

Customer Relations Theuns [cell] 072 638 4085 email: theuns.w@cjpharm.co.za

Ridwaan [cell] 072 534 8135 email: ridwaan@cjpharm.co.za

Lynne [cell] 071 472 7522 email: lynne@cjpharm.co.za

Pam [cell] 071 480 5322

Index VIP Days

Pharmacy Week 2014

Spreading hope, one seed at a time

Important industry days to remember.

Rational use of medicine and Antimicrobial Resistance (AMR).

email: pam.vc@cjpharm.co.za

Darren Brooks (CMO) [cell] 083 229 5212 email: darren@cjpharm.co.za

Account Queries Debtors : Maritsa

The Sunflower Fund has contributed a great deal in assisting patients suffering from leukaemia.

email: maritsa@cjpharm.co.za

Creditors : Sonja

email: sonja@cjpharm.co.za

Buying Department Estelle email: estelle@cjpharm.co.za Christa email: christa@cjpharm.co.za Inventory Manager Erika Oehley email: erika@cjpharm.co.za

Healthy smiles all around

Dancing to the beat of a healthy heart

A smile can say a lot about a person, especially about the state in which their oral health is.

Tech & Data Reporting Werner email: it@cjpharm.co.za Senior Management Christopher Williams (CEO)

Diet, stress, family health history and health care.

Chris Williams (MD)

Colourful Spring recipes.

email: willchem@global.co.za email: chris@cjpharm.co.za

Darren Brooks (CMO)

email: darren@cjpharm.co.za

Food 18 PDA - Complimentary Training Module

Productive mornings

Mind your health

Module 4 in the series is now available.

Nr. 7, 4th Street, Delmas PO Box 186, Delmas 2210 [Tel:] 013 010 0091 [Fax:] 086 698 1468 Advertising & Promotions Jan Bester (Marketing Coordinator) email: cjmarketing@cjpharm.co.za

[fax] 086 698 1468 Thea Botes

12 reasons the Early Bird Gets the Worm.

Mental Health Month is a useful reminder for all of us to think about the mental health of ourselves and those around us.

email: marketing@cjpharm.co.za

[fax] 086 698 1468 Customer Relations Theuns [cell] 072 638 4085 email: theuns.w@cjpharm.co.za

Lynne[cell] 071 472 7522 email: lynne@cjpharm.co.za

Ridwaan [cell] 072 534 8135 email: ridwaan@cjpharm.co.za

Pam [cell] 071 480 5322 email: pam.vc@cjpharm.co.za

Darren Brooks (CMO) [cell] 083 229 5212 email: darren@cjpharm.co.za

Account Queries Debtors : Caron email: finance@cjpharm.co.za MAGAZINE DESIGN & LAYOUT Marizelle Geldenhuis (Creative Director) Carl Loggenberg (Graphic Designer) Clarissa van der Linde (Junior Graphic Designer)

About the Cover Pharmacy Week 2014. The topic of this year’s theme, ‘Use antibiotics wisely’, talks directly to the patients’ responsibility to avoid resorting to antibiotics for a common cold which will increase the risk of AMR, which means loss of effective medicines, as the incorrect usage of antibiotics can stop them from working when you really need them. In addition, patients should know, for example what is an antibiotic, how to keep antibiotics strong enough to fight infection and to practice hygienic measures to prevent infections. The Script Pharmacy Magazine │September • October 2014

National Arbor Week 1â&#x20AC;&#x201C;7 September 2014

Non Timber Forest Products

Small Business

Indigenous Forests

Fruit

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Forests and People: Investing in a sustainable future

cia

South Africa will host the XIV World Forestry Congress in 2015

agriculture, forestry & fisheries Department: Agriculture, Forestry and Fisheries REPUBLIC OF SOUTH AFRICA

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VIPDAYS

DIARY

Keep your eye on our calendar for important industry dates. To contribute events to our calendar, kindly email maketing@cjpharm.co.za 5SEPTEMBER 2014 Casual Day Casual Day is South Africa’s foremost fundraising campaign for persons with disabilities and is the flagship project of the National Council for Persons with Physical Disabilities in SA (NCPPDSA). Casual Day has become a firm favourite on the calendar of many of South Africa’s businesses, with some corporate sponsoring stickers for their entire staff complement as a corporate social investment initiative. THIS YEAR’S THEME “BLING”

1 - 8SEPTEMBER 2014 Pharmacy Week There’s no doubt about it. Pharmacists in all sectors make a valuable contribution to the health and wellbeing of the people of South Africa. From the pharmacist working in industry to provide the medicines that treat illness to those pharmacists who make sure that patients in institutional settings and in the community receive the most benefit from their medicines, their involvement helps people to achieve and maintain health, which improves their quality of life. And without the academic institutions that train pharmacists, this wouldn’t be possible.

1-30SEPTEMBER 2014 National Oral Health Month

Pharmacy Week

29SEPTEMBER 2014 World Heart Day 2014

September is national Oral Health Month – time to pay extra attention to your dental routine, particularly as two of the world’s most common health problems affect the mouth – cavities (dental caries) and gum disease. Gum disease ranks second only to the common cold in terms of prevalence, with an estimated 90% of South Africans experiencing the problem at some point. It really is in your best interest to practice good oral hygiene. Not only does it ensure a beautiful smile, but it is good for your health – gum disease has been linked to coronary heart disease, adverse pregnancy outcomes and diabetes. And new research also shows that women with gum disease find it harder to conceive.

World Heart Day is a global initiative of the World Heart Federation (WHF), with co-sponsorship from the World Health Organisation (WHO) and UNESCO. World Heart Day aims to raise global awareness of cardiovascular disease and its prevention. At least 80% of premature deaths from heart disease and stroke could be avoided if the main risk factors, tobacco, unhealthy diet and physical inactivity, are controlled. The campaign emphasises prevention measures and risk factors, which include: Smoking; High blood pressure; High blood cholesterol; Diabetes; Lack of exercise; Obesity and Stress.

DELIVERY SCHEDULE –HERITAGE DAY 24SEPT2014 Please note that with the upcoming public holiday our delivery schedule will reflect the following changes: Heritage Day – 24th of September 2014 • There will be no deliveries and our offices will also be closed on Wednesday, 24th of September 2014. • Our telesales department will only be available until 18h00 on Tuesday, 23rd September 2014. • Orders placed on Wednesday, 24th of September, up until 19h00, will be delivered on Thursday, the 25th of September 2014. (Our Telesales department will be available from 16h00-19h00 on Wednesday, the 24th September 2014) • Please take note of the earlier cut-off time. Should there be any queries or emergencies, please don’t hesitate to contact Lynne (071 472 7522), Ridwaan (072 534 8135), Theuns Wessels (072 638 4085), Pam van Coller (071 480 5322) or Egon (082 055 3503). We apologize for the inconvenience that this might cause. The Script Pharmacy Magazine │September • October 2014

FEATURE HEADER

All you need to know about Pharmacy Week 2014 Pharmacy Week 2014, which takes place from 1 to 8 September, focuses on the theme: “Rational use of medicines and Antimicrobial Resistance (AMR)”. The topic of this year’s theme, ‘Use antibiotics wisely’, talks directly to the patients’ responsibility to avoid resorting to antibiotics for a common cold which will increase the risk of AMR, which means loss of effective medicines, as the incorrect usage of antibiotics can stop them from working when you really need them. In addition, patients should know, for example what is an antibiotic, how to keep antibiotics strong enough to fight infection and to practice hygienic measures to prevent infections. The content of the message and answers to these key questions are: What are antibiotics? Medicines that help fight infections that are caused by bacteria. Do you really need to take antibiotics? Common colds, flu and most coughs are caused by viruses not bacteria, so antibiotics will not help. How can you keep antibiotics strong enough to fight infection? Take antibiotics only when prescribed by your doctor, dentist or nurse. 6

Know how many times a day to take your antibiotics. • Do not skip any doses. • Never share antibiotics or take leftover antibiotics. How to protect yourself and your family from infections? • Wash your hands well and often. This is the best way to keep from getting sick. • Cover your mouth and nose when coughing or sneezing. • Avoid touching your eyes, nose or mouth. • Complete your course of antibiotics, even if you feel better.

Antibiotics Antibiotics are chemicals that kill or inhibit the growth of bacteria and are used to treat bacterial infections. They are produced in nature by soil bacteria and fungi. This gives the microbe an advantage when competing for food and water and other limited resources in a particular habitat, as the antibiotic kills off their competition.

The Script Pharmacy Magazine │September • October 2014

How do antibiotics work? Antibiotics take advantage of the difference between the structure of the bacterial cell and the host’s cell. They either prevent the bacterial cells from multiplying so that the bacterial population remains the same, allowing the host’s defence mechanism to fight the infection or kill the bacteria, for example stopping the mechanism responsible for building their cell walls. An antibiotic can also be classified according to the range of pathogens against which it is effective. Penicillin G will destroy only a few species of bacteria and is known as a narrow spectrum antibiotic. Tetracycline is effective against a wide range of organisms and is known as a broad spectrum antibiotic.

Antibiotic resistance

Bacteria are termed drug-resistant when they are no longer inhibited by an antibiotic to which they were previously sensitive. The emergence and spread of antibacterial-resistant bacteria has continued to grow due to

AWARENESS

JOIN THE MOVEMENT

Every pharmacy professional is asked to promote this message in their daily interactions with patients, and to make the most of every opportunity to educate and inform consumers about pharmacy. Please remember to sent your Pharmacy Week stories and photos to elmari.Venter@ sapc.za.org or moloko. masenya@sapc.za.org.

both the over-use and misuse of antibiotics. Treating a patient with antibiotics causes the microbes to adapt or die; this is known as ‘selective pressure’. If a strain of a bacterial species acquires resistance to an antibiotic, it will survive the treatment. As the bacterial cell with acquired resistance multiplies, this resistance is passed on to its offspring. In ideal conditions some bacterial cells can divide every 20 minutes; therefore after only 8 hours in excess of 16 million bacterial cells carrying resistance to that antibiotic could exist.

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ics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria. Misuse of antibiotics jeopardizes the usefulness of essential drugs. Decreasing inappropriate antibiotic use is the best way to control resistance. Children are of particular concern because they have the highest rates of antibiotic use. Antibiotic resistance can cause significant danger and suffering for people who have common infections that once were easily treatable with antibiotics. When antibiotics fail to work, the consequences are longer-lasting illnesses, more doctor visits or extended hospital stays, and the need for more expensive and toxic medications. Some resistant infections can even cause death.

Antibiotic Prescribing: Attitudes, Behaviors, & Cost How is resistance spread? Trends • Parent pressure makes a difference. Antibiotic resistance can either be inherent or acquired. Some bacteria are naturally resistant to some antibiotics due to their physiological characteristics. This is inherent resistance. Acquired resistance occurs when a bacterium that was originally sensitive to an antibiotic develops resistance. For example resistance genes can be transferred from one plasmid to another plasmid or chromosome, or resistance can occur due to a random spontaneous chromosomal mutation.

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http://www.pharmcouncil.co.za/D_phweek.asp

Quick Facts • •

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Antibiotic resistance has been called one of the world’s most pressing public health problems. The number of bacteria resistant to antibiotics has increased in the last decade. Many bacterial infections are becoming resistant to the most commonly prescribed antibiotic treatments. Every time a person takes antibiot-

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For pediatric care, a study showed that doctors prescribe antibiotics 62% of the time if they perceive parents expect them and 7% of the time if they feel parents do not expect them.[1] Antibiotics were prescribed in 68% of acute respiratory tract visits – and of those, 80% were unnecessary according to CDC guidelines.[2] National Ambulatory Medical Care Survey (NAMCS) data shows that overall antibiotic prescribing dropped from 13.8 prescriptions per 100 office visits to 12.0 prescriptions per 100 office visits comparing 1997-98 to 2005-06 with a 13% reduction in overall antimicrobial prescribing.[3] According to NAMCS, the Get Smart Campaign contributed to a reduction in antimicrobials prescribed for children <5 years in ambulatory care otitis media (ear infection) visits. In 2007 47.5 antimicrobials were prescribed per 100 visits, down from

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61 in 2006 and 69 in 1997.[4] Among children younger than 5 years, annual ARTI (acute respiratory tract infections) visit rates decreased by 17% from 1883 per 1000 population in 1995-96 to 1560 per 1000 population in 2005-06, primarily due to a 33% decrease in visit rates for otitis media. $1.1 billion is spent annually on unnecessary adult upper respiratory infection antibiotic prescriptions.[5] Get Smart has contributed to 25% reduction in antimicrobial use per outpatient office visit for presumed viral infections (NAMCS); intervention studies show a reduction of 8 to 26% for antibiotic prescriptions.[6]

Get Smart. Take a look at this chart to find out which upper respiratory infections are usually caused by viruses — germs that are not killed by antibiotics. Talk with your doctor about ways to feel better when you are sick. Ask what you should look for at home that might mean you are developing another infection for which antibiotics might be appropriate. Usual Cause Virus Bacteria

Illness

Cold Flu Chest Cold (in otherwise healthy children and adults) Sore Throats (except strep) Bronchitis (in otherwise healthy children and adults) Runny Nose (with green or yellow mucus) Fluid in the Middle Ear (otitis media with effusion)

References

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Antibiotic Needed

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2 Column Newspaper (45/8" X 1 4 7 / ")

A PDF of this graphic will be availab le for download at www.cdc.gov/getsmart on Septem ber 17, 2003.

Mangione-Smith R, McGlynn EA, Elliott MN, et al: The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior. Pediatrics 103:711-718, 1999. Scott JG, Cohen D, DiCicco-Bloom B, Orzano AJ, et al: Antibiotic use in acute respiratory infections and the ways patients pressure physicians for a prescription. J Fam Pract: 50(10): 853-8, 2001. National Ambulatory Medical Care Survey (NAMCS).Grijalva CG, Nuorti JP, Griffin M: Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA 302: 758-766, 2009. Fendrick AM, Monto AS, Nightengale B, Sarnes M: The economic burden of non-influenza related viral respiratory tract infection in the United States. Arch Int Med: 163(4): 487-94, 2003. National Ambulatory Medical Care Survey (NAMCS).

The Script Pharmacy Magazine │September • October 2014

FEATURE HEADER

Spreading hope, one seed at a time... The Sunflower Fund has contributed a great deal in assisting patients suffering from leukaemia. Here is more information about this wonderful organisation

About the Sunflower Fund

least 100 000.

The Sunflower Fund was formed in 1999 in support of the SABMR (South African Bone Marrow Registry) and was inspired by Chris Corlett and Darren Serebro’s heroic struggle against leukaemia. It was formed by parents whose children had contracted leukaemia, and in some cases had lost their battle against it. Their aim was to secure financial support in order to increase the number of bone marrow stem cell donors in South Africa. With the odds of finding a donor being 1:100 000, the idea is to expand the registry to at

The Sunflower Fund carries the full responsibility nationally for raising the funds needed to meet the costs of all tissue typing of bone marrow donors for the purposes of increasing the SABMR; it has played a major role in enabling the SABMR to expand dramatically from 1 200 to over 65,500 donors over the past 9 years.

Raising funds

Dedicated staff A passionate and dedicated team of staff now runs the Fund and a number

The Script Pharmacy Magazine │September • October 2014

of committed volunteers assist with the national call-centre, all awareness drives and fundraising events. Many recruitment drives are held at schools and corporate companies throughout South Africa .

Their mission The Sunflower Fund aims to educate and recruit a viable source of well - informed potential bone marrow stem cell donors who are ethnically diverse, in an effort to save the lives of those suffering from lifethreatening blood disorders. It strives to maintain the associated donor records of the South African Bone Marrow Registry.

AWARENESS

Imagine being diagnosed with leukaemia... For many this is just unthinkable, but each year thousands of South Africans (mostly children and teenagers) have to face this terrifying reality. Fortunately, life-threatening blood disorders such as leukaemia, aplasia, immune deficiencies, inborn errors of metabolism, and other new indications such as auto-immune disorders can now be treated. Treatment, however, entails a bone marrow/stem cell transplant from a willing donor and although it is sometimes possible for relatives to offer the closest matches, 75% of patients will not have a suitable sibling and will have to start their search for a matching non-related donor.

Where to start? To facilitate this daunting search, bone marrow registers in different countries hold tissue type information of volunteers who have provided small blood samples for testing and recording. Sadly, the chance of finding a matching donor is just 1 in 100 000! The odds are even more against South African sufferers due to the fact that our rainbow nation has more unique combinations of tissue types. Ethnic origin is important when matching donors and patients. The “markers” that are tested when searching for a match are genetically inherited and often unique to a particular race. It is therefore very important that South Africa has its own bone marrow registry and the larger that registry, the greater and faster the chance of finding a perfect match.

Frequently asked questions and important information Who do we need as donors? Every healthy person between 18 and 45 can be a donor. “Tissue-types” are inherited characteristics, used in matching donors and patients. The likelihood, therefore, of finding a suitable volunteer will be considerably greater within the same ethnic background.

Accordingly all racial groups are welcome. What is the South African Bone Marrow Registry? It is an organisation that registers potential bone marrow donors and already has 10.6 million participants. It was started in 1991 and has been designated as the hub centre for this continent. As such, we are responsible for coordinating the provision of unrelated donors for our patients in association with a world wide data base. Why do people need bone marrow transplants? Every year thousands of individuals with blood diseases such as leukaemia, marrow failure or aplasia, and inherited metabolic and immune deficiency syndromes, reach a stage where only this procedure offers a chance of cure. Why are unrelated donors needed? Family members, particularly brothers and sisters are generally most suitable. However, due to the average family size, only a small percentage of patients have a compatible sibling match. About 75 % will have to search for an unrelated matched donor. How do bone marrow transplants save lives? The patient’s diseased marrow is destroyed by combinations of cytotoxic drugs and radiation. The graft from the healthy donor is given intravenously. Thereafter the blood forming stem cells travel to cavities in the large bones and, following engraftment, begin producing normal blood. What is bone marrow? This is the tissue that could be regarded as the factory for the production of red cells to carry oxygen, white cells to fight infection and platelets to prevent bleeding. How are donors and patients matched? In the same way as red cell blood groups exist, so white cells can be categorised into groups known as “tissue-types”. Very many possible tissue types exist, so that finding the correct match depends upon having a very large register of volunteers.

Although there are over 10 million donors registered worldwide some searches are still not successful. What does the donor initially do? Volunteers, if deemed to be suitable, need to have a small blood sample taken which is sent to specialised laboratories for tissue-typing. The results are placed on an international computer registry. What happens next? Possible matching donors will be asked to provide further blood samples to help select the donor matches best for a particular patient. How is bone marrow donated? The stem (marrow) cells can be obtained by collection from the peripheral blood on a machine called a cell separator. This avoids general anaesthetic and hip punctures. It is equally efficient and comparable to bone marrow for the recipient, but much less pain and trouble for the donor. Are there any side effects for the donor? Sibling transplants have been taking place for over 10 years; a short term side effect is flu-like symptoms during G-CSF stimulation; some donors have also reported mild bone pain. Where would I donate? The medical procedure for obtaining stem cells is called a harvest. If you are asked to donate you would be required to attend a specialist harvest centre in South Africa. Is a transplant a definite cure? Unfortunately the field of bone marrow transplantation is complex and a number of patients still die of complications despite the best medical care. Increasing numbers of successful transplants are being carried out using matched unrelated donors. However, donors can be assured that they offer the hope of a future to patients whose disease would almost certainly otherwise prove fatal.

Where can I join? Donors are recruited on behalf of the SABMR by The Sunflower Fund. For more information please call: 0800-12-10-82 or find us online: www.sunflowerfund.org.za

The Script Pharmacy Magazine │September • October 2014

Healthy smiles all around... A smile can say alot about a person, especially about the state in which their oral health is, so here are a few tips on keeping your teeth pearly white and healthy September is National Oral Health Month, which makes it the perfect time to pay extra careful attention to your dental health routine. Gum disease ranks second only to the common cold in terms of prevalence in our country, with an estimated 90% of South Africans experiencing its uncomfortable symptoms at some point in their lifetime. It is also estimated that two of the most common health problems worldwide affect the mouth and teeth, namely dental caries (cavities) and gum disease.

Don’t know the first thing about teeth?

Don’t worry, here’s a crash course on the basics of teeth and how to care for them. Teeth are necessary for survival, since they make it possible for us to eat and speak clearly. And no one can argue that a dazzling bright smile will stand you in good stead in the popularity stakes! SO how do they develop? Teeth develop in different phases. • The first development of the teeth commences in the womb, with the front teeth developing at about the fourth month of pregnancy. The first phase is the eruption (growing out of the gums) of about 20 primary or milk teeth; this usually starts at about 7-9 months of age. The lower central front teeth are normally first to make an appearance, followed by the upper central front teeth. The first primary molars are usually next to appear at about 12-16 months of age; followed by the canines (16-20 months), with the last teeth of the first phase being the second molars, appearing at anything between 20 and 30 months. A child should have his/her milk teeth by about two or three years of age. • The second phase starts with the

eruption of the first permanent tooth (usually the molars) erupting behind the last primary molar, usually at about 6 years of age. The permanent teeth are hidden below the gumline and shortly before eruption, they move in an upward direction; this causes the roots of the primary teeth to resorb (loosen) and they subsequently fall out. This happy and often funny occurrence usually takes place between 6-8 years of age, with the front teeth usually the first to fall victim. Most children will have all their permanent teeth by the age of 12, but there may be a substantial variation in the eruption patterns of permanent teeth. Any delay of up to 12 months can be seen as normal and is usually not a cause for concern. • The last teeth to erupt are normally wisdom teeth, which can be expected by about 18 years of age, but are normally not associated with the arrival of the wisdom promised in their name.

Look after your teeth!

People lose teeth through caries, gum disease, illness, trauma and other causes. By following some simple steps, you can go a long way towards preserving your teeth for the rest of your life. • Brush your teeth and tongue twice a day. • Floss between your teeth at least once a day. • Wear gum guards to protect those pearly whites when participating in contact sports.

When problems arise… What is tooth erosion? Tooth erosion is the loss of the hard dental tissue from the surface of the tooth and is caused by chemicals, usually acids, which occur in the mouth. Tooth erosion is

The Script Pharmacy Magazine │September • October 2014

normally not associated with bacterial plaque. There are quite a number of acidic foods and drinks in our diets and people with increased susceptibility may suffer from tooth erosion because of this. While the body and mouth have a buffering capacity which differs between individuals, increased exposure to acidic foods or drinks may override it, leading to tooth erosion. It is advisable to limit the consumption of acidic foods and drinks to main meals and to clean your teeth at least twice a day using a fluoride toothpaste. Chewing sugar-free gum, thereby stimulating the production of saliva may help to neutralize the effects of acids on the teeth.

What to do, what to do…

Prevention is better than cure! Here are some basic tips and information to ensure that your family has healthy gums, a sparkling smile and fresh breath every day! • Basic dental care is simple: brush your teeth regularly (especially after meals, snacks, and before bed), floss every day, and use a mouthwash. Flossing at least once a day removes plaque that can damaged teeth, gums, and surrounding bone. Use toothpaste that contains fluoride which helps protect against tooth decay and cavities. You will also be rewarded if you eat healthy foods, such as whole grains, fruit, vegetables and calcium-rich dairy products, which will also contribute to an overall healthy smile and fresh breath. Excessive amounts of red wine, tobacco and sugary foods will stain your teeth and lead to bad breath. Tongue cleaning is also important in having a healthy mouth and fresh breath.

AWARENESS

Why basic oral health care and hygiene is important.

Basic oral hygiene is essential in preventing tooth decay. By employing regular oral hygiene into your daily routine you will be helping prevent gum disease which can damage gum tissue and the bones that support teeth. Gum disease can lead to the loss of teeth in the long term. By caring for your teeth and gums at home you can potentially shorten the time and money you spend at the dentist and gain a healthy mouth. By preventing tooth decay and gum disease, you can reduce the need for fillings and other costly procedures such as bridge work, false teeth and much more. Gingivitis and bad breath can be minimised through regular brushing and flossing as it rids the mouth of bacteria. • Are there ways to avoid dental problems? Good nutrition combined with regular brushing and flossing is essential in keeping your teeth and gums healthy. Avoid food that contains a lot of sugar – sugar feeds damagecausing plaque that grows on your teeth. Tobacco products can cause gum disease and oral cancer, so be sure to avoid them. Cleaning your tongue is also good for your oral health, and tongue cleaning is particularly important for people who smoke or whose tongues are coated or deeply grooved. Choose a toothbrush that offers a tongue cleaner or a softbristle toothbrush, stroking in a backto-front direction. At the start of each year, book appointments at your dentist for your entire family. Schedule them throughout the year and make sure you don’t skip them. In addition to the above, it is recommended that you change your toothbrush every three months. • When should you take your child to see a dentist? At the age of six months, you should take your child to your general practitioner who will be able to assess the likelihood of your little one having future dental complications. If the general practitioner thinks your child will have dental problems, it is advisable that you take your child to see a dentist before his or her first birthday, just

after the primary teeth have begun to emerge. You should schedule appointments for your child every six months with your dentist.

How clean is your mouth?

Poor oral hygiene is being linked to heart disease, diabetes and pre-term, low-weight births — yet few of us know we’re at risk. Most of us brush our teeth at least twice a day and, when we’re not too tired, floss and use a mouthwash to rinse. We visit a dentist every two years or so and believe this is a pretty good effort when it comes to oral health. But up to 40% of adults worldwide suffer some level of gum disease, and there are very serious illnesses now associated with gum disease including heart disease, stroke, uncontrolled diabetes, pre-term births and respiratory disease.

What is gum disease?

When plaque and tartar are not properly removed from between our teeth, gums become swollen and bleed, a condition referred to as gingivitis. If left untreated, periodontitis can develop. Gums pull away from the teeth and infected pockets appear below the gum line. The bones, gums, and connective tissue that support the teeth are destroyed without proper treatment and tooth loss may occur. The bacteria formed by gum disease can also enter the bloodstream and escalate our risk of other serious ailments like heart disease. “Gum disease is not painful and most people don’t know there is a problem until it is too late,” says periodontist Dr Howard Gluckman. “The more aggressive type of gum disease is usually found in younger people; and the more chronic in older people, but age is not a risk factor on its own. There are a whole host of factors including genetic susceptibility, specific bacteria present in the gums, the environment, smoking, diabetes and others,” Gluckman says. There have also been strong scientific links between stress, obesity and gum disease.

So how do I know I have it?

There are a number of signs to look out for, says Gluckman: 1. Bleeding gums is a major indicator,

though this can be masked in smokers as gum inflammation is reduced. 2. Loose teeth. The bone has been destroyed and the teeth are able to move in their sockets. Teeth can be mobile without the presence of gum disease but is not that prevalent. 3. Gum recession. When the necks of the roots are exposed due to the loss of bone below. This can also be due to aggressive tooth brushing and orthodontic treatment. 4. Bad breath. The severity of bad breath varies from person to person, but sufferers are often not aware of it. Sometimes the only way to detect periodontal disease is through a periodontal evaluation. This is especially important if you: • Have symptoms of periodontal disease. • Have heart disease, diabetes, respiratory disease or osteoporosis. • Are thinking of becoming pregnant. • Have a family member with periodontal disease. • Have a sore or irritation in your mouth that does not get better within two weeks.

What can I do? Brush your teeth regularly and floss, floss, floss. “Flossing is very important but is not very popular because it is difficult and requires fairly good manual dexterity,” says Gluckman. Gum disease and decay starts most often in between the teeth that are rarely cleaned. You may find it easier to use small brushes to get between those difficult to reach teeth. “Six-monthly visits to the dentist are essential to reduce the risk of gum disease and tooth decay. Patients who have already been diagnosed and treated for gum disease need to see a properly trained hygienist every three months to ensure the disease does not return,” Gluckman says. - (August 2009) This September it really is in your best interest to start practicing good oral hygiene; it does not only ensure you a beautiful smile, but is also good for your overall health!

The Script Pharmacy Magazine │September • October 2014

FEATURE HEADER

Dancing to the beat of a healthy heart Diet, stress, family health history and health care... all of these factors can affect the health and function of your heart, so in keeping with Heart Awareness Month, do your heart and yourself a favour and get it checked out September is Heart Awareness Month – an entire month dedicated to raising awareness about cardiovascular disease in South Africa, culminating with World Heart Day on 29 September. According to the Heart and Stroke Foundation, South Africa has one of the highest rates of high blood pressure worldwide, with 1 in 3 people currently living with high blood pressure. Yet almost half of the people affected don’t even know they have this condition! So, for Heart Awareness Month 2014 we are encouraging South Africans to “Beat the pressure. Get tested”. High blood pressure is one of the leading causes for heart attacks and stroke so we urge South 12

Africans to go for a free blood pressure test this September to find out if they are at risk. Along with getting their blood pressure tested, we’re also encouraging South Africans to lower their salt intake, as a high salt diet is a key driver for high blood pressure. - See more at: http://www.heartfoundation.co.za/ heart-awareness-month-0#sthash.ibYexUzCciUbDAcK.dpuf

Foods Food is central to the identity of South Africans. During meals we talk and the family meets around the table. On high days and holidays we gather around the braai and the potjie pot which reflect

The Script Pharmacy Magazine │September • October 2014

the amazing diversity of our country. But food can also be our enemy. We are seeing unprecedented and rising levels of noncommunicable diseases in South Africa, with terrible impacts on our health – heart disease, stroke, type two diabetes and cancers are all on the increase, due to our increasingly poor diet. The rise of fast foods and urban living have taken their toll. We all know that staying healthy can be difficult. We have busy schedules and shrinking household budgets. Healthy foods recommended to us often seem inaccessible and unaffordable, making us feel inadequate if we can’t achieve those ideals. It can be time-consuming to make the journey to

AWARENESS

the supermarket and to prepare a meal, when we can find fast food closer to home. The truth is that healthy eating doesn’t have to be boring, expensive or complicated! It can be as simple as making small changes to your family’s favourite dishes and even bringing in new traditions. Our collection of recipes shows how to make food that tastes good, is simple to prepare and easy on the pocket. It also gives tips about how to stretch your budget further. By using readily available ingredients, you too can prevent yourself and your families from the dangers of noncommunicable diseases. - See more at: http://www.heartfoundation.co.za/ food-0#sthash.mMlbI01Y.6FYfsZ97.dpuf

Health It’s easy to dismiss your health as something to work on when you get the time. That is, until it fails you. Many of us don’t see ourselves at risk, but you can do a lot by paying attention to staying healthy. How do you do this? Keep moving, eat a healthy, balanced diet, de-stress your life, and cut out excessive alcohol use, smoking and drugs. Stick to these golden rules, and you’ll go a long way to living a healthy life - See more at: http://www.heartfoundation.co.za/ health#sthash.F3GlZ3gp.5FOshM5N.dpuf

Get support There are a number of ways that the HSF (Heart and Stroke Foundation) can support you. Perhaps you or someone you know has suffered a cardiovascular event, and would like to attend one of the support groups. Maybe you would like to attend a heart health screening. The HSF can offer you printed information in the form of a brochure, or you can sign up for a regular e-newsletter. If you have a lifestyle question for one of their dietitians, you can give them a call on their Heart and Stroke Health Line (086 0143 278) a share call number. If you are a school or a corporate organisation, the HSF can help you to improve the healthiness of your tuckshop or canteen, or can offer support for your wellness day - See more at: http://www.heartfoundation.co.za/

support#sthash.yKcoXSNS.OTY4JFW5.dpuf

5 Facts to know about the heart 1. How the human heart functions Every day, your heart beats about 100,000 times, sending 7000 litres of blood surging through your body. Although it’s no bigger than your fist, your heart has the mighty job of keeping blood flowing through the 96 000km of blood vessels that feed your organs and tissues. Any damage to the heart or its valves can reduce that pumping power, forcing the heart to work harder just to keep up with the body’s demand for blood. So how do you make sure your heart is in tip-top shape? “Keeping your body in good health helps keep the heart a more efficient organ”. In other words, eat healthy, well-balanced meals and don’t skimp on the exercise. 2. Male heart attack symptoms, female heart attack symptoms. When it comes to matters of the heart, men and women definitely aren’t created equal. For instance, a man’s heart weighs about 300g, while a woman’s heart weighs approximately 240g. Not only is a woman’s heart smaller than a man’s, but the signs that it’s in trouble are a lot less obvious. When women have a heart attack -- and more than a half million do each year -- they’re more likely to have nausea, indigestion, and shoulder aches rather than the hallmark chest pain. Heart disease is the biggest killer of both men and women worldwide and both genders should heed this healthy advice: Don’t smoke, keep your blood pressure and cholesterol levels in check, and watch for the obvious and the more subtle warning signs your heart could be in trouble.

walls relaxes and expands. So have a good giggle. Your heart will thank you. 4. Stress and the Monday morning heart attack You’re more likely to have a heart attack on Monday morning than at any other time of the week. Doctors have long known that morning is prime time for heart attacks. It is often called “the witching” hour for heart attacks. That’s because levels of a stress hormone called cortisol peak early in the day. When this happens, cholesterol plaque that has built up in the arteries can rupture and block the flow of blood to the heart. Add in the rise in blood pressure and increased heart rate from the stress of returning to work after the weekend, and you have the perfect recipe for a Monday morning heart attack. That’s why it’s important to reduce your stress levels as much as you can. Practice yoga, meditate, exercise, laugh (see tip No. 3), or spend more quality time with your family --whatever works best for you. 5, Your heart is positioned in the middle, tipping only slightly to the left. Put your hand on your heart. Did you place your hand on the left side of your chest? Many people do, but the heart is actually located almost in the center of the chest, between the lungs. It’s tipped slightly so that a part of it sticks out and taps against the left side of the chest, which is what makes it seem as though it is located there.

3. Laughter Health experts now have proof that laughter is good medicine. A good belly laugh can send 20% more blood flowing through your entire body.One study found that when people watched a funny movie, their blood flow increased. That’s why laughter might just be the perfect antidote to stress. When you laugh, the lining of your blood vessel The position of the human heart

The Script Pharmacy Magazine │September • October 2014

FEATURE HEADER

The Script Pharmacy Magazine │September • October 2014

FEATURE HEADER

The Script Pharmacy Magazine │September • October 2014

THERE IS NO “DEBATE” ON SOLUBLE VERSUS ENTERIC ASPIRIN!1 FEATURE HEADER

Least Likelihood of Treatment Failure with Dispersible Disprin Cardiocare Outcome of treatment with enteric-coated aspirin, asasantin and dispersible aspirin1

• In contrast to enteric-

coated aspirin incomplete

†

thromboxane inhibition was

54.3%

unlikely with dispersible

aspirin and treatment

failures did not occur

• Patients using low-dose

Percent

†

36.0%

30 25 20

dispersible aspirin are more

likely to attain full clinical

benefits, with the lowest

risk of adverse bleeding

*P=0.011 between treatments †P=0.0004 between treatments

13%

8.0%

events1

Enteric-coated aspirin (n=46)

0.0%

Asasantin (n=25)

Treatment failure (<95% inhibition of thromboxane)

8.%

Dispersible aspirin (n=25) Incomplete inhibition (<99% inhibition of thromboxane)

Convenient • Easy to swallow and pleasant tasting • Can be dispersed on the tongue without water

DISPRIN CARDIOCARE2

Absorbed rapidly

• Schedule 0 • Dispersible tablet containing 100 mg aspirin • To reduce the risk of cardiovascular events

• More rapidly absorbed than plain or enteric coated aspirin (Tmax for soluble aspirin achieved within 31 minutes versus 240 minutes for enteric coated aspirin)3

Reduces risk of vascular events by up to 32%4

Effective cardiovascular protection4

References: 1. Cox D, Maree AO, Dooley M, Conroy R, Byrne MF, Fitzgerald DJ. Effect of enteric coating on antiplatelet activity of low dose aspirin in healthy volunteers. Stroke 2006,37:2153-2158. 2. Dispirin® Cardiocare (Dispersible Tablet) PI. 3. Sagar KA, Smyth MR. A comparative bioavailabilty study of different aspirin formulations using on-line multidimensional chromatography. Journal of Pharmaceutical and Biomedical Analysis 1999;21:383-392. 4. Patrono C, Baigent C, Hirsh J, Roth G. Antiplatelet Drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133:199S-233S. See Package Insert for full prescribing details. PROPRIETARY NAME (AND DOSAGE FORM): S0 Disprin® Cardiocare 100 mg. COMPOSITION: Each tablet contains 100 mg Aspirin. REGISTRATION NUMBER: 31/2.8/0071. NAME AND BUSINESS ADDRESS OF THE HOLDER OF THE CERTIFICATE OF REGISTRATION: Reckitt Benckiser Pharmaceuticals (Pty) Ltd, 8 Jet Park Road, Elandsfontein, 1601. DIS14 - 01/14

07-1

The Script Pharmacy Magazine │September • October 2014

The mission is to position National Braai Day as South Africaâ&#x20AC;&#x2122;s annual day of celebration. South Africans gathering around fires, being the central theme of the celebration. National Heritage Day is a public holiday in South Africa. Our

government set this day aside for all South Africans to celebrate our rich heritage. Across race, language, region and religion, we all share one common heritage. It is called many things: Chisa Nyama, Braai and Ukosa to name few. Although the ingredients may differ,

the one thing that never changes is that when we have something to celebrate we light fires, and prepare great feasts. We encourage all South Africans to at some point during 24 September each year, gather around a fire and braai.

Join the movement ... on Facebook National Braai Day and invite your friends to join as well. Follow Jan Braai (@janbraai) Twitter, and help spread the message ...

Most importantly, light a fire, and braai on Wednesday 24 September 2014!

COLOURFUL SPRING RECIPES Celebrate the return of spring with these delicious, colourful recipes

Blueberry buttermilk pancakes Ingredients

• • • • • • •

150g (1 cup) self-raising flour 1 egg, lightly whisked 500ml (2 cups) buttermilk Melted butter, to grease 125g punnet fresh blueberries Pure maple syrup, to serve Butter (optional), to serve

Method: Sift the flour into a large bowl. Make a well in the centre. Add egg and buttermilk. Use a fork to mix until just combined. Heat a large non-stick frying pan over medium heat. Brush with melted butter. Pour three 2-tablespoon portions of the batter into the pan. Arrange a few blueberries over the surface of each. Cook for 2 minutes or until bubbles appear on the surface. Turn and cook for 2 minutes or until golden. Transfer to a plate. Cover with foil to keep warm. Repeat, in 3 more batches, with blueberries and remaining batter to make 12 pancakes.Serve with any remaining blueberries, maple syrup and butter, 18

if desired.

Slow braised beef burritos Ingredients

• • • • • • • • • • • • • • • •

2 - 3 tablespoons olive oil

•

1 cup grated tasty or mild cheddar cheese

•

1/2 cup sour cream

•

1 lime, cut into wedges to serve

1 - 1 1/2 kg chuck steak, 5cm pieces 2 onions, roughly chopped 1/2 head of garlic, crushed 1 tablespoon smoked paprika 1 teaspoon ground cumin 1 teaspoon ground coriander 1/4 teaspoon cinnamon 1 teaspoon ground chilli (optional) 2 teaspoons salt 800g canned diced tomatoes 3 red long chillies 1 packet 10 large tortillas 1/2 red cabbage, finely sliced 1/2 iceberg lettuce, finely sliced 1 bunch coriander, washed, roughly chopped

The Script Pharmacy Magazine │September • October 2014

Method: Use a large saucepan / stock pot that is preferably not non-stick. Add 1 tablespoon of olive oil, when hot add 1/3 of the meat, caramelise in batches until golden brown on each side. Remove meat from pan, discard juices, set aside and repeat with remaining meat. Add a cup or so of hot water into the pan, swirl around to remove any meat residue and reserve the water. Add a little more olive oil, add onions and garlic and cook for 3 minutes, then add smoked paprika, cumin, coriander, cinnamon, ground chilli and cook for a further two minutes. Add diced tomatoes and return beef and reserved cooking water back into the pan. Add 2 cups of water, stir well, bring to the boil then simmer for 3 – 4 hours until meat naturally falls apart. Top up with a little water if it seems like liquid is reducing too quickly and stir occasionally. Meanwhile, blister chillies by placing on gas stove top turning occasionally until their skin is blackened all over. Place in plastic bag and tie in knot, allowing them to sweat for 10 minutes. Remove from bag and gently flake off blackened skin. Roughly chop chillies and add them

FOOD

to the beef mix. Beef mixture is ready when the liquid has almost completely reduced, the mixture is thick and the meat is falling apart. When ready season with a little extra salt, and a dash more of smoked paprika, chilli (optional) and cumin. To make the burritos, cook tortillas according to packet instructions, place a good amount of beef mixture in the centre of the burrito leaving 5 – 10 cms free at the edge so that you can wrap the burrito. Top with cheese, lettuce, red cabbage, sour cream and coriander. Serve with lime wedges.

Fabulous French toast Ingredients

• • • •

1/3 cup low-fat milk

•

Icing sugar, for dusting

8 slices toast sliced bread 1/3 cup maple syrup 4 eggs

Method: Serve each person with two pieces of French toast, drizzled with maple syrup and dusted with icing sugar. Whisk eggs and milk in a bowl. Heat a non-stick frying pan on medium. Dip a slice of bread into egg mixture to coat both sides. Cook for 1-2 mins each side, until golden. Repeat with remaining bread and egg mixture.

Antipasto bruschetta

Ingredients

• • • • • •

1 red capsicum

• •

1 garlic clove, peeled, halved

100g semi-dried tomatoes 100g chargrilled mushrooms 75g sliced saami 50g pitted kalamata olives 8 thick slices day-old wood-fired bread 2 tablespoons exltra virgin olive oil

Method:

• •

1 lemon

• • • • • • • •

2 large eggs

1 tablespoon plus 1/3 cup sugar, divided 1 large egg white 1 cup low-fat milk 2/3 cup all-purpose flour 1/2 teaspoon almond extract Pinch of salt 1 tablespoon sliced almonds Confectioners’ sugar , for dusting

Preheat grill on high heat. Cut capsicum into large flat pieces. Discard seeds and membrane. Place capsicum, skin-side up, onto grill tray. Grill for 10 minutes or until skin is black. Place into a plastic bag. Seal. Stand for 10 minutes. Peel. Discard the skin.

Method:

Roughly chop capsicum, tomatoes, mushrooms, salami and olives so all pieces are similar sizes. Place into a bowl.

Preheat oven to 350°F. Coat a 10-inch round baking dish or oval casserole with cooking spray. Sprinkle 1 tablespoon sugar evenly over the bottom. Drain the apricots (reserving the syrup) and arrange in the baking dish.

Preheat grill on medium-high heat. Grill both sides of bread slices until toasted. While hot, rub 1 side of each slice with garlic. Drizzle each with 1 teaspoon of oil. Spoon antipasto mixture onto bread and serve.

Apricot-Almond Clafouti Ingredients

•

1 pound fresh apricots , (about 8 medium), pitted and cut into wedges

•

1/4 cup almond liqueur, such as amaretto, or orange juice

Combine apricots and almond liqueur (or orange juice) in a large bowl. Grate 2 teaspoons zest from the lemon and set aside. Juice the lemon and stir 2 teaspoons of the juice into the apricots. Let stand for at least 1 hour.

Combine whole eggs, egg white and the remaining 1/3 cup sugar in a medium bowl. Beat with an electric mixer on medium speed until pale yellow. Add milk, flour, almond extract, salt, the reserved lemon zest and the reserved syrup; beat well to blend. Pour the batter over the apricots; sprinkle with almonds. Bake the clafouti until puffed and golden, 45 to 55 minutes. Let cool about 20 minutes. Sprinkle with confectioners’ sugar; serve it warm.

The Script Pharmacy Magazine │September • October 2014

FEATURE HEADER

The Script Pharmacy Magazine │September • October 2014

LAUGH A LITTLE

Tongue twister:

I thought a thought. But the thought I thought wasn’t the thought I thought I thought. If the thought I thought I thought had been the thought I thought, I wouldn’t have thought so much.

Men vs. women

Woman 1: Oh! You got a haircut! That’s so cute! Woman 2: Do you think so? I wasn’t sure when she was gave me the mirror. I mean, you don’t think it’s too fluffy looking? Woman 1: Oh God no! No, it’s perfect. I’d love to get my hair cut like that, but I think my face is too wide. I’m pretty much stuck with this stuff I think. Woman 2: Are you serious? I think your face is adorable. And you could easily get one of those layer cuts – that would look so cute I think. I was actually going to do that except that I was afraid it would accent my long neck. Woman 1: Oh – that’s funny! I would love to have your neck! Anything to take attention away from this two-by-four I have for a shoulder line. Woman 2: Are you kidding? I know girls that would love to have your shoulders. Everything drapes so well on you. I mean, look at my arms – see how short they are? If I had your shoulders I could get clothes to fit me so much easier. Man 1: Haircut? Man 2: Yeah.

Man VS Woman:

Man – Haven’t I seen you someplace before? Woman – Yes, that’s why I don’t go there anymore. Man – Can I buy you a drink? Woman – I think I’d rather have the money! Man – Will you go out with me this Saturday? Woman – Sorry, I’m having a headache this weekend. Man – Is this seat empty? Woman – Yes, and this one will be if you sit down.

Man – So what do you do for a living? Woman – I’m a female impersonator.

Consistancy

Bob Smith was sick of his job and was determined to find work elsewhere. But no matter how hard he tried, his reputation as someone who was not dedicated to the job, seemed to follow him around. One day the phone rang at his office. Although Bob did not usually pick up the phone, he picked it up and said hello. “Hi” said the man on the line, “I have an unusual question to ask you, I’m looking into a fellow Bob Smith for a position in my company. Do you know this fellow?” “Sure I know him”, responded Bob with a smile. “Tell me,” asked the man. “Is he consistent with his work? Does he always show up on time?” “Well I’ll be honest with you” Bob truthfully replied, “I’m not so consistent myself, but whenever I’m here he’s here!”

Bumper Stickers: • • • • • •

Honk, if you love peace and quiet. If you can read this, i can slam on my brakes and sue you. I is a college student. Fight crime – shoot back. I love animals – they taste great We are staying together, for the sake of our cats.

fever, and was terribly hoarse. After waiting in the waiting room at the doctor’s office for over an hour, we were finally admitted to see the Doctor. After the usual routine of listening to her breathing and checking her ears, the Doctor looked my daughter in the eye and said, “So what would you say is bothering you the most?” Without skipping a beat my daughter promptly answered, “Billy, he always breaks my toys!” “Mom, can I have an animal cracker?” asked 3 year old Bob. “Sure Bob,” said his mom. “Open up the box, and take a few.” Forty five minutes later Bob’s mother walked into the kitchen. “Bob, why’d you spill out all of the animal crackers, and what are you looking for?” “It said on the box not to eat it if the seal is broken.” Bob replied “I spilled out the whole box, I looked through all of the animals but I can’t find any seals!” I lovingly gave my niece a kiss on her cheek upon seeing her at a family gettogether. Afterwards, I noticed her wiping her cheek. “Are you wiping off my kiss?”, I asked her. “No”, she smartly replied, “I’m just rubbing it in!”

One Liners:

•

• •

Adults are always asking little kids what they want to be when they grow up because they’re looking for ideas. ~Paula Poundstone Take my advice; I don’t use it anyway. Always remember you’re unique, just like everyone else.

Kids:

My four year old daughter had a terrible case of the flu, she was achy, had a high

The Script Pharmacy Magazine │September • October 2014

fact FEATURE HEADER

Customers appreciate reminders about things that are important in their life!

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Quality Branded Headgear Branded Hampers ideal for team building events and conferences Carroll Booyes Branded Corporate Gift Range

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PHONE US NOW! Tel: 0130100091 or email: sales@cjpharm.co.za for an estimate. 22

The Script Pharmacy Magazine │September • October 2014

www.pdacademy.co.za

PHARMACY

Towards quality care together

Use antibiotics wisely I have a cold! Should I use antibiotics?

Antibiotics are not the right treatment for viruses such as colds and flu

Using antibiotics incorrectly can stop them from working when you really need them Know your medicine Ask your pharmacist

Improved Access. Improved Services. Better Health Outcomes.

South African Pharmacy Council

Pharmaceutical Society of South Africa

CPD Module

Take one once oncea month every every month ......and anddon’t don’tforget forgetto to call callus usin inthe themorning morning

Pharmacist PharmacistCPDs CPDsare arenot notlinked linkedto topoints pointsas aswith withother otherhealth health professionals; professionals;pharmacists pharmacistsare arerequired requiredto tolink linktheir theirCPDs CPDsto to SAPC SAPCcompetency competencystandards standardsand andcomplete completeone oneCPD CPDactivity activity for foreach eachmonth monthof ofthe theyear. year.

ES?? ULES ODUL MOD CPDDM PDAACP HYPD W WHY • • • • • • • • • • • • • •

Our OurCPDs CPDsare aredivided dividedinto intoshort, short,high-impact high-impactmodules modules You Youcan caneasily easilykeep keepininline linewith withSAPC SAPCrequirements requirementsby bydoing doingone onemodule moduleper permonth month CPDs CPDsare arelinked linkedtotoSAPC SAPCcompetency competencystandards standards You Youdo donot nothave havetotoleave leaveyour yourpharmacy, pharmacy,asasour ourmodules modulescan canbe bedone done100% 100%online online Some Somemodules modulescost costasaslittle littleasasR100 R100 Your certificate of completion can be uploaded onto the SAPC system Your certificate of completion can be uploaded onto the SAPC system Promote team cohesion in your pharmacy by enrolling yourself and your staff on the same Promote team cohesion in your pharmacy by enrolling yourself and your staff on the same modules, modules,since sinceour ourmodules modulesare aredeveloped developedfor forpharmacists, pharmacists,pharmacist’s pharmacist’sassistants assistantsand andfront front shop staff shop staff

Enrol Enrolfor forone oneofofthese thesecourses coursescurrently currentlyon onoffer: offer: • • Refresh Refresh your your Anatomy Anatomy Knowledge Knowledge inin only only 1212modules modules • • Want Want your your staff staff toto treat treat your your customers customers better? better?Enrol Enrolthem themallallonon the the Customer Customer Care Care Course Course – only – only 5 modules 5 modules • • Increase Increase your your turnover turnover and and add-on add-on sales sales bybyMerchandising Merchandisingyour your pharmacy pharmacy toto perfection perfection – done – done inin 5 modules 5 modules • • Want Want toto become become a Drug a Drug Wise Wise counsellor counsellor - only - only9 9modules modules

WHERE WHERECREATIVE CREATIVETHINKING THINKINGMEETS MEETSQUALITY QUALITYTRAINING TRAINING

For Formore moreinformation informationcontact contactPDA PDAon on013 013010 0100091 0091ororemail: email:admin@pdacademy.co.za admin@pdacademy.co.za

www.pdacademy.co.za

MODULE 4

Antibiotics Stewardship

Welcome to the fourth CPD module presented by PDA. Continuous education programmes are important to keep you up to date with new developments and can form a significant element of your CPD portfolio. Record your learning and upload it on the SAPC website.

About this module

Objectives: At the end of this module, you should be able to: • Define antibiotic stewardship • Explain the abbreviations AMR and ABR and its implications • List and explain some of the possible causes of antimicrobial resistance • Provide general tips on how to be a responsible steward of antibiotics

PDA continuing professional development programme This section is suitable for use by pharmacists, pharmacist assistants and front shop staff as part of their continuing professional development. After reading this, complete the learning scenarios at the end of this module.

Welcome to Module 4: Antibiotic Stewardship PDA wishes to congratulate the top performer in the assessment for the second CPD Module, Roana Pillay from Hillcrest Pharmacy Springs! She scored an excellent 90% for the assessment and received the R250 voucher. Well done, Roana!

Antibiotic stewardship is a phrase coined over the last few years to describe an increasing awareness among healthcare practitioners that the use of antimicrobial agents should be approached with more care and conscious thought than has perhaps been the case over the past 40 years. This awareness has been growing internationally due to the alarming rise in recent years of antibiotic resistant (ABR) bacteria that cause common infections worldwide.

CPD Module

HEATLH TOPIC

Antibiotic Stewardship In its report published in 2014 the World Health Organization (WHO) stated that antibiotic resistant bacteria (ABR) is not a worry of the future, but rather a very current threat even today, severely affecting the medical fraternity’s ability to treat even common conditions such as urinary tract infections, sexually-transmitted infections and pneumonia. Equally alarming is the rise in resistance of bacteria to first-line treatment drugs for Staphylococcus aureus, as well as to last resort drugs (carbapenem drugs) for the treatment of life-threatening infections caused by common intestinal bacteria. Even tuberculosis, which has traditionally been a quite curable disease, has fallen victim to ABR bacteria, with about 6% of new TB cases and 20% of TB cases previously treated, being classified as multidrug-resistant cases (WHO, 2014). Before we think about what we should do, let’s consider how this concerning state came about. Antibiotics: 1940 to today Since its first use in the treatment of infectious diseases during the 1940s, antibiotics have saved countless lives that would otherwise have been lost; it has been mankind’s greatest ally in the struggle for survival in an environment where humans are outnumbered by bacteria by 2858:1 (in biomass, expressed in kilogrammes, roughly calculated). When prescribed and taken correctly the value of antibiotics cannot be overstated; the strength of the alliance

between human and antibiotic is wavering, however, and it is due to three main factors: • Naturally arising resistance in microbes due to erroneous replications and the exchange of resistance between organisms • The continued use and even misuse of antimicrobial drugs • Poor infection control and inadequate sanitary conditions, including the incorrect and unsafe handling of foodstuffs Today, not even patients in hospitals are safe against ABR bacteria: the Centres for Disease Control and Prevention (CDC) in the USA has published a report stating that in 2011, an estimated 1 in 25 patients suffered from a healthcare-associated infection (HAI, infection acquired in a healthcare setting) on any given day. Worldwide, the following trends have emerged with regards to ABR bacteria: • Resistance to fluoroquinolones, a widelyused drug for the treatment of urinary tract infections caused by Escherichia coli, is widespread • Increased instances of methicillinresistant Staphylococcus aureus (MRSA), an infection usually associated with healthcare situations, where sufferers have no links to healthcare systems Closer to home, the first cases of common internal bacteria resistant to carbapenem drugs (a powerful group of broad-spectrum antibiotics, previously referred to as “our last effective defence against multi-

resistant strains of bacteria like Klebsiella pneumoniae and Escherichia coli”, National Health England, 2013), were already described in 2010 in South Africa. With such alarming statistics, it is of crucial importance that all healthcare practitioners work together to curb these tendencies. Of equal importance is the education of patients on the responsible use of antibiotics and the associated dangers of incorrect use thereof. One initiative supporting these ideals is the topic chosen by the South African Pharmacy Council (SAPC) for Pharmacy Week 2014, which stretches from 1-8 September 2014. The chosen topic is “Rational use of medicines and antimicrobial resistance: Use antibiotics wisely”. In their flyers and campaign materials the SAPC reflects that, for patients to know how to use antibiotics correctly and to understand the negative effects of incorrect usage, they should be educated towards the following: • a basic understanding of what antibiotics are • how they should be stored to maintain efficacy • which hygienic measures can be taken to prevent infections • when antibiotics are required and when not • antibiotics are always to be taken according to usage instructions and should never be shared

www.pdacademy.co.za

• antibiotics courses should always be finished, even when a patient’s health has apparently improved

promote the message of the correct use of antibiotics only in cases that warrant their use, to their patients on a daily basis.

The view of the WHO supports these recommendations, as indicated in their 2014 report; this report also states that the role of pharmacists and other healthcare workers in antibiotic stewardship is to enhance infection control, prescribing and dispensing antibiotics only when truly required.

A final word…

The right of prescribers to “indiscriminately prescribe whatever antibiotic they wish, in whatever fashion”, was questioned in an article in the South African Medical Journal, Vol 102, No 7 (2012).

The WHO warns in its 2014 report on antimicrobial resistance that we are “heading towards a post-antibiotic era, in which common infections and minor injuries, which have been treatable for decades, can once again kill”. In collaboration with the SAPC, let us do our part to prevent this scenario by being responsible stewards of antibiotics!

The SAPC recommends that pharmacists References • World Health Organization Fact sheet on Antimicrobial resistance, updated April 2014 • About antimicrobial resistance: a brief overview, Centres for Disease Control and Prevention, 2013, accessed 6 August 2014, <http:// www.cdc.gov/drugresistance/about.html> • Patient safety: what you can do to be a safe patient, Centres for Disease Control and Prevention, 2014, accessed 6 August 2014, <http://www.cdc.gov/HAI/patientSafety/patient-safety.html>

•

Data and statistics, Centres for Disease Control and Prevention, 2014, accessed 6 August 2014, <http://www.cdc.gov/HAI/ surveillance/index.html>

•

Brink et al., The spread of carbapenem-resistant Enterobacteriaceae in South Africa: risk factors for acquisition and prevention, South African Medical Journal, Vol. 102, No. 7, 2012

•

Pharmacy week, South African Pharmacy Council 2014, accessed 6 August 2014, <http://www.pharmcouncil.co.za/D_phweek.asp>

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SOLAL® HCA Appetite Control Reduce those cravings and support energy Derived from the Garcinia Cambogia, a plant native to Southeast Asia, HCA reduces cravings while boosting energy when following a weight loss plan.

Features: • 60% hydroxycitric acid extract from Garcinia Cambogia Attributes: • Promotes healthy weight by reducing carbohydrates conversion into fat • Helps control appetite • Contains chromium polynicotinate to promote energy release rather than fat storage Benefits: • For safe, non-stimulatory weight loss • Prevent post meal fatigue, reduce carbohydrate cravings and increase energy and vigour • Promotes fat loss in a unique way, by preventing carbohydrates converting into fat

SOLAL® d-Chiro Inositol Reduce insulin resistance Promote weight loss and boost energy levels in individuals resistant to weight loss, caused by insulin resistance. Features: • A vitamin B-like substance Attributes: • Improves the body’s cellular responses to insulin

• Supports improvement of symptoms associated with polycystic ovary syndrome Benefits: • Useful for insulin resistant conditions such as metabolic syndrome and diabetes • May promote weight loss and boost energy levels

SOLAL® Alpha Lipoic Acid (Dual R-Form) The universal antioxidant Alpha lipoic acid is a naturally occurring antioxidant, structurally similar to B-complex vitamins. Features: • Vitamin B-like molecule with potent antioxidant properties Attributes: • Contains two forms: R and R-dihydro ALA • Both water and fat soluble, therefore protects all areas of the body • Greater biological activity Benefits: • Antioxidant protection • Promotes healthy blood sugar levels, preventing insulin resistance

CPD Module

For That Good GUT FEELING... WHY IS NEW SYMBIO-D® SELLING SO WELL? An interview with Richard Asman, Pharmacist and one of the team members who helped formulate Symbio-D® with a leading South African Endocrinologist Q.Who is buying Symbio-D® and why? A. More and more people are realising that their bodies are under attack from the modern lifestyle they lead. In particular their gut health is not able to work at the optimum level to combat the damage, excesses and deficiencies of a modern lifestyle and diet. Remember, you literally are what you eat and no matter how hard you try to avoid today’s damaging foodstuffs, you can’t avoid them all. So, we see a lot of people taking it to feel good, for general good gut health, and those who are taking Symbio-D® to detoxify and maintain their good health. We also have those taking it to protect themselves against lifestyle diseases like cancer and heart disease and the possible onset of diabetes and obesity. Q. How does Symbio-D® work? A. Basically the digestive system is the body’s super highway to good health. It carries the fuel the body needs to function properly. It transports nutrition from the mouth, through our stomach and ‘S Bends’ of the intestines, to the colon and then out the other end.

The gut is a fundamental part of our immune system, keeping it healthy and in top condition translates into good health. Symbio-D®, through its combination of two capsules, a special Probiotic Blend and Omega 3, helps keep the gut in good health by reducing the effects that a modern diet and lifestyle can have. Basically, by taking the two capsules everyday it keeps the gut working as efficiently as possible by boosting its anti-oxidant defences and correcting the imbalance in the intestinal flora. Q. Is there anything else on the market like Symbio-D®? A. No, not to our knowledge. Symbio-D® was developed under strict clinical conditions with a leading Endocrinologist in South Africa. It is the first nutritional supplement clinically proven to show beneficial effects against the metabolic syndrome, I have spoken about, and reduce the overall collateral damage of a modern lifestyle. Q. Can you tell us about new Symbio-D® Junior? A. Symbio-D® Junior is based on the unique and successful Symbio-D® (for adults). It’s a probiotic formulation that has been specifically formulated into a chewable, easy-to-take, fruity flavoured tablet and can easily popped into school lunch boxes. For additional daily health, Symbio-D® Junior is packed full of multivitamins and is free from sugar, artificial flavours, colourants, lactose and gluten.

Refrences: 1. Dermikelp® Product Monograph 2. Dermikelp® Cream package insert 3. Preliminary evaluation of the soothing power of two cosmetic products throught a clinical-insrumental test.

Dermikelp Skincare range also includes Dermikelp Shampoo and Dermikelp Moisturising Lotion

5.Evaluation of the possible irritant power of a cosmetic product according to the amended Draize classifaction. Patch

www.pdacademy.co.za

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Reuterina™ Drops contains one of the most extensively Reuterina™ Drops contains of the extensively studied probiotic strains in theone world. Thismost once-daily supplement is clinically proven to world. help boost studied probiotic strains in the This your once-daily 3,5,6 and relieve infantile colic child’s child’s immune supplement is strength, clinically proven to help boost your 7,8 6,9 symptoms, diarrhoea 3,5,6 and antibiotic associated and relieve infantile colic symptoms,7,8 immune strength, 4,9 side effects.6,9 4,9

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For more information on Reuterina™ Drops, speak to For more on or Reuterina™ Drops, speak to your your doctorinformation or pharmacist, visit www.reuterina.co.za.

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Reuterina™ is a trademark of Akacia™ HealthCare (Pty) Ltd. info@akaciahealthcare.com/www.akaciahealthcare.com

Reuterina™ is aoftrademark of Akacia™ (Pty) Ltd. Reuterina™ Drops 5 ml: Each dose 5 drops contains 100 millionHealthCare cfu* of Lactobacillus reuteri PROTECTIS®. * cfu = colony forming units at expiry Reuterina™ Drops 5 ml: Each dose of 5 drops contains a minimum of 100 million cfu of

PROTECTIS®. = colony expiry K. Colonization and Immunomodulation by Lactobacillus reuteri ATCC 55730 in the Human Gastrointestinal Tract. Appl Environ Microbial 2004; 70 (2) : 1.Lactobacillus Impact Rx Data: Datareuteri on file. 2. Centrix Data: Data on* ficfu le. 3. Valeur N, Engelforming P, Carbajal N,units Connollyat E, Ladefoged 1176 – 1181. 4. Weizman Z, Asli G, Alsheikh A. Effect of a Probiotic Infant Formula on Infections in Child Care Centers: Comparison of Two Probiotic Agents. Pediatrics 2005; 115 : 5 – 9. 5. Gibson GR. and Brostoff J. An evaluation of probiotic effects in the human gut: microaspects, 2005. www.foodstandards.gov.uk. 6. Connolly E. Lactobacillus reuteri ATCC 55730 A clinically proven probiotic. Nutrafoods 2004; 3 (1) : 15 – 22. 7. Savino F, Pelle E, Palumeri E, Oggero R, Miniero R. Lactobacillus reuteri (American Type Culture Collection strain ATCC 55730) versus Simethicone in the treatment of infantile colic: a prospective randomized study. Pediatrics 2007; 119 :124 –130. 8. Savino F, Cordisco L, Tarasco V, Palumeri E, Calabrese R, Oggero R, Roos S. Lactobacillus reuteri DSM 17938 in Infantile Colic: A 1. Impact Double-Blind, Rx Data: Data on file. 2. Centrix Data2010; on fi126 le. 3. Valeur N,9.Engel P, E,Carbajal E, SP, Ladefoged K. Colonization and Immunomodulation by Lactobacillus ATCC reuteri 55730therapy in thetoHuman Randomized, Placebo-Controlled Trial.Data: Pediatrics : 526 – 533. Lionetti Miniello N, VL,Connolly Castellaneta Magistá AM, de Canio A, Maurogiovanni G, Ierardi E, Cavallo L, Francavilla R.reuteri Lactobacillus reduce side-effects during antiGastrointestinal Tract. Appl Environa randomized Microbial 2004; (2) : 1176 1181. 4.Pharmacol Weizman Z, 2006; Asli G, A. Effect of a Probiotic Infant Formula on Infections in Child Care Centers: Comparison of Two Probiotic Agents. Helicobacter pylori treatment in children: placebo70 controlled trial.–Aliment Ther 24Alsheikh : 1461 – 1468. Pediatrics 2005; 115 : 5 – 9. 5. Gibson GR. and Brostoff J. An evaluation of probiotic effects in the human gut: microaspects, 2005. www.foodstandards.gov.uk. 6. Connolly E. Lactobacillus reuteri ATCC 55730 A clinically AK 359 10/13 proven probiotic. Nutrafoods 2004; 3 (1) : 15 – 22. 7. Savino F, Pelle E, Palumeri E, Oggero R, Miniero R. Lactobacillus reuteri (American Type Culture Collection strain ATCC 55730) versus Simethicone in the treatment of infantile colic: a prospective randomized study. Pediatrics 2007; 119 :124 –130. 8. Savino F, Cordisco L, Tarasco V, Palumeri E, Calabrese R, Oggero R, Roos S. Lactobacillus reuteri DSM 17938 in Infantile Colic: A Randomized, Double-Blind, Placebo-Controlled Trial. Pediatrics 2010; 126 : 526 – 533. 9. Lionetti E, Miniello VL, Castellaneta SP, Magistá AM, de Canio A, Maurogiovanni G, Ierardi E, Cavallo L, Francavilla R. Lactobacillus reuteri therapy to reduce side-effects during anti-Helicobacter pylori treatment in children: a randomized placebo controlled trial. Aliment Pharmacol Ther 2006; 24 : 1461 – 1468.

CPD Module

Do you really need antibiotics?

A summary of antibiotic stewardship • • • • •

•

• •

• • •

Antibiotics are medicines that help your body fight infections that are caused by bacteria Bacterial infections are: less common than viral infections do not spread as easily as viral infections Help your antibiotics do their job: - finish your course even if you feel better - take your medicine as prescribed, don’t miss doses - do not share your medicine with anyone else Antibiotics are losing their power: What is antibiotic resistance? - Bacteria have antibiotic resistance when they cannot be killed by antibiotics - Use antibiotics wisely – prevent resistance - Do not expect an antibiotic for every infection; trust your doctor if an antibiotic has not been prescribed - Prevent spread of infection - Be a good example – wash your hands Not all infections need antibiotics. Your body has a natural defence against bacteria and viruses. Give it a chance to work

Cough Cough A cough a natural response irritation A cough is ais natural response to to irritation of of thethe expel expel lungs and passages and designed lungs and airair passages and is is designed to to 1 1 harmful substances from respiratory tract. harmful substances from thethe respiratory tract.

A cough classifi either chronic acute A cough is is classifi eded asas either chronic oror acute Chronic cough is symptom a symptom post-nasal drip, • • Chronic cough is a of of post-nasal drip, secondary either a cold, bronchitis, sinusitis secondary to to either a cold, bronchitis, sinusitis oror 2 2 asthma asthma Acute cough is usually caused a viral infection • • Acute cough is usually caused byby a viral infection 2 2 upper respiratory tract of of thethe upper respiratory tract

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Antibiotics do not work against viruses. Common colds, flu, most coughs and sore throats are caused by viruses. Antibiotics will not help these infections You can make a difference Prevent spread of infection follow these simple rules for better health: Wash your hands well using plain soap and water - After using the toilet, blowing your nose, handling shared objects - Before eating, preparing food

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References: 1. Henry British Medical Association New Guide to Medicines & Drugs London(UK) Dorling Kindersley;2007; Mason Over-the-counter treatment coughs and colds. PharmJ J References: 1. Henry JA.JA. British Medical Association New Guide to Medicines & Drugs 7th7th ed.ed. London(UK) Dorling Kindersley;2007; p. p. 92,92, 96.96. 2. 2. Mason P. P. Over-the-counter treatment of of coughs and colds. Pharm 2002;269:612-614. 3. Morice et Recommendations al. Recommendations management of cough in adults. Thorax 2006;61(Suppl 1):1-24. Schoor Colds and approach recommending cough mixtures 2002;269:612-614. 3. Morice AH,AH, et al. for for thethe management of cough in adults. Thorax 2006;61(Suppl 1):1-24. 4. 4. VanVan Schoor J. J. Colds and flu:flu: anan approach to to recommending cough mixtures in in thethe pharmacy. Pharm J 2012;79(5):1-3. 5. Saeb-Parsy K,al, et editors. al, editors. Instant Pharmacology. John Wiley & Sons. 1999: p293. 6. Core bromhexine product information. [cited 2011 March 13]; Available from URL: http://www. pharmacy. SA SA Pharm J 2012;79(5):1-3. 5. Saeb-Parsy K, et Instant Pharmacology. John Wiley & Sons. 1999: p293. 6. Core bromhexine product information. [cited 2011 March 13]; Available from URL: http://www. asmi.com.au/industry/PI%20Bromhexine.pdf. asmi.com.au/industry/PI%20Bromhexine.pdf. S2 S2 Proprietary name (and dosage form): DURO-TUSS Linctus. Composition: Each 5 mL liquid contains Salbutamol sulphate 2.41 mg; Bromhexine hydrochloride 4 mg.Preservative: Preservative: Proprietary name (and dosage form): DURO-TUSS Linctus. Composition: Each 5 mL liquid contains Salbutamol sulphate 2.41 mg; Bromhexine hydrochloride 4 mg. Scheduling status: Scheduling status: Sodium Benzoate 0.2% Registration number: A39/10.1/0390 101/1965] Sodium Benzoate 0.2% m/v.m/v. Registration number: A39/10.1/0390 [Act[Act 101/1965] Name business address of applicant: iNova Pharmaceuticals (Pty) Reg. 1952/001640/07. Riley Road, Bedfordview. 011 087 0000www.inovapharma.co.za www.inovapharma.co.za Name andand business address of applicant: iNova Pharmaceuticals (Pty) Ltd.Ltd. Co.Co. Reg. No.No. 1952/001640/07. 15e15e Riley Road, Bedfordview. Tel:Tel: 011 087 0000 prescribing information, refer to the individual package insert approved medicines regulatory authority. Further information is available request from iNova Pharmaceuticals. IN1017/14 ForFor fullfull prescribing information, refer to the individual package insert as as approved by by thethe medicines regulatory authority. Further information is available onon request from iNova Pharmaceuticals. IN1017/14

TThinsmucus mucus6 6 ThTh TThins

ASSESSMENT QUESTIONS Please answer the following multiple choice questions on the answer sheet on the next page Once you have completed the answer sheet in ink, return it to the address below. Clear photocopies are acceptable. You may need to consult other information sources to answer the questions. 1. Choose the CORRECT statement regarding SOLAL® HCA Appetite Control: a. Contains chromium picolinate b. Prevents carbohydrates being stored as fat c. Contains 40% hydroxycitric acid extract from Garcinia Cambogia d. Should not be used in children under 12 years of age 2. True or False: SOLAL® Alpha Lipoic Acid (Dual R-Form) also contains the inactive S-form of alpha lipoic. a. True b. False 3. Choose the INCORRECT statement regarding SOLAL® Chromium Polynicotinate: a. Supports insulin’s effects b. Useful for carbohydrate and sugar cravings c. May assist weight loss d. Contains the picolinate form of chromium for best absorption 4. True or False: SOLAL® d-Chiro Inositol assists with metabolic syndrome and diabetes and may therefore promote weight loss. a. True b. False 5. What is the name of South Africa’s No 1 selling sea water nasal spray? a. Midmar® b. Granmar® c. Sinumar® d. Stérimar® 6. Which variant of this sea water nasal spray is hypertonic? a. Stérimar® Nasal Hygiene 50 ml b. Stérimar® Nasal Hygiene 100 ml c. Stérimar® Nasal Hygiene Baby d. Stérimar® Blocked Nose 7. Stérimar® should be discarded 30 days after opening. a. True b. False 8. Which of the following statements is False a. Stérimar® nasal spray contains preservatives which allow it to have a shelf-life of more than 2 years. b. The non-return valve keeps the product free of any contamination. c. The specially designed nozzle delivers

a micro-diffused spray which cannot harm you or your baby. d. Repeated use of Stérimar® may cause damage to nasal passages and cause “rebound congestion”. 9. Which one of the following statements is not true regarding Dermikelp® cream? a. It’s a steroidal preparation b. It can be used for itching associated skin irritations c. It can be used for itching associated with eczema, contact dermatitis and seborrhoeic dermatitis d. It can be used for itching associated with minor insect bites and allergic skin reactions due to soap, detergents and jewellery 10. Which of the following statements regarding Dermikelp® shampoo is not true? a. It assists in relieving dry, itchy and inflamed scalp conditions b. It is applied to wet hair and massaged gently into the scalp c. It is applied to dry hair and massaged gently into the scalp d. It is clinically proven to rapidly reduce irritation 11. Which one of the following statement is not true regarding Dermikelp®? a. It is suitable for use by all ages even babies b. Dermikelp® moisturising lotion help to re-hydrate damaged skin c. It is non-steroidal, hypo-allergenic and fragrance free d. It can be used by patients allergic to iodine 12. Which member in the family cannot use Duro-Tuss®? a. Baby Jane 6 months old b. Child Kara 6 years old c. Dad Henko 40 years old d. Grandma Sandra, 80 years old and a diabetic 13. Which of the following statements regarding Duro-Tuss in false? a. It is alcohol-free, tartrazine-free and sugar-free b. It is administered three to four times a day c. Has a pleasant orange taste and smell d. Has a pleasant strawberry taste and smell 14. True or False: Duro-Tuss® has unique Dual-Action relief for severe we cough and tight chest a) True b) False 15. Which of the following statements is not true regarding Symbio-D® Junior? a. It has a probiotic formulation full of multivitamins b. It’s a chewable, easy to take tablet c. It has a grape flavoured taste d. It is free from sugar, artificial flavours, colorants, lactose and gluten

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16. True or false: Symbio-D® is a combination of two capsules – a special Probiotic Blend and Omega 6 a. True b. False 17. Symbio-D® can be used for all of the following except? a. To detoxify and maintain good health of the gut b. Patient needs to take two capsules per day c. It’s the first nutritional clinical proven supplement having beneficial effects against metabolic syndrome d. It protects against diseases such as cancer, diabetes, obesity and arthritis 18. Which of the following is NOT a true statement with regards to antibiotics stewardship? a. Antibiotic stewardship is the responsibility of all health care professionals and patients alike b. Antibiotic stewardship refers to the fact that micro-organisms are increasingly becoming resistant to traditional antimicrobial treatments c. Antibiotic stewardship aims to raise awareness of the fact that antimicrobials should be taken correctly and only when really necessary 19. Which of the following contributes to increased antimicrobial resistance? a. Proper hygiene and infection control b. Incorrect use and even misuse of antimicrobial medicines and products c. Good sanitation and safe handling of foodstuffs 20. What should pharmacists and pharmacy support personnel do to increase awareness with regards to the correct use of antimicrobials? a. Provide correct and useful information with regards to the correct usage instructions of antimicrobials b. Pharmacists should advise patients when antibiotics are not required, such as for colds and flu, which are caused by viruses c. Advise patients on good sanitation and hygiene, in order to assist in the fight against the spread of microbes d. All of the above

win! Achieve a score of 80% or more and automatically stand a chance to win a R250 giftvoucher. Please note that previous winners of the voucher will not be eligble to enter the competition for 3 issues (6 months) after winning the voucher.

Congratulations. You have successfully completed this module Remember! should you wish to enrol for our anatomy course send an email to admin@cjpharm.co.za for more information

CPD Module

ANSWER SHEET:

CIRCLE your answers below and send to PDA – fax number: 086 540 5512 or e-mail: admin@ pdacademy.co.za. This assessment will be marked and you will be notified of your results and sent a copy of the correct answers. The assessor’s decision is final and no correspondence will be entered into.

11] a

12] a

13] a

14] a

15] a

16] a

17] a

18] a

19] a

10] a

20] a

Title:

Full Name & Surname:

Pharmacy Name and Address:

Daytime Contact Number:

Date:

Email Address:

PHARMACIST

POST BASIC PA

BASIC PA

FRONT SHOP

I confirm the form submitted is my own work (signature)

M401 AD/STE/CJ/1.0 08/2014

s s e n d o o Pure G Choose from a wide variety of refreshing spring water that will make you feel absolutely good!

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Credit and Returned Goods Policy Dear Valued Customer - At CJ Pharmaceuticals we endeavour to provide you with the best service at all times. Accepting returned stock and passing a credit is part of that service. We would like to provide you with fair and practical guidelines. No credit exists until a credit note is issued by CJ Pharmaceuticals and no deduction, or adjustment to any invoice may be made by the customer except on the basis of a credit note. Before any product is returned to CJ Pharmaceutical Enterprises a CJW reference number must be obtained from our Customer Care Department. When returning liquids, place all the liquids in a plastic bag, before placing the products in a box. CJ Pharmaceuticals will only accept returns if the batch of the products are directly from CJ Pharmaceutical Enterprises. Products must be returned in full, unopened, undamaged, original packaging. Pharmacies must provide adequate documentation (invoice number, batch and expiry) to ensure that it is CJ Pharmaceutical Enterprises products.

ing errors. You will be issued with a CJW reference number and the product is to be returned. A credit will be issued upon receipt of the product

Acceptable Returns

Criteria applicable:

Product may be returned for credit under the following conditions: 1. Picking Errors 2. Visible Damage 3. Concealed Damage 4. Expired Goods 5. Customer Ordering Error 6. Shortages

Picking Errors: Immediately contact the Customer Care Department and report any Picking Errors. You will be issued with a CJW reference number for the product to be returned

Visible Damage: Any visible damage should be noted on the POD upon receipt of the order. Immediately contact our Customer Care Department for a CJW reference number

Concealed Damage: Immediately contact our Customer Care Department and report any concealed damage noted upon receipt of your order or within 48 hours. Our Customer Care Department will issue you with a CJW reference number as soon as we receive the stock a credit will be processed

Expired Goods: Stock received from us, nearing expiring date will be taken back according to the specific Supplier policy (Copy of Supplier Returns Policy will be attached) and provided it is from the same batch number received from us. If Better Dated stock was bought we cannot except expired stock back. Product must be in original, sealed, full unopened container. Product must have a batch number and expiration date

Customer Ordering: Immediately contact our Customer Care Department and report any customer order-

Shortages: Our policy in this case is purely based on our mutual trust relationship. We have recently introduced additional procedures and controls in order to improve our precision in this regard. Shortages must be reported within 48 hours upon receipt of stock to our Customer Care Department. Customer Care Department will give the information through to our Security Department for the CCTV footage to be viewed for the shortage. Feedback with regards to the query will be given before 48 hours after the call has been logged • Once the content of a box or parcel is checked against the invoice and any discrepancy is found ( items short or damaged), we request that it is reported to our Customer Care Department within 48 hours • Box Short - a reference number (CJW number) must be obtained from our Customer Care Department – 013 665 1011 • Once you have received a reference number (CJW number), our delivery team will present a collection manifest (CJW) (white and pink copy) to collect the stock • No stock will be collected without the pink copy (CJW) of the Collection Manifest attached to the goods – please also attach a copy of the applicable invoice • When the stock arrives at the warehouse it will be checked - the invoice with the pink copy of the collection manifest will be taken to our Customer Care Department for a credit to be passed • An authorised return must be returned within 48 hours from the receipt of a CJW reference number • A valid CJW reference number and invoice must accompany all returns for proper credit • Credit is based on the original purchase price • Credit will be issued in the form of a Credit Note • We require proof of purchase (invoice) of all products returned for credit

Non-returnable Items:

• Products without a CJW reference number (unauthorized returns) • Products with more than six (6) months remaining shelf life • Products retained more than twelve (12) months and if better dated stock was purchased. • Private Label products or repacked goods

• Products with missing label or with missing batch number and expiration date • Products broken, marked or with price stickers • Products sold on a non-returnable basis • Products damaged/deteriorated due to improper handling or storage • Products not purchased directly from CJ Pharmaceutical • Fridge items • Overstock, unless agreed by the CEO in writing We would like to suggest the following procedures when receiving stock: 1. Check every invoice number (and the number of boxes and parcels per invoice) individually.(Please don’t just reconcile the total number of boxes / parcels delivered, to the quantities indicated on the POD?) 2. If our driver is calling the invoice numbers, please ensure that you witness the process and put the verified boxes / parcels behind you. 3. In the event that a box has not been received or that the box is damaged the Receiving Person must immediately declare it - next to the Invoice number on the POD. (Ex. “Box not received”, “Box damaged”) 4. We cannot be held liable for any shortages or damages, unless the POD is specifically endorsed. 5. Please get the driver to counter sign the endorsement! 6. Once the POD has been signed, NO CREDIT can be passed for any delayed claims for damaged or short boxes / parcels. 7. Please take note that the absence of a tick, or a cross, next to the undelivered invoice number cannot suffice as a proper endorsement 8. As a final check we suggest that you do a count of all the boxes and parcels that were delivered and balance that back to the quantities indicated on the POD. 9. It is regretted that we cannot entertain credits for boxes not delivered, unless the POD is endorsed accordingly We trust that the suggestions will enable both parties to solely rely on the POD in case of any future discrepancies or claims. CJ Pharmaceuticals may at its discretion, make exceptions to the Return Goods Policy based on extenuating circumstances. All returns must be made according to this Return Goods Policy. Thank you

Erika Oehley

Inventory Risk Manager

CALENDAR ORDER Size (297mm x 425mm) Namaqualand (BL) your details go here

Minimum quantity of 250 per order

@ R3.78 excl vat each

Sunset (BW) your details go here

Minimum quantity of 250 per order

@ R3.78 excl vat each

Quantity Option BL (Namaqualand) x

Option BW (Sunset) x

Fax to 086 698 1468 Pharmacy Name: Person Responsible for payment: Tel: Total amount Calendars:

What do you want on your calendar? Header Details:

Info: contact Marketing on 013 010 0091, or email: marketing@cjpharm.co.za

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References: 1. IMS Total Private Market MAT. May 2013 (R02A. Pharyngeal Preparations). 2. Simard-Savoie S, et al. Topical anaesthetic activity of benzydamine. Curr Ther Res 1978;23(6):634-745. Scheduling status: S1 Proprietary name (and dosage form): ANDOLEX Solution. Composition: Each 15 mL contains Benzydamine HCI 22.5 mg. Preservative: Methyl hydroxybenzoate 0.1 % m/v. Contains alcohol 10 % v/v. Pharmacological classification: A.16 Ear, nose and throat preparations. Indications: Symptomatic relief of painful inflammatory conditions of the mouth and throat including: Traumatic conditions: Pharyngitis following tonsillectomy or after the use of nasogastric tube. Inflammatory conditions: Pharyngitis, aphthous ulcers and oral ulceration due to radiation therapy. Dentistry: For use after dental operations. Registration number: Z/16/40 [Act 101/1965] Name and business address of applicant: iNova Pharmaceuticals (Pty) Limited, Co. Reg. No. 1952/001640/07, 15E Riley Road, Bedfordview. Tel. No. (011) 087-0000. www.inovapharma.co.za. For full prescribing information, refer to the package inserts as approved by the medicines regulatory authority. Further information is available on request from iNova Pharmaceuticals. IN894/13.

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All prices are exclusive of VAT For any further enquiries regarding the above please contact Thea 013 010 0091 or email marketing@cjpharm.co.za The Script Pharmacy Magazine │September • October 2014

FEATURE HEADER

BY JASON HAYNES - from lifehack.org

Productive Mornings:

12 Reasons the Early Bird Gets the Worm I think we’ve all heard the saying, “The Early Bird Gets The Worm”. I’ve spent most of my life as a proud Night Owl. I was always looking for new ways to enhance my productivity; ready to put in the hours when others weren’t willing…or so I thought. It wasn’t until about 6 months ago that I began to take an interest in the age-old “Bird vs Owl” debate. Long story short, I’m now a passionate member of Team Early Bird. There’s a number of incredibly beneficial things I’ve discovered, just by choosing to rise before the sun. It’s no secret, time is our most valued commodity. We’re all given the same number of hours, but it’s up to you when and how you spend them. By choosing to wake up early, you will experience a drastic change in your quality of life.

I Get Prepared. Make a habit of going into each day with a list of items you will accomplish. Some say to set these goals the night before. Others claim it must be done first thing in the morning. I don’t care – just do it. The task is simple and very effective. 38

Don’t over think this. Keep the list short and sweet (3-7 items). Make it your mission to cross these things off throughout the day. Some say to start with the most challenging. Others say you need to start with the easiest and work your way up. I don’t care – just start it. This will do wonders for keeping yourself accountable on how your time is being spent. Believe me, it feels good to cross things off the list.

“By failing to prepare, you are preparing to fail.” — Benjamin Franklin I Get Creative. After you wake up and get moving, you’ll find that the process of creation flows a bit easier in the mornings. Your mind is well-rested and ready to create. Many of us consider ourselves creative, but it wasn’t until I started waking up early that I was really able to see a difference in the level of quality that was output. Futher-

The Script Pharmacy Magazine │September • October 2014

more, when you start your mornings with this mindset, it will set the standard for the rest of your day.

I Get Exercise. A lot of people have excuses about how they don’t have time to work out. Yet all of these people spend their morning hitting the snooze button, creating obnoxious 10-minute sessions of half-sleep. You will experience a greater quality of life by choosing to workout, it’s just science. Wake up and make the time. This doesn’t have to be complicated. Most people think to “workout” you’ve got to go buy a gym membership, a new wardrobe and a bunch of fit gadgets. Those won’t hurt, but why not start with what’s going to give you the results – the workout. Even small things can yield noticeable results.

I Get Healthy. Start making healthy decisions in the morning and set the pace for the day. When you wake up and make time to prepare a proper breakfast (and maybe

SKILLS

even a lunch for later), you’re much more likely to keep on track with your remaining meals. A study at Northwestern University showed that night owls consumed nearly 250 more calories, twice as much fast food and half as many fruits and vegetables than their early bird counter parts. This eventually attributes to a noticeably higher average BMI.

I Build Momentum. When you make the choice to wake up early, you’re already ahead of most of the world. You can get more done before lunch than most people do all day. It feels good to be ahead, even if it is just for the day. I love going to Starbucks early in the morning; I’m often the first one there. I’ll sit working for hours before the morning rush starts. I can’t help but realize how much I just got done while these people were busy dragging out their sluggish morning routine. Start each morning with purpose and you’ll stay ahead each day.

I Get Focused. After only a couple days of committing to these early mornings, you’ll notice a new clarity that comes to whatever it is your spending your time on in the morning. It’s fairly simple: there are typically less distractions and more silence, which means better focus. Wake up, while the world is still sleeping.

“Either you run the day or the day runs you.” — Jim Rohn I Get Better Sleep. We spend almost one-third of our lives asleep. Getting up early doesn’t necessarily make your days longer, just more effective. Be sure you’re getting enough time asleep, so that will make your time awake, worthwhile. Waking up early will allow you to ultimately sleep more soundly. This can take a couple weeks to get used to, but it’s certainly worth making the adjustment. Start slowly by just setting your alarm and extra 15 minutes earlier everyday, until your find your sweet spot for kicking off your morning.

I am Optimistic. Who isn’t happy getting ahead in life? So, why not make this part of your daily mantra. Make the commitment to get up early every morning. You will experience the continued satisfaction of being that much more ahead of everyone else that stayed up binge-watching some Netflix.

“With the new day comes new strength and new thoughts.“ — Eleanor Roosevelt I Have Easier Commutes. I don’t always commute…but when I do, I leave early. You can seriously cut down your time in the car, by simply choosing to leave early. The average person can cut their commute in half by avoiding the rush hour scene. By the end of the week, those hours start to stack up. No, you don’t have to go to work early, if you don’t want. Just leave home early, and consider going to a coffee shop near work. Use the extra time out of the car to do something meaningful to you. If you do go to work early, you can look forward to saving even more time by missing the rush hour coming back home.

I Have More ‘Me’ Time. I’ve always been a fan of the “work hard / play hard” model. When you choose to start your day by accomplishing everything you need to, you’re often left with guilt-free evenings to spend the way you want. Make it your daily priority to cross everything off your list, so you can spend the remaining time each day doing whatever it is you love to do.

I Have a Fresh Perspective. This one is a little different for everyone, but it’s definitely worth mentioning. There’s a certain energy that exists early in the morning, which helps you to see things in a new light. It’s hard to explain, but If you’ve ever watched the sun rise or been in a place that’s typically crowded, with no one around, you might get it. Grab a coffee and enjoy the view.

“The first step toward success is taken when you refuse to be a captive of the environment in which you first find yourself.” — Mark Caine I am Aligned with Bright Minds. As you begin to follow successful people and their habits, you’ll notice a common thread amongst this tight-knit group. Nearly all of them start strong, early in the morning, and move through their day with intension. This concept has actually been a part of some of the earlist inspirations to our modern culture.

“Early to bed and early to rise makes a man healthy, wealthy, and wise.” — Benjamin Franklin It’s not just the moguls that are set on starting their day early. A Texas University study concluded that college students, claiming to be early birds, held a 3.5 GPA on average. The same class of students, that considered themselves night owls, held a 2.5 GPS on average. This isn’t a coincidence, it’s a truth that has been consistent from the beginning.

Why Do Productive People Wake Up So Early? Here’s Why. Are You Ready To Start Bein More Productive? I know the idea of changing your daily routine can seem overwhelming. We all wish there were some magic solution to making this happen, but there’s not. The truth is, you just need to start. This might be the only thing I would recommend starting tomorrow, just because you’re already awake today. Commit to getting up early and make the most of your precious time. This may not be as glamorous as some new-fangled fad diet or experimental energy pills, but this works.

The Script Pharmacy Magazine │September • October 2014

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PRETTY BABY Quality Baby Products and Child Safety Accessories Assorted Bottles • Teats • Dummies • Sippers • Feeding Bowls & Cutlery • Cabinet Locks • Socket & Corner Protectors and much more! View full range online at www.cjpharm.co.za

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124558

PRETTYBABY BABY ON BOARD SIGN 2105

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R 16.90

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For more information regarding these or any other products available from us speak to your CJ Representative Lynne[cell] 071 472 7522 email: lynne@cjpharm.co.za Ridwaan [cell] 072 534 8135 email: ridwaan@cjpharm.co.za Theuns [cell] 072 638 4085 email: theuns.w@cjpharm.co.za Pam [cell] 071 480 5322 email: pam.vc@cjpharm.co.za

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COSMETRIX Quality grooming & beauty accessories now available from CJ Pharmaceuticals! Nail-care • Make-up Applicators & Sponges • Shower Caps • Foot-care

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COSMETRIX 3 WAY NAIL BUFFER 130030

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FREESTYLE Quality Hair Accessories now available from CJ Pharmaceuticals

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FREESTYLE BRUSH CUSHION TRAVEL FS442

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FEATURE HEADER

MIND YOUR HEALTH

Mental Health Month is a useful reminder for all of us to think about the mental health of ourselves and those around us. It’s a great opportunity to engage all members of the community in activities that can enhance their mental health and wellbeing. It’s also a good excuse to get out there and have some fun. It sometimes takes a step back to realise that we don’t have to be perfect and its something small like smiling each day that helps us keep a health state of mind. LAUGH OUT LOUD

What’s so funny?

We all know that laughter inherently makes us feel good, however how often do we laugh out loud each day? The incredible feeling of chuckling all the way to your belly, can linger long after an episode of laughter is over. Whether it’s an awesome or awful day, an unexpected moment of humour can instantly help in alleviating a low mood, yet laughter can be easily overlooked

as a priority in our day to day lives. Research from the past 40 years has found that laughing does more than just perk up our day. Its benefits have been found to range from the psychological dimension to physical health and even to social health.

Laughter does good things for our health Studies have shown that laughter reduces anxiety and stress while provid-

The Script Pharmacy Magazine │September • October 2014

ing increased self-esteem, energy, and a sense of control. Furthermore, laughing induces physiological responses that simulate exercising, which has been found to improve immunity and prevent heart diseases. At the basic level, laughter is especially useful at times of stress, because it can help to shift our perspective and view a stressor more optimistically. Laughter also helps us to

MENTAL HEALTH AWARENESS MONTH

work more efficiently by increasing catecholamine levels in the body, a hormone that improves overall memory, responsiveness and alertness. With a clearer mind, this can indirectly help us confront stressors more proactively. Laughing is actually considered to be a healthy stress, known as ‘eustress’. This type of stress is known to counteract a range of stress hormones, which when decreased make us feel good. Because stress hormones can suppress our immune system, this counteraction can also improve physical health. When we laugh, we also increase levels of endorphin, one of the hormones that is known to be responsible for boosting mood and overriding negative thoughts.

Laugh your way to better relationships If this hasn’t convinced you already, on yet another level, laughter can improve social life. As researcher Barbara Fredrickson writes in her book “Positivity,” amusement is social. She writes “although at times we laugh alone, those laughs are only pale renditions of the laughter we share with another..in fact, like yawns, laughter is highly contagious.” Apart from a deeper positive feeling experienced when laughing with others, there are other social benefits to laughing too. It makes us more attractive and also helps form stronger relationships by making interactions with friends and family members more positive, exciting and amusing.

Ways to laugh more: Given all the evidence of the benefits of laughter, it makes sense to think of ways we could increase laughter in our day to decrease stress, help us problem solve better and improve relationships. If you are not a natural comedian, you can find Anh’s tip useful – children often see the funny side of life. However, if you don’t have children around you, give the following tips a go: • Watch a funny video or movie. Whether it is something on Youtube or Meet the Parents, comedic films are all produced to bring more humour into your life. • Recall a few of the most embarrassing moments in your life.

•

• • •

However, be selective of what you recall—you will not want to remember those that you cannot laugh at. Walk towards laughter. Whenever you hear laughter, ask ‘What’s so funny?’ The others will definitely tell you what they are laughing about - just so they can enjoy the joke all over again. Find a funny person. Buddy up with someone who can routinely find humour in day to day events. You’ll definitely notice the difference. Laughter is contagious. Bring out your silly side. Got a camera? Try taking pictures of you and your friends pulling weird faces. Too much fuss? Just get your friend (or yourself) to speak in an accent. Find someone to tickle you. Guaranteed to bring on laughter, even if it’s a little painful at first!

Need more help? If you are having persistent difficulty experiencing laughter, amusement or joy in your day, alongside feelings of sadness, apathy or lethargy, you might want to talk to a mental health professional.

BE IMPERFECT What’s so bad about being perfect?

There is nothing inherently wrong with having goals and striving to achieve them. However sometimes our goals and standards are unrealistic and can contribute to stress. Perfectionism can rear its unhelpful head in a number of areas: from work and study to taking care of our personal appearance and housework. Most of us can probably recognise the effects of perfectionism in ourselves or others. Striving for perfection can mean we take far longer than is needed in order to get a task done, avoid a task completely for fear we won’t measure up (otherwise known as procrastination!). The pursuit of perfection can even deny us enjoyment of our eventual successes and achievements because they fall short of what we were hoping for. It makes sense, that if we take regular steps to be “less than” perfect we can look forward to greater satisfaction and fulfillment when we achieve those

goals. It will also mean that we might focus less on the negatives. Essentially, if our expectations are more in line with reasonable goals, we’ll get to experience less stress and more success, more often!

Being ‘less than perfect.’ Tips for dealing with perfectionism If you feel you have unreasonably high standards for yourself in some area of your life try these tips for dealing with perfectionism: • Try and recognise when your perfectionist tendencies are getting in the way of getting something done. Stop and acknowledge them. • Try replacing your goal of perfection with something else. For example, instead of being • driven to get the best possible mark for an essay, use the experience of writing the essay as an • opportunity to learn something new. • Check out your goals to see if they are realistic (maybe a friend or workmate could help with this). We can often set ourselves up for failure before we begin, by setting unreachable goals. • Set smaller targets on the way for a big study, work or personal project so you can reward yourself for achievements you make along the way. • Focus on the areas where you are experiencing success. If you are a parent, perhaps your kids didn’t get to bed on time, but they may have tried a new vegetable at dinner and along the way you found a new way to deal with the inevitable frustrations of being a parent. Don’t forget that changing your thinking will take time and practice; so don’t be too hard on yourself if you can’t break your habits overnight; and remember to focus on the more achievable goals. Perfectionism and mental health issues High levels of perfectionism have been associated with a range of mental health issues, including anxiety, depression and eating disorders. Some people may benefit from working through these issues with a mental health professional.

The Script Pharmacy Magazine │September • October 2014

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