V o l u m e 1 I s s u e 2
B S C l i n i c a l P h a r m a c e u t i c a l S c i e n c e s
Whati s
?
P I F
2 0 1 4Cl i n i c a l
Pha r ma c ySummi t
F a t u r e d Cl i ni calPharmaci st Hon. Ant honyAl dr i nSant i ago
Learni ngsandExperi ences
Lect ur esf r omDr .Wul andar i
“Taki nguptheMantl eofResponsi bi l i tyf oraBetterCl i ni calPharmacyPracti ce”
EDITOR’S NOTE
Many of pharmacy students, when asked if they chose their course, would most likely say that this is not so. Either they would say that their parents made them choose this profession or even just went along with the decisions of friends. We of the BS Clinical Pharmaceutical Sciences, may have been initially forced to take BS Pharmacy, but let it be known that it is with our own full knowledge and judgment that we took on the challenge to become clinical pharmacists. Most of us in this class already have our licenses. We could have already plunged into the professional world, displaying our knowledge and skills while at the same time contributing to the growth of our nation, yet we didn’t. We chose to stay in school and learn more, in order to further hone our skills and to better serve our people. But the inevitable truth is, what we are learning in school is just the tip of the iceberg. It is in the professional world where we will learn the most. Our learnings in school taking up only a mere portion of the whole bulk of learnings in this profession. Being a clinical pharmacist in a country who has not properly acknowledged its professional pharmacists is a challenge in and of itself. But this is the challenge we have willingly taken.
1
PHARMACIST’S DIGEST MAR 2014
A journey starts with a single step. As the school year nears its end, our classroom training also rapidly concludes. Next is the challenge of applying our knowledge in a controlled and practical setting, hospital internship. As we prepare to leave the school in order to learn more in a completely new environment, speaking a language not routinely used, we are completing that step that would start our journey towards the realization of our goals. As we leave this school year behind, we hope to have already imprinted our footstep towards a road less taken and we do so along with the hopes that our footsteps become a guide towards a new avenue of our practice.
THE COVER As we are approaching the end of our school year, we are also closer towards our chosen specialization. Depicted is one of the primary role of a clinical pharmacist, providing medication counseling towards patients in order to improve their quality of life. This represents our future roles in the community, the role which we have been preparing for, a true Carolinian Clinical Pharmacist.
EDITORIAL
[
The second semester of the B.S. Clinical Pharmaceutical Sciences program is a continuation and application of the subjects taught during the first semester. The skills in calculation and pharmaceutical information are developed during this semester.
]
Here is a table summarizing the different subjects of the fifth years on the second semester:
SUBJECT CODE
PHAR 52
SUBJECT TITLE Pharmaceutical Care II
SUBJECT DESCRIPTION Pharmaceutical care II is a continuation course of Pharmaceutical care I. It involves the discussion on emergency drugs involved in cardiovascular and neurologic systems and its calculations. The proper use and application of the different drug delivery systems are also discussed in this subject.
Pharmacotherapy II
Pharmacotherapy II is a continuing subject. Discussed in this course are case studies involving the diseases of the different organ systems in the body.
PHAR 56
Pharmaceutical Administration
Pharmaceutical administration discusses the different processes of planning, organizing, leading and controlling an organization. This is to prepare the students for administrative, managerial, marketing or pharmacoeconomic research careers in the pharmaceutical industry, pharmacy education, health care institutions, community pharmacies, and pharmacy organizations.
PHAR 58
Special Topics
PHAR 54
PHAR 60 PHAR 62
Discussed in this subject are the medications that are not usually discussed during the undergraduate course like herbal preparations, dangerous drugs, vitamins and alternative medicines.
Special Project
Special project involves surveys and interviews about the medications available in the local school clinics and health centers. A study on how the local health centers dispense medications is also conducted .
Internship II
This course is the application of all the lessons taught in the clinical pharmacy course in real life situations. Hospital internship is done to expose the student on the duties and responsibilities of a clinical pharmacist.
PHARMACIST’S DIGEST MAR 2014
2
[photo by Maria Krissna Isabele Cruz]
NEWS
A HELPING HAND A BEACON of
HOPE By Felbert Maningo
Yolanda, how could the Filipino people ever forget that name? On November 8, 2013, the strongest typhoon the world has yet to encounter, hit the Philippines, leaving at its wake nothing but destruction, death and despair to the victims in several towns and provinces in Central Visayas. The sight of the wrecked communities just kills a part of us inside. The damages were much more than we expected. We thought we were ready, but Mother Nature was unforgiving. Many lives were lost, many hopes were crushed, and it was a disaster that we thought only existed in our nightmares.
3
PHARMACIST’S DIGEST MAR 2014
NEWS In the midst of massive despair and destruction, our role as Carolinians became evident. The virtues that has been instilled in us as students, are now being put into test, and true enough, we Carolinians stood up and proved that indeed our virtues are true. Stationed in Cebu City, we are in the most strategic location to send aid as well as relief goods towards the victims of the typhoon. Utilizing the different available resources of the University, we are among the first to send aid towards the different affected areas most especially those within Cebu province. As Carolinian Clinical Pharmacy students, we too responded to this call of service by offering our time, knowledge and effort in order to help our fellowmen. Throughout the week, day after day, we 5th year students, together with the other departments in the University of
San Carlos aided by the local government have brought medicines along with food rations and hygiene products for our fellowmen in need. We bought, organized, and packed medicines in University of San Carlos- Downtown Campus. The least we could do as pharmacists was to make sure that the donated medicines were safe and effective to use which includes, checking the expiry dates, eyeing for damages and counterfeits, conducting inventories of medicines and purchasing of additional drugs that might be of benefit to the victims. Others even went to Northern Cebu as volunteers to extend personally the goods and medicines to the victims.
wasn’t their turn. We were forced to make decisions based solely on our judgment. No matter how hard it was, when we looked into the eyes of the patients- those eyes that have seen their own loved ones dying in their own arms, helpless and confused, those eyes that saw their own lives crumble and we just knew that we needed to give the best assistance we could give. And this is where we put our skills and knowledge to test. In the absence of proper instruments, we utilized our knowledge about compounding in order to properly reconstitute needed antibiotics. Our knowledge about drug information were tested, since we needed to suggest alternatives for medications not available in the area. Our skills as intermediates between the physician and the patients were also tested when we had to counsel our patient about the proper use of their medications. Managing the proper documentation of the stocks was another challenge that we faced and conquered. Amidst these challenges, we persevered since our reward was not in receiving free lunches, nor was it in travelling to different places. Our reward lay in the people whom we were serving. The smiles and the heartfelt thanks were more than enough compensation for our sacrifice and hard work. The knowledge that even in our own little ways we were able to alleviate their pain and bring a smile to their faces was enough for us to wake up, and do it all over again. This disaster might have been the worst typhoon the world has seen. It may have broken hearts, lives and homes but we have proven that no disaster remains a disaster if we help each other. Together we can build up hope for all victims. We may need more time to get back on our feet, but we the Filipino people, have proven our mettle. We will rise up and smile for we know that with each other as support as well as faith in our God, we can recover what we lost and live full and happy lives.
As students who were given the chance to help the evacuated victims from Tacloban, we travelled to Mactan to assist and welcome the evacuees. During the medical mission, we experienced firsthand the difficulty of the volunteers in Tacloban. The skills that we learned in school were put to the test: decision making, multitasking, and calculating skills. Not to mention dealing with the pressure from the patients when they beg you for help but
PHARMACIST’S DIGEST MAR 2014
4
NEWS
New Way blood glucose to keep the
at bay
by Vangenique Nieves Cagulada
In 2011, over 347 million people worldwide have diabetes and by 2030, World Health Organization (WHO) projects that diabetes will be the 7th leading cause of death. More than 80% of diabetic deaths occur in middle- and low-income countries such as the Philippines. A new treatment option has been approved by the US-FDA to be the first-in-class medication to combat Type 2 Diabetes Mellitus. Johnson & Johnson’s Invokana® (generic name Canagliflozin) is indicated as an adjunct to diet and exercise to improve glycemic control in adults with Type 2 Diabetes Mellitus. It was certified last March 29, 2013. This sugar-lowering drug, unlike the existing oral hypoglycemic agents, has a different mechanism of action. Invokana® lowers the blood glucose by inhibiting the sodium-glucose co-transporter 2 (SGLT2), which is responsible for the reabsorption of filtered glucose from the tubular lumen. This pioneering member of the new class of oral hypogycemic drugs called sodium-glucose co-transported 2 inhibitors works by blocking the reabsorption of glucose by the kidney, increasing glucose excretion, and lowering blood glucose levels in diabetics who have elevated blood glucose levels. The safety and effectiveness of canagliflozin were evaluated in nine clinical trials involving over 10,285 patients with type 2 diabetes. Invokana has been studied as a stand-alone therapy and in combination with other type 2 diabetes therapies including metformin, sulfonylureas, pioglitazone, and insulin. It may be used alone or with other medicines that lower blood sugar, as prescribed by your doctor. However, Invokana cannot be used in patients with type 1 diabetes; in those who have diabetic ketoacidosis; or in those with severe renal impairment, end stage renal disease, or in patients on dialysis. Because of the large amounts of glucose in the urine, the most common side effects of Invokana are vaginal yeast infection (vulvovaginal candidiasis) and uri-
5
PHARMACIST’S DIGEST MAR 2014
nary tract infection. It is also associated with a diuretic effect, thus, can cause a reduction in intravascular volume leading to orthostatic or postural hypotension. This may result in symptoms such as dizziness or fainting, and is most common in the first three months of therapy.
In a phase 3 clinical trial, patients with type 2 diabetes not controlled by metformin plus a sulfonylurea, adding canagliflozin (Invokana) improved glycemic control better than adding sitagliptin (Januvia). However, genital fungal infections were a common side effect.
Though already certified, the FDA still required Johnson & Johnson to conduct five additional long-term studies of Invokana’s effects on cardiac health, liver problems, cancer, and pancreatic disease.
In 52 weeks, the patients’ mean HbA1C levels dropped by 1.03% with canagliflozin versus the 0.66% drop with sitagliptin. Canagliflozin also resulted in weight loss and a drop in the blood pressure of the patients. However, 9.2% of men and 15.3% of women developed genital infections while taking this drug.
Invokana tops Januvia as Third-line [4] Therapy, with drawbacks
References: 1. WHO (2013). Diabetes. Retrieved March 2, 2014, from http://www.who.int/mediacentre/factsheets/fs312/en/ 2. Haiken, M. (April 2013). New Diabetes Drug Invokana has Major Treatment-and Market- Potential. Retrieved March 2, 2014, from http://www.forbes.com/sites/melaniehaiken/2013/04/01/invokana-a-potential-blockbuster-diabetes-drug-approved-by-the -fda/ 3. US –FDA (March 29, 2013). FDA approves Invokana to treat type 2 diabetes. Retrieved March 2, 2014, from http:// www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm345848.htm 4. Busko, M. (April 16, 2013). Invokana tops Januvia as third-line therapy, with Drawbacks. Retrieved March 26, 2013, from http://www.medscape.com/viewarticle/782571
NEWS
A REMARKABLE HOPE forLeukemia Treatment by John Elden Lopena
Ibrutinib is a first-in-class inhibitor of Bruton's tyrosine kinase which forms a covalent bond with the BTK active site, leading to inhibition of BTK activity. BTK is important for activation of pathways necessary for B-cell chemotaxis, and cancer proliferation. The drug has shown "striking" efficacy and has stirred up considerable excitement in hematology circles, with experts describing it as a " turning point" in the treatment of chronic lymphocytic leukemia, and " a step change" in the treatment of mantle cell lymphoma.
The U.S. Food and Drug Administration approved the additional use of Ibrutinib (ImbruvicaÂŽ), previously approved for mantle cell lymphoma, for chronic lymphocytic leukemia patients who have received at least one previous therapy. Chronic lymphocytic leukemia is a rare blood and bone marrow disease that usually gets worse slowly over time, causing a gradual increase in white blood cells called B lymphocytes. The National Cancer Institute estimates that 15,680 Americans were diagnosed and 4,580 died from the disease in 2013.
In a clinical study, 48 previously treated participants diagnosed with CLL 6.7 years on average prior to the study had received 4 previous therapies. All of them received ibrutinib 420 mg orally until the treatment reached unacceptable toxicity or the disease progressed. The results show an overall response rate of nearly 58%. At the time of the study, the duration of response ranged from 5.6 to 24.2 months. Ibrutininb is also active in patients who have not received previous drug therapy. According to Byrd, in another study he conducted published in this year's issue of Lancet Oncology, "the showed that in elderly patients who received ibrutinib as initial therapy, the 24-month disease-free survival was 96%. To put this in perspective, the best combination therapy of chlorambucil and obinutuzumab reached 50% at that same time period," he said. "So it's really blowing the pants off what we are standardly doing in elderly CLL patients." So far Ibrutinib has been shown to have fewer side effects than most standard chemotherapy drugs, although it can still cause serious side effects in some people such as thrombocytopenia (57%), diarrhea (51%), neutropenia(47%) and anemia (41%).
GOOD TO KNOW References: FDA (2014) FDA approves Imbruvica to treat chronic lymphocytic leukemia. Fda News Release. Retrieved from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ ucm385764.htm
Hemp for victory! During World War II, US government strongly encouraged hemp cultivation which is processed into uniforms, canvas, and ropes.
PHARMACIST’S DIGEST MAR 2014
6
FEATURE
Flesh Eating Disease Controversy:
AN EXAMPLE of
Misleading Information By Christine Valdez and Mark Gullem
Recently, there were cases reported of the so-called “mysterious disease” in Pangasinan that is eating the flesh of its victims. But reports suddenly clarified that it was not true and no mystery at all. There is no reported case of ‘flesh-eating’ skin disease in the country yet, and there is absolutely no reason for the public to panic. ABS-CBN reported in their late-night program “Bandila” that a “mysterious flesh-eating disease” is slowly spreading in Pangasinan. The reporter, clad in protective gear and face mask, interviewed two cases in Villasis and Santa Barbara who were said to be “decaying” due to a “mysterious” disease. But the provincial health officer dispelled the report, saying the two victims had psoriasis and leprosy.
What is Leprosy? Leprosy (Ketong) is an infectious, bacterial disease that causes severe, disfiguring skin sores and nerve damage in the arms and legs. Its history can be traced back into the ancient times and people afflicted with this disease has been described in the Bible and other ancient texts. Leprosy is caused by Mycobacterium leprae. You can catch it only if you come into close and repeated contact with nose and mouth droplets from someone with untreated leprosy. Due to its debilitating effects, this disease has been a nightmare for ancient civilizations because no effective treatment has been discovered yet. This stigma then lead to ancient society shunning and treating lepers as if they are scum. Nowadays the stigma of contracting this disease has since waned due to the discovery of effective medicines that treats this
disfiguring disease. Leprosy is now easily treated with a 6–12-month course of multidrug therapy. Therapy may come in different combinations of the following antibiotics: dapsone, rifampicin and clofazimine. If left untreated, the disease can cause nerve damage leading to muscle weakness and atrophy, and permanent disabilities.
What is Psoriasis? Psoriasis is an autoimmune disease that causes skin cells to grow too quickly, resulting in thick, white, silvery, or red patches of the skin. Psoriasis is not contagious. It cannot be spread by touch from person to person. This condition creates skin cells that mature and die in less than a week, which is extremely rapid considering normal skill cells mature and replace dead ones usually in a month’s time.
GOOD TO KNOW Warfarin, used to clot blood and to prevent blood clots from moving, is the most widely used anticoagulant in North America, but it was originally developed as a pesticide against rodents and it is still available for that purpose.
7
PHARMACIST’S DIGEST MAR 2014
Catsup or ketchup was once used as a medicine before. It was in 1830's when ketchup was used as a medicine in the United States and was called 'Dr. Miles Compound Extract of Tomato'.
The first drug that was sold as a water soluble tablet was aspirin in 1900.
FEATURE
Psoriasis unfortunately, has no permanent cure but it can be managed. Management of psoriasis may involve medications, stress reduction and adjuncts such as sunshine, moisturizers and salicylic acid. Medications used in the management of psoriasis may include corticosteroids, immunomodulators and keratolytic agents. The goals of treatment involves prevention of psoriasis flares, treatment of skin lesions and prevention of complications.
“Flesh Eating Disease” Also known as Necrotizing fasciitis is an infection caused by several bacteria, but the most common and deadly causative agent is Streptococcus pyogenes, or Group A hemolytic Streptococci. It can destroy skin, fat, and the tissue covering the muscles within a very short time. Bacteria spread rapidly once they enter the body. They infect flat layers of a membrane known as the fascia, connective bands of tissue that surround muscles, nerves, fat, and blood vessels. The word "necrotizing" refers to something that causes body tissue to die. Necrotizing fasciitis is a very rare but also serious infection. About 1 out of 4 people who get this infection die from it.1 Many people who get necrotizing fasciitis are in good health before they get the infection.
Signs and Symptoms: The symptoms often start suddenly after an injury. You may need medical care right away if you have pain that gets better over 24 to 36 hours and then suddenly gets worse. The pain may be worse than what you would expect from the size of the wound or injury. The chief symptom, unique to necrotizing fasciitis, is severe pain disproportionate to physical findings. At the first sign of infection, a small, reddish, painful spot or bump appears on the skin. The spot quickly grows to a very painful bronze or purple colored patch that grows rapidly. The center of the infection may become black and necrotic and the skin may break open and weep fluid. The wound quickly grows, frequently in less than an hour. Other symptoms may include a general ill feeling, fever, sweating, chills, nausea, dizziness, profound weakness, and shock. Without treatment, death is likely and can occur rapidly.
Should we be alarmed of the incidences of “Flesh Eating Disease”? Flesh-eating disease is caused by cytotoxins released by bacteria, with the majority of infections caused by Group A Staphylococcus bacteria. It is possible to contract flesh -eating disease from a razor cut, but this only rarely happens. It only happens if the razor used is unclean, rusty, or has been used by someone carrying the bacteria that causes it is on their skin. According to the Centers for Disease Control and Prevention (CDC) “If you're healthy, have a strong immune system, and practice good hygiene and proper wound care, your chances of getting necrotizing fasciitis (“flesh-eating” bacteria) are extremely low.” Most people carry the bacteria that causes this condition on their skin. Methicilin-Resistant Staphylococcus aureus (MRSA) which causes staph infection, is also a possible causative agent. Strong broad spectrum antibiotics given IV are the first line agents for this disease. But antibiotics may not be able to reach all infected and decaying areas which have been “eaten” by the bacterial toxins, these areas are now destroyed soft tissues with reduced blood flow. For these cases rapid surgical removal of dead tissue together with the antibiotics is the most appropriate way to stop the infection. In addition immunoglobulins may also be given to help fight the infection in some cases. But again, the odds of you contracting this disease are minute that you should not be worrying about it unless you present with the different signs and symptoms mentioned above.
REFERENCES: CDC. (2013) Necrotizing Fasciitis: A Rare Disease, Especially for the Healthy. Retrieved from http://www.cdc.gov/features/necrotizingfasciitis/ Nagel, E. (nd) Necrotizing Fasciitis . Retrieved from http://www.austincc.edu/microbio/2421a/gas.htm WebMD. (2011) Necrotizing Fasciitis (Flesh-Eating Bacteria). Retrieved from http://www.webmd.com/a-to-z-guides/necrotizing-fasciitis-flesh-eating-bacteria-topic-overview WHO. (2014) Lepsory. Retrieved from http://www.who.int/topics/leprosy/en/ The Healthline Editorial Team. (2011) What Do You Want to Know About Psoriasis?. Retrieved from http://www.healthline.com/health/psoriasis
PHARMACIST’S DIGEST MAR 2014
8
FEATURE
Clinical Pharmacy Students Experience
& Presents...
Philippine Pharmacists Association
2014 Clinical Pharmacy Summit March 7-9, 2014
Mariano K. Tan Hall, UL Bayanihan Center THEME: Moving Mainstream Practice Toward Clinical Pharmacy
9
PHARMACIST’S DIGEST MAR 2014
FEATURE
DAY 1 A Talk about How to be an Effective
Clinician
By Allison Bonpin, Giana Fernandez and Mara Samantha Alejandria
The practice of clinical pharmacy is unique in the sense that it is directed towards the optimization of medication therapy for the benefit of the patient rather than product itself. It takes certain people to fulfill the demanding job of a clinical pharmacist. To be an effective clinical pharmacist and clinician, one must possess specialized therapeutic knowledge on medications, developed throughout the time of practice in the field, as well as values of professionalism, character and critical thinking. On the first day of the summit, the topics tackled were mainly focused on clinical pharmacy practitioner and preceptor development for the aim of optimizing effectiveness as a clinician and educator. For the first part of the session, the speaker Mr. Alan Lau had dived into how pharmacy education and clinical practice have evolved in United States. He defined the clinical practice as a patient care that optimizes medication and therapy and promotes health, wellness and disease prevention, that the profession embraces the philosophy of pharmaceutical care, caring oriented with specialized therapeutic knowledge, experience, and judgment for the purpose of ensuring optimal patient outcomes. In the definition that he provided, it also emphasized the obligation of a clinical pharmacist to contribute for the generation of new knowledge that advances health and quality of life. He
explained that a clinical pharmacist is part of the healthcare team for the sole purpose of ensuring that the medication prescribed for the patient contribute to the best possible health outcome and that physician-pharmacist relationship is always collaborative because they aim for one goal, and that goal is for better patient health outcome. In light with the topic, he also explained how they practice their profession in their own institution, as a clinical pharmacist or as an educator. For example, as a clinical pharmacist practicing in their state, daily activities and tasks of a clinical pharmacist includes patient care rounds with the health care team and collaborative drug therapy management agreements.
classroom and in the patient care setting. They have expounded on the traits of an excellent teacher, which are competent, challenging and caring. Competent in a sense of having the necessary knowledge and ability to impart the information to the students well enough so that they understand the principle and not just theoretically, challenging in a way that students are able to use their ability and critical thinking, not spoon-feeding them with answers. And lastly is caring, this is also important so that the students would not feel that the teacher is pushing them down and letting them struggle on their own. The speaker had talks about didactic teaching, learning styles, tips on precepting and their roles.
The second speaker was Mr. Michael Maddux. He talked about how clinical pharmacists contribute to direct patient care. Since pharmacists are the socalled “drug experts”, our responsibility includes recognition and confirmation of patient-specific assessments/problems; evaluation of pharmacotherapy; provision of recommendations to optimize therapy; monitoring pharmacotherapy and patient specific problems; education and counseling of patients, family or caregivers and lastly education of other health professionals. He defined direct patient care as direct observation of the patient for the purpose of selection, modification and monitoring of patient-specific drug therapy with the help of the healthcare team. He had stressed about professional development to be a continuing cycle for a clinical pharmacist and taking responsibility and doing it right.
To be an effective clinician, clinical pharmacists should commit to their duty, excellence, honor and integrity. The speaker have also stressed about the importance of critical thinking and defined it as the identification and evaluation of evidence to guide decision making, since one of the task of a clinical pharmacist is choosing appropriate medications specifically for the patient case. Effective communication skills are also vital in the clinical pharmacy profession because collaborating is through communication and communication serves as a medium for reaching optimal patient care.
For the second half of the session, the speakers Dr. Stacy, Dr. Groo and Dr. Gross enlightened us about the attributes of an effective teacher and clinician as well as teaching clinical skills in the
Lastly, using different teaching skills for determining and meeting students’ needs is a potentially efficient method of delivering effective teaching ability outcomes in school settings. If this will be applied in our country’s setting, there will be a high probability for better education and brighter future for this generation’s clinical pharmacists. Moreover, it will help generate more competent and skilled clinical pharmacists.
PHARMACIST’S DIGEST MAR 2014
10
FEATURE
DAY 3
DAY 2 Novel Oral Anticoagulants:
A Glimpse on
A New Era in Anti-thrombotic Therapy
in the US
By Alana Dominique Reroma, Nikka Angela Gaitera, Danielle Kristine Demegillo
By Justine Eve Carbonilla and Lovely Anne Go
Have you heard of the drugs, Dabigatran, Rivaroxaban and Apixaban? Do you have any idea on why these drugs were recently approved by the Food and Drug Adminstration and what they are indicated for?
How about we put warfarin in the picture? It has been a practice in the clinical setting for more than a decade now that warfarin is the only treatment option for long-term anticoagulation of patients with atrial fibrillation, venous thromboembolism, or other medical conditions that require chronic anticoagulation. But because of these new agents, classified as the Novel Oral Anticoagulants (NOAC), clinicians now have a broader choice. NOAC is indicated for stroke prevention in patients with atrial fibrillation. Given the recent approval and availability of these medications, clinician's main concern with regards to the medication is whether the benefit equals the risk or the benefit outweighs the risk. This is now being practiced in the United States and slowly being adapted here in the Philippines but a lot of people in the practice is not yet very familiar with this since it is a relatively new therapy. The Novel Oral Anticoagulants (NOACs) are new drugs employed as anticoagulants. It provides fixed dosing administration thus providing enough anticoagulation to decrease thrombosis while minimizing bleeding. Agents included in this new therapy are Dabigatran, a strong P-glycoprotein inhibitor and Rivaroxaban, a strong inhibitor or inducer of CYP3A4. NOAC agents have interactions with acetylsalicylic acid (ASA), dual antiplatelet therapy and non-steroidal anti-inflammatory drugs (NSAIDs) for it may increase bleeding risk of patients. Moisture affects capsule integrity of Dabigatran resulting in loss of potency and as for Rivaroxaban, bioavailability increases by 23%-39% with food. NOACs have undergone bleeding postmarketing studies. The Danish Medicines Registry was able to compare Dabigatran and warfarin. Result show that dabigatran has less GI bleeding risk compared to warfarin. Indications and dosing protocols of the NOAC agents were also presented. Warfarin requires dose adjustment in accordance with the patient’s PT-INR results, which requires proper patient monitoring and counseling. NOACs on the otherhand, needs less patient monitoring and thus no patient counseling making it easier for both the patient and the healthcare team. This therapy is already being practiced in some of the hospitals in Manila. Hundreds of agents are being studied today and a lot of new drugs or agents are being marketed worldwide. As pharmacists, it is our duty to be up to date and be in the know of the new developments involving our profession. The opportunity to take part in the 2014 Clinical Pharmacy Summit was one we were glad to take. We were able to expose ourselves to the clinical practices of other countries particularly in the United States and were able to interact with other clinical pharmacists as well. To summarize the event, it was definitely fulfilling, self -gratifying and motivational. Fifty or so years ago, the United States was in the same predicament the Philippines is in right now in terms of the advancement in health care. But with efforts from each and everyone in the health care practice to go beyond their profession and take that extra mile for the betterment of our country’s health care system, we can achieve what other advanced countries already did and maybe even more.
11
PHARMACIST’S DIGEST MAR 2014
and manage the medications that prevent blood clots. It is staffed by pharmacists working in conjunction with a physician. The function of ACC is to determine indication and duration of therapy, establish therapeutic range for anticoagulants, educate the patient and health care providers, assess adherence to regimen, review medications, comorbidities and diet and screen for recurrence of thromCardiovascular Clinical Phar- bosis or bleeding events based macy Services include Antico- on PT-INR or PTT of the patient. agulation Services and Heart Failure (HF) management. The For heart failure inpatient manspeakers shared the inpatient and outpatient services they agement, the role of the pharprovide in Chicago. The inpa- macist is to provide active thertient anticoagulation service apy management, identify drugconsists a team of 5 pharma- related problems, direct pacists and 2 pharmacy residents tients to assistance program, available 7 days a week. They develop clinical pathways or provide consultation activities guidelines and educate patients in medications such as Unfractionated Heparin (UFH), Low- regarding medications and selfmolecular-weight heparin assessment of heart failure. The (LMWH), direct thrombin in- general approach they provide hibitors, Warfarin and Antico- for HF include relief of congesagulation monitoring and tran- tions and volume overload sitions. They also give patient through sodium and fluid reeducation on the proper use of striction and diuretic use, and such medications to achieve the optimum therapeutic outcome. addition of IV vasodilators such This inpatient management as nitroglycerin. The use of inoprovides an opportunity to re- tropes should be severely limduce patient length of stay and ited as it can cause arrhythmias, overall health care costs. Sev- neurohormonal activation and eral measures have been develincrease mortality. They also oped to ensure the safe and effective use of anticoagulants. give discharge evaluation and For the outpatient service, they planning for follow-up to have Anticoagulation Clinic reduce readmission. For the (ACC) established to monitor outpatient management,
During
the Clinical Pharmacy Summit, the topic Cardiovascular Clinical Pharmacy Services were discussed by Dr. Zachary Stacy and Dr. Vicki Groo on the last day, March 9, 2014 of the convention. It is more focused on clinical pharmacy services implementation and practice management of Cardiovascular diseases in Chicago.
FEATURE
What Doesn’t Kill
Makes
You
Stronger
By Daniel Niño P. Demegillo Pharmacist has a big role in the heart failure clinic. They provide patient interview to determine heart failure status, history and response to therapy, recommend medications to physician, educate patient on medication changes with written instructions and telephone follow-up. With all these services provided by Pharmacists in Chicago, we can say that Pharmacist has indeed a substantial role in overall patient care. This marks the paradigm shift of the outlook on Pharmacists from product-centered to patientcentered. In the Philippines, although there are still much to work on, if each of the Pharmacists would reach out into patient simply by starting on patient counseling, time will come that people will see us not merely as tinderas but part of the health care team.
Antimicrobial drugs have been used aggressively to fight bacterial infections of different degrees. As this trend of use has been developed, mishandling and wrong dosing of this drug can occur – this has lead to the development of microbial resistance to antibiotics that we now face. Prompting the population to utilize a more aggressive antimicrobial agent to fight off infections and thus developing antimicrobial stewardship. Dr. Alan Gross a clinical assistant professor from the University of Illinois, Chicago discussed about how antimicrobial stewardship is done sharing several strategies and application on this practice. Infections treated with antibiotics without proper, rational, or drug reconciliation practices microbial resistance to these drugs occurs. This means that the causative agent will not be susceptible to the drug. This would make the antimicrobial drug useless in fighting off the infection and would cause the patient to use a higher type or other form of antimicrobial drug. This strategy not only is costly but may also cause more harm than good to the patient. Aside from developing resistance, some infections are also precipitated by antimicrobial agents themselves. Since this has emerged, several strategies have been developed in order to avoid the continuing increase in the incidence of this problem. The use of the Antibiogram, wherein the specific drug of choice for every microbial agent is being evaluated to determine which of the drugs would be more effective in eradicating the infection and thus administering treatment that would be appropriate to the patient. This method also shows how to be cost effective when it comes to microbial infections. Antimicrobial stewardship aims to educate us on how to use antimicrobials properly in the safest and most effective way. This program when applied correctly can help
eliminate improper use of antimicrobials especially when it is not needed in the pharmacologic management of the patient. With this practice, it would help clinicians choose the most appropriate drug that will render the most positive outcome, regardless if it is the strongest or most aggressive form of therapy. In this setting, this is where a clinical pharmacist will be able to give quality service: being able to interpret the needs of the patient’s case depending on the circumstances they are in and not only by what is the usual protocol done in such cases. With the clinical pharmacist’s knowledge of this type of stewardship, it would help eliminate drug resistance to the most aggressive drugs, and will help promote the use of much safer and less toxic antimicrobial agents. Antimicrobial stewardship by clinical pharmacist develops a good practice towards proper handling of antibiotic agents. As we nurture this skill and practice, antimicrobial resistance may be decreased or if possible eradicated to a minimum.
PHARMACIST’S DIGEST MAR 2014
12
FEATURE
FEATURED
Clinical
Pharmacist
An interview with Hon. Anthony Aldrin Santiago
Long ago, the practice of pharmacy here in the Philippines is simple and focuses on the community and hospital setting. However, in this century, the practice of pharmacy is starting to evolve. The roles of a pharmacist is starting to change into something more challenging and sometimes overlapping with other professionals.
O
ne aspect that a pharmacist can enhance his knowl-
edge and skills is the clinical pharmacy practice. Now, maybe some of you are wondering what we are talking about. Some of you may ask what pharmacy is and who these pharmacist are. Maybe, by now you are curious what clinical pharmacy means and what it can contribute to the Philippines. To answer those questions lingering in your minds, we are grateful to be given this chance to have an interview with Hon. Anthony Aldrin C. Santiago, to enlighten you about the importance and evolution of pharmacy here in the Philippines. We took this opportunity to get to know more about him and his experiences. Hon. Anthony Aldrin is the first licensed clinical pharmacist here in the Philippines and he is the new member of the Board of Pharmacy. Currently, he is part of the clinical pharmacy department at The Medical City, Ortigas Avenue, Pasig City, Manila, Philippines. Now, let’s get to know more about him and his outlook on pharmacy practice particularly on the clinical pharmacy aspect.
13
PHARMACIST’S DIGEST MAR 2014
Can you tell us something about yourself and about your work? “I'm attending the convention ngayon. I'm having a break with you. I'm basically connected with the hospital. I've been in the hospital for 12 years, academe for 8 years and community for about 3 years. Familiarity wise in the operations that's the area where I would like to see myself today and the coming years. Of course I'm involved now with the regulatory because of my responsibility with the board of pharmacy so it's a very good opportunity also to help contribute in the direction of profession.”
How did you become a clinical pharmacist? “I graduated 1991 from the University of the Philippines and I also taught in the same university. During that time, I saw that the trend is going clinical. It’s not a matter of if "mangyayari ba to?", but it’s really a question of "kung kailan mangyayari" so you have that sight where the profession is really going. It is not something new, you can read it through literature that this is where the paradigm shift is really going. The interest is you have to work towards that interest. Initially my post graduate course is in pharmacology, but eventually I got a scholarship from my Masters in Clinical Pharmacy in Queensland University, Australia. During that time I have to decide whether to finish my masters in pharmacology because I’m already on the thesis side versus leave in 2000 for my scholarship for my clinical pharmacy. So in terms on my background in academic and formal training it’s really on clinical. So when I came back, because I was teaching then I took the clinical pharmacy subjects. It was during that time that the clinical pharmacy practice evolved into something, so sabi ko "kailangang pumunta ako sa operation because it’s not enough to teach this", so I went to practice, my first hospital engagement was in PGH (Philippine General Hospital) at 2004-2005. I was a supervisor and one of the areas I was handling was training clinical pharmacist 'tapos nagkaroon kami ng clinical pharmacy training program so it’s both a practice and training yun nga lang away from the academic institution.”
How many years did you get your masters?
“2 years”
FEATURE
“Yes, we call it clerkship. I was engage in about 4 different hospitals. It’s really more looking on the differences of patient and of their system. But the main goal is trying to customize the practice in the Philippines, because in there you have to deal with Australian, the way you communicate with them. But here in the Philippines, say for example in Cebu you need to speak their dialect for the patient to understand. It’s mainly trying to customize the practice where you are, and also your resources because comparing it to PGH we have limited resources so in terms of what I can do as a clinical pharmacist would be mainly limited on the number of clinical pharmacist. So you start very small in that area and the fact that it is a training hospital we should have clinical and comparing it to where I am right now and in St. Luke’s before because mainly they support whatever resources are needed to have that practice on board so you get to hire clinical pharmacist, train them, purchase data bases. You have to cater where you are, particular limitations that you may have for the process and resources that's why you have to manage clinical pharmacy.”
How would you view the practice of clinical pharmacy practice in the Philippines? “The practice of clinical pharmacist is evolving into difference services, based on what we need. The practice branched out to different sub specialties, but before it is just simply clinical pharmacy, but now like what we are to do in Medical City, Critical Care Pharmacy. We have to look into sub- specialization already to be more specific on the area you are practicing and well that was one extreme but in between the time I've finished my clinical pharmacy and now all things have evolved. The big improvement I saw was on the side of teaching, that is why we, on the practice setting, we would like to align what we have in the teaching so that graduates will be molded to be a clinical pharmacist and not be limited to lectures/ theories, so it’s a conceptive effort. One of the resolutions that we should do is to create a plan. I think that each hospital have their own efforts and that we are not really left behind, it’s really gathering together, having people convert that interest to actual practice. It is not enough to do your share in one corner of the hospital, eventually you have to spread word of mouth or spread the good news. Internally, you have your personal commitment that we need to do and because you can feel fulfilment in serving your patients. It is more on "Not only doing the right things, but doing things right.”
How will an ordinary pharmacist help in the promotion and implementation of clinical practice in the Philippines? “We should be advocates. It's not enough that we are competent already in one level or another in the practice. Again, we want to make a lot of convincing to the administration, to other health care provider with that particular function but again the difficulty is how to justify because of the different elements such as salary, buying of data base but again you have to be persistent on the things we are passionate about, some would go out of the country because as they say "the grass is greener in other countries" but I think it’s important that we contribute to the development of our country like inviting speakers/ lecturers to share their practice and experiences. There are different levels of distribution that we could offer and I believe with the talents that we have, both skills and knowledge. I think the most important thing is that you have a heart on what you are doing "gusto mo at masaya ka sa ginagawa mo" and the sincerity of helping others.”
Can you enumerate the difference of the clinical practice in Australia and here in the Philippines?
3 parameters: people, process and resources. “When I analyse certain things I always look into
Let's start with people, in Australia it’s well established, they have credentials and finished their clinical pharmacy so it’s
widespread. They earned it as a formal degree in their school. Process, the guidelines are all the same, what is good in it is that you don't have to re-invent the will, even though we are left behind we already have a reference all we have to do is to implement or perhaps customize a little what will be applicable for us. The third is the resources. I think the biggest thing we need to know is that "we are trained not to know everything, but we are trained mainly to know where to find the answers given the questions." Example, what database will be useful? Because it takes money also to have that. In Australia, auxiliary labels and patients medical record is already part of their system. In the Philippines we don't have that, but the good thing is that we know how to strategize, so it’s really a matter of what we have now and what we will have on the next years.”
Of all the fields, why did you choose to develop or help develop the clinical pharmacy? “One, mainly because I saw the need before, and selfactualization. Not everyone can be clinical pharmacist. First, because you need to study more (and) not everyone can communicate to other people. Aside from the fact that you see that to be in an area of your interest, what will be compatible for you? That compatibility comes because you also know yourself (and) that is what is important. It is hard to be someone that you are not. So at the end of the day although there is a component on what you want to see your mission in life you also have to examine yourself whether that will fit you as a person or in your profession.”
What is the most fulfilling part being a clinical pharmacist? “Well, I want to see myself to be able to contribute in everyday of my life whatever I put myself into. Kasi parang i'm wearing a lot of hats, I'm with the PRC looking at our practice here and comparing it to the other countries, and then tatawagin ako sa hospital kasi we have problems in terms of management of stocks, availability, sa kabila merong tawag for the interventions of pharmacy, so it is really hard to pinpoint certain things that would really fulfill you. It is really a compilation of everything although may kasabihan tayo "walang personalan trabaho lang", but at the end of the day life is not on working lang it is still personal you find fulfillment also, like ganito you get to interact with younger pharmacist so you can find fulfillment sa ginagawa mo. And even sa buhay kahit na hindi maganda ang experiences, but it is part of you, eventually becoming a better person someday. I think that is a key message because somehow you will feel overwhelmed to many different things happening in your life, so you have to enjoy what you are doing. Sometimes, things may not be enjoyable but after that you will realize why those things happened to you. It is really more appreciating what you have, learning from the experiences that you had.” Do you think there is a disadvantage of us being a clinical pharmacist especially that we are more concentrated on the hospital setting? “No, the clinical pharmacy practice, you can actually apply it even to your parents or yourself in simple ways that will really be applicable. Clinical pharmacy it is not only in hospital or community, but I would look at it as a way of life because you can have that knowledge. For example, sa bahay yung parents mo na may mga gamot na iniinom, minsan sila pa matigas ang ulo. Pag sinabi mong wag mong inumin yan sila pa ayaw makinig sa’yo pero eventually naman makikinig yang mga yan.”
Since you are in the regulatory board, do you have any mission or vision regarding the practice? “Well, it’s carrying your advocacy and making it formal kasi dati kapag may activity you emerge yourself but now you are part of the one implementing so there is greater responsibility that you have to do, now nag crystallize lang that the script of our good Lord, formalize mo na yan, hindi lang pwede na you just advocate it during mga meeting. Be one in the forefront and do whatever you can.” Do you have plans in mind, what you want to happen? “Well sa akin mainly, we should align it to the direction of the commission, the direction of the commission is mainly to go global so you try to align what you have with others, learn from experiences. Kasi people go out, make them prepare (and) make them know what is out there. Get them ready for those challenges and of course there are a lot of other things that you can do, kung baga sa exam make it more relevant.” Going globally, do you think the Filipino health community will fully embrace the practice of clinical pharmacy? “Yes! Madami na e, we just need to do a lot of convincing. Kasi in hierarchy, doctors will be the one on the captain of the ship so if the captain recognizes your role then you could go in a lot of places. (Ang) importante lang we should prove that we are worthy of their trust especially for those doctors na nagtrain abroad alam na alam na nila yan so if you have gain that trust and to be recognize as critical part of the team. Two way naman yan e, naniniwala siya sayo, ikaw dapat maniwala ka din sa sarili mo na you can contribute kasi kung hindi wala din mangyayari sa mga pinaghirapan mo. “
Lastly, what message can you give for the future clinical pharmacist?
“I believe that the children are our future, teach them well and let them lead the way." The greatest love of all is knowing that you love yourself, you love what you do as clinical pharmacist and spread your love to others.”
Hearing from currently one of the most prominent personas of our generation, it is very humbling to have someone that has a vision that includes us – the future of the Clinical Pharmacy practice. Through efforts of people like him, our generation will not really have to start from scratch, but only to help sustain, develop and see outcomes in these new endeavours we are delving into and are continuing to pursue. May Mr. Santiago become our inspiration to be able to reach not only our personal goals in life but to help attain as well a better and more fruitful Pharmacy practice in the Philippines.
[
[
Other than lectures, are there also internships?
Interview was done by the contributors at UL Bayanihan Center, Mandaluyong City, Manila, Philippines last March 9, 2014 during the 2014 Clinical Pharmacy Summit Contributors:
Jaen, Alyssa Rae D. Perfas, Kathleen L. Sandoval, Mary Jesna Joy Elise L.
PHARMACIST’S DIGEST MAR 2014
14
FEATURE
Learnings from the
Lectures of
Dr. Lestyo Wulandari By Michille Rose Tabamo
The world is a big place made small by globalization and communication. A true professional nowadays should not only have knowledge she garnered in school but also be aware of the recent developments and advances in her chosen career. As postgraduate students, we were expected to be knowledgeable of the clinical developments in the pharmaceutical industry, but an opportunity to learn more came when Dr. Lestyo Wulandari of University of Jember visited the University.
15
PHARMACIST’S DIGEST MAR 2014
FEATURE
When we heard news of us participating in a lecture by a foreign professor, we were excited at the news. We expected to hear about the practice of clinical pharmacy of another country, our South East Asian neighbour of Indonesia. The lecture was an unexpected surprise. What we learned was not about the clinical pharmacy practice of Indonesia, but rather it was about the application of pharmacy and chemistry in the development and manufacture of drugs! At first we were confused but eventually we saw the wisdom of learning about drug development and its application to our chosen field. What we learned those days were both interesting and striking. During Dr. Wulandari’s lectures we usually found ourselves dumbfounded and amazed because her lectures showed us how inadequate our knowledge was. She showed us techniques and equipment which would have made our respective thesis easier and better. She taught us the interpretations and the impact of statistical findings which would have made our own interpretation of our respective thesis data more understandable. Dr. Wulandari’s lecture showed us how advanced their drug development curriculum was, and this knowledge is humbling. A University such as ours, considered to be one of the best in the Philippines and our department considered to be one of the well-equipped in the Visayas, pales when compared to the sophistication of their instruments, equipment and studies in University of Jember. As I was listening to her lecture, I saw just how much further we have to catch up in order to achieve their level. But I also know that we are getting there. We may not have the most sophisticated of instruments, but we make up for it by searching for novel alternatives which also proven effective in our research. Dr. Lestyo Wulandari specializes in drug development and quality control. She has authored and co-authored several pub-
lished studies about novel drug mechanisms as well as quality control techniques. She discussed about the different principles and standards utilized in quality control as well as the different instruments used quality control. The application of physical pharmacy, pharmaceutical chemistry and quality control in drug development was also emphasized and clarified. Our three days of lecture with Dr. Wulandari did not only entail discussions from her. She assigned us to research about different published studies and present the data in class. We were evaluated using the same method Dr. Wulandari utilizes to evaluate her students in University of Jember. This evaluation method not only utilized input from the lecturer but also from the audience. This method ensured that students listened to the report of their fellow student since the form was given to random students. Dr. Wulandari also presented samples of studies that their students and faculty participate in. Dr. Wulandari’s lecture did not only showcase their advanced drug development curriculum, it also showed us how pharmacy is being taught in their country. It showed us the differences in our policies as well as in the application of pharmacy in their country. It also showed us the connection between clinical pharmacy and drug development. A good knowledge in the drug development process, allows us to properly monitor our patients for adverse drug events. It can also be said that the practice of clinical pharmacy is on its own, a continuous research which provides invaluable knowledge about drugs. As clinical pharmacists, we encounter side effects and adverse drug events in real time, thus making us indispensable in the drug development process, allowing us to improve drugs through our reports and observations. The lectures were truly time well spent. The lectures may have been difficult, but they were also eye openers as well as extremely informative and its value for us is immeasurable.
GOOD TO KNOW The brain itself cannot feel pain! While your brain might be the pain center when you cut your finger, the brain contains no pain receptors and cannot feel pain. Therefore, when tumors or cysts cause people to experience headaches, the pain is actually resulting from pressure on nerve tissue or blood vessels that surround the brain, not the brain itself. According to Chinese legend, the benefits of acupuncture were discovered when a soldier who had suffered from a stiff shoulder for many years was cured when an enemy arrow hit him in the leg! Botox was discovered in the fat of spoiled pork and was called botulism by the doctor who figured out a medicinal use for it. Babies are born without knee caps. They don’t appear until the child reaches 2-6 years of age. Babies always have blue eyes when they are born: Melanin and exposure to ultraviolet light are needed to bring out the true color of babies eyes. Until then, they all have blue eyes.
PHARMACIST’S DIGEST MAR 2014
16
FEATURE
Advancing Pharmacy Worldwide with Interested in working abroad? Probably interested to be an intern outside the Philippines? Or do you want to be active in forums regarding our own field and be up to-date with the upcoming events in the pharmacy society? This might be your way to discover what life has in store for you.
What is FIP? Founded in 1912, “FIP” or “International Pharmaceutical Federation” is a global federation of national associations of pharmacists and pharmaceutical scientists and is in official relations with the World Health Organization or WHO. Changes in pharmacy and emergence of pharmacy practice as a cornerstone of the medical profession have lead FIP to become globally visible for its advocacy on behalf of the role of the pharmacist in the provision of healthcare, while still maintaining its grounding in the pharmaceutical sciences. The 20th century might have been the century of physical sciences, but the 21st will be the century of life sciences. This is the mission and vision formulated by the FIP for its programs on 2020. Its vision is to be “Always present wherever and whenever decision makers discuss aspects of medicines on a global level”. Meanwhile, its mission is to “Improve global health by advancing pharmacy practice and science to enable better discovery, development, access to and safe use of appropriate, cost-effective, quality medicines worldwide”.
17
PHARMACIST’S DIGEST MAR 2014
FIP has three strategic objectives which includes: (1) to advance pharmacy practice in all setting,this is to emphasize the role of pharmacist in healthcare setting; (2) to advance the pharmaceutical setting to achieve continuous work and communication with pharmaceutical scientists; (3) to increase FIP’s role in reforming pharmacy and pharmaceutical sciences education in order have a quality standard for education for the development of the pharmacy practice in this present time and in the future. The FIP’s three strategic objectives cannot be achieved without well-designed approaches. The four Tactical Approaches: to build constructive partnerships, to increase visibility of FIP in the global environment, to increase revenues for FIP to accomplish its global mission, and to increase effective communication. These approaches define how FIP should achieve the three Strategic Objectives In conclusion, the light of the FIP vision is refracted through the prism of the FIP mission. The mission is, in turn, displayed in the spectrum of the three FIP strategic objectives and their achievement through the four FIP tactical approaches. With these strategic objectives and tactical approaches, coupled with vibrant organization and governance supported by committed member organizations, FIP should realize its Vision 2020.
FEATURE
What are the benefits of becoming a member of FIP? Some of the benefits of becoming a member includes: Access to FIP world congresses at a significantly reduced rate Access to FIP sections with focused programs and communications Access to world leaders in the pharmacy profession and pharmaceutical sciences Opportunities to meet international colleagues and exchange experiences, views and information Access to continuing education programmes Access to FIP Conference and symposium Chance to be an intern and experience pharmacy practice in other countries Opportunities to actively participate in discussion groups, workgroups and taskforces. You have newsletters and invitations for the international congress sent right at your own doorstep. To meet international colleagues and exchange experiences, views and information Access to continuing education programmes Access to FIP Conference and symposium Chance to be an intern and experience pharmacy practice in other countries Opportunities to actively participate in discussion groups, workgroups and taskforces. You have newsletters and invitations for the international congress sent right at your own doorstep.
Upcoming Programs and Activities: Every year FIP organizes the World Congress of Pharmacy and Pharmaceutical Sciences, were thousands of pharmacists meet, learn, share and exchange views. Probably you should mark these dates in your planner for some of the upcoming events in your waiting for you this year.
How much is the registration to be a member? Becoming a member depends on what field you want to actively participate in. If you register as a student, you will be automatically involved in the Young Pharmacy Graduate (YPG) and it comes as a free field in your membership. Other fields available are: Hospital Pharmacy, Industrial Pharmacy, Community Pharmacy, Pharmacy Information, Clinical Biology, Administrative Pharmacy, Military and Emergency Pharmacy and lastly, Laboratory and Medicinal Control. Students and recent graduates are entitled to a 50% discount on membership fees for up to 5 years after the first degree. If you choose 2 sections, it costs around 35 euros. Since we can still avail for the student discount, instead of paying 35 euros annually it will just be 25.50 euros (Php 1750) and enjoy the benefits for a year. Additional section cost around 16 euros (Php 985.13).
Interested stakeholders and the public are encouraged to visit https://www.fip.org/ for more information.
PHARMACIST’S DIGEST MAR 2014
18
ENTERTAINMENT
Summer Tips By Mary Jesna Sandoval
Less than a month from summer vacation and we are now experiencing Mister Sun’s fierceness way too much. These past few weeks’ temperature just makes want to go take a splash in a body of cool water somewhere. Some people can’t just help but be under the sun, especially during summertime when we have all the time (well, some of us!) to kick back and unwind from all the stress from the past 10 months at school. We just can’t contain ourselves too much that we tend to forget about how harmful sun can be, so here are some tips to follow to have awesome, worry free, sunny summer days.
Drink at least 8 glasses of water every day. These words aren’t really new to us, and it should be really taken seriously especially during summer. Summer’s hot weather makes us lose more water than we usually do on other days of the year, so it is very much important that we always rehydrate and replenish. Carry a bottle of water using a reusable plastic container with you every time you head out-let’s you save your health, money and the environment.
Wear pastel/cool colored clothing in light, breezy fabrics. It doesn’t take a genius to know that this can help you feel a lot cooler as it lets more air in, and efficiently deflects rather than absorbing the heat from the sun. Most patients experiencing heat stroke account it for the kind of clothing they are wearing which has a major contribution to elevating the body’s temperature.
Use sunscreen with SPF.
Another overused statement that most of us don’t follow. Some people think that the use of sunscreens is a vanity, but it is really an essential, especially that we live in a tropical archipelago where the sun’s heat rarely shies away. It prevents you from getting sun burnt skin and helps prevent skin cancer due to over exposure to the sun in the long run.
Maximize eating seasonal fruits and veggies. Most tropical fruits come only at a particular time of the year, so we should take advantage of its availability. Fruits in season during summer are very rich in vitamin C, which helps build up our immune system, armoring us on the upcoming rainy season.
Maintain proper personal hygiene. Good hygiene prevents summer diseases especially those that are infectious such as pink eye, fungal infections and skin problems such as prickly heat rash.
Follow these simple tips to make the most out of your summer and make it the best summer ever!
19
PHARMACIST’S DIGEST MAR 2014
Skin Care
by using Sunblock
By Lovely Anne T. Go
Sunblock
helps prevent the sun's ultraviolet (UV) radiation from reaching the skin. UV radiation, a known carcinogen, can cause harmful effects on the skin. The two types of UV radiation that can affect the skin are UVA and UVB that have both been linked to skin cancer and a weakening of the immune system. They also contribute to premature aging of the skin, cataracts (a condition that impairs eyesight) and cause skin color changes. UVA rays, which are not absorbed by the ozone layer, penetrate deep into the skin and contribute to premature aging. UVB rays, which are partially absorbed by the ozone layer, mostly affect the surface of the skin and are the primary cause of sunburn. All sunblocks have SPF (Sun Protection Factor) rating. The SPF rating indicates how long a sunscreen remains effective on the skin. A user can determine how long their sunblock will be effective by multiplying the SPF factor by the length of time it takes for him or her to suffer a burn without sunscreen. For instance, if he or she normally develops sunburn in 10 minutes without wearing a sunscreen, a sunscreen with an SPF of 15 will protect him or her for 150 minutes (10 minutes multiplied by the SPF of 15). The best sunblock varies from individual to individual. Broad spectrum sunblock is recommended with UVA and UVB protection, a SPF rating of at least 30, in a form that is gentle enough for daily use. Active ingredients of sunblock vary from manufacturer to manufacturer and can be divided into chemical versus physical agents. Chemical sunblocks work by absorbing the energy of UV radiation before it affects your skin. Physical sunblocks reflect or scatter UV radiation before it reaches your skin. Some sunblocks combine both chemical and physical sunblocks. The two types of physical sunblocks that are available are zinc oxide and titanium dioxide. Both provide broad spectrum UVA and UVB protection and are gentle enough for everyday use. Because these are physical blocking agents and not chemicals, they are especially useful for individuals with sensitive skin, as they rarely cause skin irritation. Most chemical sunblocks are composed of several active ingredients. This is because no single chemical ingredient blocks the entire UV spectrum (unlike physical sunblocks). Instead, most chemicals only block a narrow region of the UV spectrum. Therefore, by combining several chemicals, with each one blocking a different region of UV light, one can produce a sunblock that provides broad spectrum protection. The majority of chemical agents used in sunblock work in the UVB region. Only a few chemicals block the UVA region. Since UVA can also cause long-term skin injury, dermatologists at UCSF routinely recommends sunblocks that contain either a physical blocking agent (e.g. titanium dioxide or zinc oxide) or Avobenzone (also known as Parsol 1789). All sunscreens should be applied 15-20 minutes before sun exposure to allow a protective film to develop, then reapplied after water contact and sweating. Some sunblocks can lose effectiveness after two hours, so reapply frequently. The most common allergic reactions occur with sunscreens that contain PABA-based chemicals. If he or she develops a rash to a sunblock, check the label to see if PABA is an ingredient. Alternatively, try a titanium dioxide or zinc oxide containing sunblock as they rarely cause skin irritation and provide very good broad spectrum UV protection. Water resistant sunblocks are available for active individuals or those involved in water sports. It's important to check the label to ensure they say "water-resistant" or "very water-resistant." Waterresistant sunblock maintains the SPF level after 40 minutes of water immersion and very water-resistant sunblock maintains the SPF level after 80 minutes of water immersion Although sunscreen use helps minimize sun damage, no sunscreen completely blocks all wavelengths of UV light. Wearing sun protective clothing and avoiding sun exposure from 10 AM to 4p.m. will also help protect your skin from overexposure and minimize sun damage. References: Epstein,J. and Wang, S. (2014). Retrieved March 2, 2014 from The Skin Cancer Foundation, http://www.skincancer.org/prevention/uva-and-uvb/understanding-uva-and-uvb Sunscreens Explained. (2014). Retrieved March 2, 2014 from The Skin Cancer Foundation, http://www.skincancer.org/prevention/sun-protection/sunscreen/sunscreens-explained
ENTERTAINMENT
Safety for Beauty By Vangenique Nieves Caguglada
Cosmetics, we have been living very long enough relying on these products for over thousands of years that it is unthinkable for us to live without them. They are part of us, in the morning when we take a bath to getting ready for school, during classes or work, and even when we sleep. Today, cosmetics have a broad array of products, from a simple soap to a very sophisticated rich-colored makeup. However, along with its aesthetically pleasant effect, cosmetics also brought us detrimental effects. Studies have shown that not all cosmetics are safe . Some products contain traces of harmful chemicals like lead and mercury that accumulate in our body with long-term use. So how do we know if they’re safe?
There are many ways to keep us safe from defective and harmful cosmetics. A checklist would be helpful before you decide to purchase cosmetics.
: Safety Tips
Check the container for safety information, including hazard symbols.
Always read and follow directions carefully. Misuse of a product can lead to problems like rashes, burns or eye damage.
Most cosmetics contain preservatives. These important ingredients help keep germs from growing in the product. To make sure your cosmetics stay germ-free, follow these simple rules: Wash your hands before putting on makeup Do not share makeup Do not add water or saliva to dilute makeup Keep cosmetics in a dry area, away from direct heat and sunlight Do not use a cosmetic if it changes in smell, colour, or feel
To check if you are sensitive or allergic to something in the cosmetic, do a test, follow these instructions: Clean a small area of skin behind your ear or on the inside of your forearm. Apply a small amount of the cosmetic and allow it to dry. After 24 hours, wash the area gently with soap and water. The cosmetic should not be used any more if the area is red, itchy, burning or blistering.
If you think you've had an adverse reaction to a cosmetic, stop using the product. See a doctor for advice if the reaction looks irritated and lasts long.
Lastly, check the expiry dates of the products you are using and mark your calendars to keep you updated. Expired cosmetics do more harm than good.
CHECK THE LABEL FOR Aluminum Where: Deodorants, anti-perspirants Hazard: Linked to Alzheimer’s and brain disorders
Parabens Where: Make-up, moisturizers, shampoos Hazard: Linked to cancer, endocrine disruption, and reproductive toxicity
Phthalates Where: Perfume/ Parfum, deodorants, lotions Hazard: Headache, dizziness, asthma, allergies and cancer
Talc Where: Baby powders Hazard: Linked to ovarian cancer and respiratory problems
Triclosan Where: Toothpaste, cleansers, antiperspirants Hazard: Suspected endocrine disrupters and may contribute to antibiotic resistance
Siloxanes Where: Moisturizers, make-up, hair products Hazard: Interfere with hormone functions and damage to the liver *Heavy metals such as lead, mercury, cadmium, arsenic, nickel and more are not listed because they are considered contaminants, not ingredients. They are linked to cancer, brain disorders, hormone disruptions and respiratory toxins.
It is important to look good, to feel confident. However, safety is a priority. So, always remember: “Safety before beauty!” REFERENCES: Cosmetics and safety. (2014) http://www.healthycanadians.gc.ca/consumer-consommation/products-produits/safety-securite-eng.php
PHARMACIST’S DIGEST MAR 2014
20
ENTERTAINMENT
combination drug made up of amlodipine besylate/ atorvastatin calcium
5
brand name of Atorvastatin
6
Brand name of Conjugated Estrogen
7
generic name of trileptal
9
generic name of Celebrex
10
generic name of dalmane
11
generic name for Pravachol
13
Brand name of Metformin ER 1000mg (OSM)
14
generic name of Keppra
18
generic name of maxidex
20
brand name of clarithromycin
21
brand name of ceftriaxone
22
Brand name of Hydroxyzine Chloride
23
brand name of metaxalone
2
3
4
5 6
7
8
9
10
11
uzzle
3
Crossword
1
ACROSS
12
13
DOWN
14
8
generic name of Elavil
12
brand name of tamsulosin
13
inhaler form of Fluticasone
15 16
brand name of quetiapine brand name of diclofenac Potassium
20
17
generic name of Foradil
22
19
Combination drug made up of dipyridamole and aspirin
21
23
Flurazepam Pravastatin
10 11
Oxcarbazepine Celecoxib
7 9
Lipitor Premarin
5 6
Caduet
3
ANSWERS: Across
Seroquel Cathaflam
15 16
Flomax Flovent
12 13
Amitriptyline
8
Lopressor
5
Clonidine Flonase
3 4
Nexium Asmanex
1 2
Down PHARMACIST’S DIGEST MAR 2014
Fortamet Levetiracitam
21
13 14
Brand name of metoprolol Tartrate
19
Formoterol Aggrenox
5
18
17
17 19
Brand name of Fluticasone Nasal Spray
16
Dexamethasone Biaxin
4
15
18 20
generic name of Catapres
Rocephin Atarax
inhaler form of mometasone
3
Skelaxin
2
21 22
Brand name of esomeprazole
23
1
PHOTOS
. . . g n i r u t a e F
BS Clinical Pharmaceutical Sciences Batch 2013-2014
PHARMACIST’S DIGEST MAR 2014
22
PHOTOS
Helping the Yolanda victims
23
PHARMACIST’S DIGEST MAR 2014
PHOTOS
with the professors from Jember University in Indonesia
2014 Clinical Pharmacy Summit
PHARMACIST’S DIGEST MAR 2014
24
Quodc i buses tal i i s , al i i ses tvenenum Whati sf o o dt os o mei spo i s o nt oo t he r s .
Uni ver si t yofSanCar l osSchoolofHeal t hCar ePr of essi ons Depar t mentofPhar macySt udentPubl i cat i on