ITK April/May 2015 - Edition 41 by Gold Cross Products & Services

ISSUE #41 : APRIL/MAY 2015

P r a c t i c a l I n f o r m at i o n f o r T o d a y ’ s Co m m u n i t y P h a r m a c i s t

IN THE KNOW

• Cherry picking the best from around the world • CPD – Cold Sores • Professional Review

• Down to Business • Consistent Customer Service • Training and Education

MAXIGESIC DELIVERS ®

MAXIMUM DOSAGE HARTLEY ATKINSON PHARMACOLOGIST Inventor of MAXIGESIC®

MAKE THE SWITCH TO

MAXIGESIC

速

DOUBLE ACTION PAIN RELIEF WITHOUT CODEINE

MAXIGESIC® is the only combina maximum recommended daily OT and Ibuprofen 1200mg, if requir }

MAXIGESIC® DELIVERS MORE MAXIGESIC® delivers 2.5 times more combined Paracetamol and Ibuprofen than Nuromol®** at maximum recommended daily dosage, if required*

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PROVEN EFFECTIVENESS Clinically proven to reduce pain levels by at least 32% more than a full daily OTC dose of either Paracetamol or Ibuprofen alone1.

}

SIMPLE, FLEXIBLE DOSAGE REGIMEN 1–2 tablets up to 4 times per day, if required, offers flexibility and control in managing daily pain

}

UNIQUE COMBINATION Available only in pharmacies, the patented MAXIGESIC® combination cannot be replicated by combining individual OTC products. * 2 tablets of MAXIGESIC® taken every 6 hours over a 24 hour period ** Nuromol® is a registered trademark of Reckitt Benckiser Group PLC

Please review the full Product Information before recommending, available at www.maxigesic.com.au References: 1. Merry, A. F., Gibbs, R. D., Edwards, J., Ting, G. S., Frampton, C., Davies, E. and Anderson, B. J. (2010). “Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial” British Journal of Anaesthesia 104(1): 80-88. Result achieved in a trial of post-operative pain relief after removal of 1–4 wisdom teeth using Maxigesic® compared with Paracetamol 4000mg or Ibuprofen 1200mg alone per day in four divided doses. Maxigesic® film coated tablets (Paracetamol 500mg and Ibuprofen 150mg; 10s, 16s and 30s) are a Pharmacist Only (S3) Medicine for the temporary relief of pain and reduction of fever. The usual dosage for Adults and Children over 12 years is 1-2 tablets taken every 6 hours with a full glass of water, as required, up to a maximum of 8 tablets in 24 hours. Patients should not take more than 8 tablets in a 24 hour period. Incorrect use can be harmful. Do not use in children under 12 years or if patients have kidney disease. Do not use if patients have asthma or a stomach ulcer. Do not combine with any other Paracetamol or Ibuprofen containing medicines. Patent No. 2005260243.

ation analgesic that delivers the TC dose of Paracetamol 4000mg * red. HARTLEY ATKINSON,

Pharmacologist and Inventor of MAXIGESIC速

HELPS KILL BACTERIA & RELIEVES DURING THE DAY Betadine Sore Throat Facts: Differences between Betadine Sore Throat Gargle & Lozenges Betadine Ready to Use Sore Throat Gargle

• Sore throats can be caused by bacteria which can be killed by Betadine Sore Throat Gargle within 30 seconds, in laboratory studies

• Aids in the treatment of sore throats • Contains a powerful active ingredient, povidone-iodine How to use: ✓ Pour to the measure cap fill line (15mL) ✓ Gargle for 30 seconds, do not swallow ✓ Repeat every 3 to 4 hours, as required ✓ Store below 25°C

Do not use: 7 if you are hypersensitive to iodine 7 if you are pregnant or breast feeding 7 if the cap seal is broken

AD-BITK1-215 DEC 2014

Caution:

! If irritation, redness or swelling occurs, stop using

! See a doctor, if you have a severe sore

Betadine Sore Throat Lozenges • Helps to kill the bacteria which can cause sore throat and mouth infections • Helps provide fast, soothing and effective relief from the discomfort of sore throats • Iodine free, available in great tasting honey & lemon, menthol & eucalyptus and orange How to use: ✓ Dissolve 1 lozenge slowly in the mouth ✓ Every 2 to 3 hours, as required ✓ Store below 30°C

Caution:

! If symptoms persist, consult your doctor ! Keep all medicines out of reach of children

throat with fever, headache, nausea or vomiting, or your sore throat lasts for more than two days

Active ingredients: • 10mg/mL povidone-iodine equivalent to 1mg/mL available iodine • Also contains sodium saccharin and ethanol

Do not use: 7 for children under 6 years 7 if the foil seal is broken

Active ingredients: • Each lozenge contains 1.2mg/mL dichlorobenzyl alcohol & 600 μg amylmetacresol • Also contains sugar

For more information, contact the Sanofi healthline on 1800 802 777. Always read the label. Use only as directed. If symptoms persist, consult your healthcare professional. Betadine is a registered trademark under licence from Mundipharma B. V. Netherlands.

ASMI 24387-0115

CONTENTS

APP

After Hours 54 Anzac day

Category Review 4 A Fresh New Flavour 30 Cold sores 32 Food Allergies Explained

Down to Business 12 Managing Anaphylaxis 16 Optimisation of Fertility and Pregnancy Outcome Through Nutrition 22 Consistent Customer Service 24 The Patient with Food Allergy and Anaphylaxis 26 Having a Team That Works 28 Know and love your top 100 customers 38 A Focus on QPIP

Guild News 3 Cherry Picking the Best From Around the World

Professional Review BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

As this edition of ITK goes to print, APP 2015 is being held on the Gold Coast, with delegates enjoying an event punctuated by an outstanding line up of speakers in a terrific venue. The theme and 25 year milestone for this year’s APP is testament to the event that continues to grow from strength to strength. The planes have landed, cars heading north and south as the excitement and bustle of APP is NOW! We will feature a summary of APP in our next edition of ITK, suffice to say in advance that the event was a resounding success, thank you one and all. Our continuing professional development module, company news and updates and after hours feature

18 Betadine launches on-the-go solution for relief of sore throats 34 How to Achieve the Best Deal on your Retail Lease

Regulars 46 What’s New and Company News 49 Business Directory 51 Product Spotlight 53 60 Seconds with 55 Classifieds 56 Health Calendar

Special Feature 6 Cold Sores

Training and Education 37 Wagner MSM 40 Getting Schooled on Fish Oil – Purity and Quality 41 FAB IRON, an Iron Supplement for Growing Children 42 Murine Launches New Eye Mist Spray 43 Achieving Dispensary Efficiency 44 Break Free From Medically Diagnosed IBS Symptoms 45 Betadine Sore Throat Range

are must read components of this edition

of ITK. We look forward to meeting at APP. Thank you for your ongoing support of this publication, readers, contributors and media partners alike. Best Regards, Sean Tunny Editor

BROUGHT TO YOU BY:

PLEASE USE THIS PUBLICATION TO KEEP YOUR PHARMACY IN THE KNOW. EDITOR: Sean Tunny 0457 029 052 sean.tunny@goldx.com.au DESIGN: Megan Hibberd 0408 452 133 www.artbymegan.com.au PRINT & DISTRIBUTION: APN Print 1300 134 628 www.apnprint.com.au PUBLISHED BY: Gold Cross Products & Services. PO Box 505 Spring Hill Qld 4004. Contact Jessica O’Connor – Email: jessica.oconnor@goldx.com.au. In The Know is produced for the information of Australian Pharmacists. The presence of the logo of the Pharmacy Guild does not constitute endorsement of a product. The Pharmacy Guild of Australia accepts no responsibility for claims made by advertisers. Opinions and views expressed in articles do not necessarily reflect those of Gold Cross.

NEWS FROM THE GUILD PRESIDENT

Cherry picking the best from around the world George Tambassis National President of The Pharmacy Guild of Australia

While I would be the first to argue that Australia has the best system of community pharmacy in the world, comparable countries can still teach us a thing or two about making improvements.

The Guild aims to enhance the use of community pharmacy and pharmacists in the health system to bring Australia in-line with the best aspects of pharmacy in countries such as the United Kingdom, New Zealand, Canada, the US, Ireland, South Africa and Portugal. Around the world, governments, hospitals, health insurers and health professionals, including GPs, are increasingly recognising that better use of community pharmacies takes pressure off the wider health system and provides faster, better and cheaper access to treatments and advice for patients.

“Consumers, doctors, pharmacists and governments recognise it is not a good use of GPs’ time or skills to have GP surgeries and emergency departments clogged up by patients who can be readily treated by pharmacists.”

Also in the US, pharmacists diagnose and treat minor throat infections after a simple saliva test.

often resulted in a decline in the total number of consultations and prescribing for minor ailments at general practices’.

For example, the provision of immunisation services involving pharmacists trained and certified to administer vaccines, utilising agreed protocols and collaborative arrangements, is now well accepted in countries such as the US, the UK, Ireland and Portugal.

In the UK, the Royal College of General Practitioners is working with the National Health Service and the Royal Pharmaceutical Society (RPS) to publicly encourage patients to make pharmacy their first port of call for treating minor ailments such as coughs and colds, and in the US, Canada and NZ governments fund pharmacies to provide vaccinations such as influenza, measles and hepatitis as part of an immunisation program.

Consumers, doctors, pharmacists and governments recognise it is not a good use of GPs’ time or skills to have GP surgeries and emergency departments clogged up by patients who can be readily treated by pharmacists. Nor is it an efficient use of the finite resources to run the public health system.

In particular, US pharmacists are now authorised to administer vaccines in all 50 States and, as with the UK and Canada, are now providing a significant and growing proportion of all immunisations.

A recent report to the Guild from respected consultancy Deloitte Access Economics also supports these proposals, stating: ‘Evidence from the UK suggests that the introduction of pharmacy-based minor ailment schemes

However, Australia lags behind some countries, including the UK, New Zealand and the US, in recognising and supporting the role that pharmacies and their staff can play in delivering better patient-centred care and more cost-effective outcomes.

We’ve seen the role of community pharmacy enhanced across the world. GPs in these countries are also supportive of these moves. At a time of great pressure on Medicare and the current primary health care model in Australia, it’s time to realise the full potential of community pharmacy in Australia.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

THE FRESHEST NEW MINT, ISN’T A MINT.

A FRESH NEW FLAVOUR Australia’s favourite brand of jellybeans, Glucogel, is about to launch a brand new mint flavour to its range, making it the first mint jellybean available in Australia. Trevor Clarkin, General Manager of Gold Cross Products and Services outlined a little more about why this highly anticipated jellybean is destined to be a crowd pleaser.

EDITOR: It’s been ten years since you last

EDITOR: What is involved in producing

EDITOR: How will this new flavour impact

introduced a new flavour. Why did it take

a new flavour?

your current range?

so long?

TREVOR: We worked in consultation

TREVOR: It’s a great addition because

TREVOR: Confectionary technology and

with Nestlé – one of the world’s leading

it provides consumers with not just

formulations are constantly evolving

confectionery companies. They have very

a completely different flavour, but a new

and we wanted to capitalise on the new

stringent manufacturing processes that

category as well. Plus it’s likely to attract

developments that are arising in the

ensure we produce exactly the right colour,

a new market that aren’t traditionally

industry regarding taste, flavour and

texture, consistency and flavour to the

jellybean consumers, but are after a fresh

quality.

highest food standards available.

minty taste.

In particular, the advancement of natural

It’s actually a very complex process and a

Following on from our success in

colours was something we wanted to

lot of people are involved – technologists,

introducing a natural colour for the mint

incorporate into our new jellybean flavour.

scientists, engineers, food chemists,

flavour, we’ll also be transitioning our

So it took a little while because we wanted

confectioners and nutritionists – and it

current range over to natural colours in

to make sure that when we did introduce

can take months to get the product just

the next 6 months, so that we can maintain

a new flavour, it was produced using

right. As Australia’s most popular and best

that consistent level of quality across

natural colours, and it would be of the

tasting jellybean, it was definitely in our

our range.

highest quality.

best interest to ensure that our mint flavour

EDITOR: What made you decide on mint? TREVOR: When you look at the confectionary category, mint is a dominant trend and is in a rapid growth phase at the moment. So we wanted to create a jellybean that would offer consumers the fresh taste of mint, but in a completely different form.

upheld our strict standards of taste, quality and safety. And that’s just the process involved in developing a new flavour. What a lot of people don’t realise is the amount of time it takes to produce the humble jellybean: currently it takes about three weeks.

EDITOR: How do you think the new mint jellybean will be received in the market? TREVOR: You can’t underestimate the novelty factor. As the only mint jellybean in Australia, people will definitely be intrigued. As for the taste, we’ve conducted several taste test panels in conjunction with Nestlé, and the acceptance of the flavour and the concept has been extremely high.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

EDITOR: Who is the mint jellybean

Users can also access this game through

targeted at?

a dedicated microsite page.

TREVOR: The Glucogel jellybean market has

Plus we officially launched at the

primarily consisted of women aged 35–55

Australian Professional Pharmacy

who are the primary purchasers of products

Conference on the Gold Coast in March

in a pharmacy. However, the broad appeal

with some fun giveaways and a few

of this mint category will certainly capture

surprises to support the market launch.

other segments of the market.

EDITOR: Following on the success of your

EDITOR: How will you launch the

new mint flavour, do you think there will

new flavour?

be any more flavours on the horizon?

TREVOR: Our sales team, Lightning

TREVOR: We’re always open to new

Brokers, has worked hard to produce

flavours. The key for us is ensuring that

a range of point-of-sale materials that will

we maintain a high level of quality. But by

generate excitement and awareness of the

partnering with Nestle, we have access to

new brand. In-store materials will include

their world-leading knowledge, technology

Glucojel Mint counter display units, Glucojel

and expertise – so anything is possible.

Mint dispensers; hang strips and a special introductory deal for pharmacies. We are also launching a consumer social media

EDITOR: And finally, what is your favourite Glucogel flavour?

campaign through our Glucojel Facebook

TREVOR: I’ve always been a huge orange

page where Glucojel customers can play

fan. But I have to say this new mint flavour

an engaging game, which will also aim to

is definitely swaying me.

create awareness of the new Mint Flavour.

Order from your preferred wholesaler Product

70gm Glucogel Mint x 36

API

948705

Symbion

184284

Sigma

173880

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

CONTINUING PROFESSIONAL DEVELOPMENT

Cold Sores Tackling the Tingle! Tim Roberts Professional Development Manager, Pharmacy Guild of Australia (QLD) B.Pharm (Hons), AACPA, DipBusMgt

Around 90% of adults have herpes simplex antibodies in their bloodstream, meaning that they have usually been infected with the virus at some point in their lifetime1. Approximately 1/3rd of infected people experience ‘cold sores’ – non-genital skin lesions caused by the herpes simplex virus type-1 (HSV1)1,2.

Learning Objectives After reading this article, the learner should be able to: •• Recognize the pathogenesis of cold sores •• Identify the signs and symptoms associated with a cold sore outbreak •• Identify the high risk groups who can be affected by cold sores •• Describe appropriate pharmacological treatment strategies for managing cold sore outbreaks •• Recognize the place in therapy of non-pharmacological and complimentary medicines for cold sores

Competency standards addressed (as defined by the National Competency Standards Framework for Pharmacists in Australia): 6.1, 6.2, 7.1

Accreditation number: G2014045 This activity has been accredited for 0.5 hours of Group 1 CPD (or 0.5 CPD credits) suitable for inclusion in an individual pharmacist’s CPD plan which can be converted to 0.5 hours of Group 2 CPD (or 1.0 CPD credits) upon successful completion of relevant assessment activities.

With the key to management of cold sores being early recognition and treatment, the ease-of-access to medicines and professional advice at community pharmacies leave pharmacists ideally placed to and help patients break the cold sore cycle!

Pathogenesis, signs and symptoms HSV-1, also known as herpes labialis, is commonly contracted during childhood or adolescence. HSV-1 transmission is typically via non-sexual skin contact in the young, however the spread can increase with sexual contact throughout adolescence and adulthood. Typical transmission mechanisms can include sharing of towels, utensils, kissing or other mechanisms of skin to skin contact with an infected person. Herpes simplex virus type-2 (HSV-2), the typical cause of genital herpes can also cause cold sores if direct skin to skin contact occurs (however these are less likely to become recurrent).2 Cold sore outbreaks can be divided into initial primary infections and recurrent infections (occurring subsequently). Manifestation of cold sores can occur spontaneously, or it can be brought about by exposure to UV light (eg. excessive sun exposure in summer)3. Primary infections typically show symptoms between 2 and 20 days after contact with the virus. Primary or initial episodes of cold sores mainly occur in younger children aged 1–5 years, and are quite often asymptomatic – however sometimes may

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

cause small (but painful) mouth ulcers (acute gingivostomatitis) with swollen gums and accompanied by fever and enlarged lymph nodes4. After recovery from a primary infection, the virus is not cleared from the body, but it is transported to the trigeminal ganglion where it can lie dormant until reactivation.3 Recurrent (or subsequent) outbreaks of cold sores often begin with a localised burning, tingling, pain or itching a few hours before (or up to 24 hours before) lesions appear – these signs are referred to as prodrome, and it is important to note that not all patients experience this. Lesions typically appear as a crop of blisters, grouped in an area around the size of a 5 cent coin. The lesions quickly dry to form a scab (which can often be unsightly) which then heals in approximately 7-10 days, typically without any permanent scarring or loss of sensation3. Cold sores are most infectious when the lesions are newly formed in the first 1-2 days from appearance. This is the best time to have a swap taken if laboratory diagnosis is required, as once lesions dry out they are less infectious and HSV is less present at the site3. Cold sore lesions can become infected with bacteria (presenting with localized honey-coloured crusting/weeping) and some people who suffer from atopic dermatitis can develop eczema herpeticum (a severe rash with numerous blisters/scabs which may erupt on the face or other parts of the body) – referral to a general practitioner is indicated in these instances4.

CONTINUING PROFESSIONAL DEVELOPMENT

“Typical transmission mechanisms can include sharing of towels, utensils, kissing or other mechanisms of skin to skin contact with an infected person.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

CONTINUING PROFESSIONAL DEVELOPMENT

duration and healing time (if applied at the first sign of a lesion)6. Idoxuridine 0.5% (in combination with lignocaine 2%) is considered to be less effective than topical acyclovir and penciclovir6. The clinical efficacy of topical iodine has not been determined in the treatment of herpes labialis3.

Risk Factors and High Risk Groups

“There are a number of available management strategies, with varying levels of effectiveness ranging from simple riskmanagement strategies to pharmacological therapies.”

Most people affected by cold sores may experience up to 2-3 outbreaks per year, however for others reoccurrence may be significantly more frequent3. When cold sores appear more than 3 times per year, a referral to a general practitioner for further investigation is warranted. There are a number of risk factors associated with the frequent recurrence of cold sores, including3,4;

•• •• •• •• ••

Immunocompromised patients Atopic eczema Stress and fatigue High sun exposure Trauma to the area (i.e dry/chapped lips, dental treatment) •• Sexual behaviour Patients who are immunocompromised (particularly HIV patients and chemotherapy patients) are at a higher risk of complications from HSV-1. In HIV-positive individuals with a low CD4 count (<100 x 106/L) herpes lesions (including cold sores) can be persistent rather than self-limiting and HIV-related immunosuppression generally means that there is a poorer response to antiviral treatments (topical and oral)5.

Management Strategies The appearance of cold sores can be unsightly, and in most cases are uncomfortable – so most patients seeking treatment from community pharmacies are interested in finding effective remedies that minimize discomfort, reduce the size/visibility of lesions and reduce the timeframe that the lesion is present. There are a number of available management strategies, with varying levels of effectiveness ranging from simple riskmanagement strategies to pharmacological therapies.

Traditional Pharmacotherapy •• Topical agents: Both aciclovir (1%) and penciclovir (5%) are commercially available topical agents for the treatment of mild herpes simplex skin infections, with modest efficacy in reducing pain

Aciclovir is recommended to be applied at the first sign of a lesion (during the prodromal symptoms if possible) and re-applied every 4 hours while awake (at least 5 times per day). Penciclovir is also most effective if taken at the first sign of a lesion (or during prodromal symptoms) and re-applied every 2 hours (at least 6 times per day). The recommended course of treatment with this 4-5 days for acyclovir and 4 days for penciclovir6.

•• Oral Therapies: Single-dose oral famciclovir (1500mg) treatment has similar efficacy to topical aciclovir (1%) and penciclovir (5%), it has been found to reduce healing time of lesions by an average of 1.8 days (compared to placebo)7. However, as topical antivirals require frequent reapplication (every 2 to 4 hours), single-dose oral regimens may be a preferred option as a convenient alternative with a marked improvement in patient adherence. Oral famciclovir is most effective when taken within the first few hours of the first sign(s) of an outbreak (during prodromal symptoms, as per topical antivirals). Treatment initiated greater than 24 hours after the onset of symptoms may have limited efficacy7.

Complementary Medicines There are a number of herbal and complementary medicine preparations marketed for the prevention and relief of cold sore symptoms, however there is limited reliable clinical evidence to support their use. Lysine and zinc supplements are commonly available and recommended, while there may be a correlation between frequent cold sore outbreaks and zinc deficiency (warranting zinc supplementation), there is very little evidence to support that regular use of lysine supplements can prevent outbreaks2, 3.

References 1. Better Health Network. Fact Sheet: Cold Sores. Victorian Department of Health. 2015. Accessed from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/ Cold_sores 2. Cernick C, Gallina K, Brodell R. The Treatment of Herpes Simplex Infections: An Evidence-Based Review. Arch Intern Med. 2008; 168(11): 1137-1144 3. Australian HSV Management Forum. Managing Oral Herpes (online). 2011. Accessed from: http://ahmf.squarespace.com/storage/Managing%20Oral%20Herpes_final.pdf 4. New Zealand Dermatological Society Inc. DermNet NZ – Herpes Simplex (online). 2014. Accessed from: http://www.dermnetnz.org/viral/herpes-simplex.html 5. Australian HSV Management Forum. HSV in HIV Infected Individuals (online). 2011. Accessed from: http://ahmf.squarespace.com/storage/HSV%20in%20HIV%20Infected%20 Individuals_final.pdf 6. Antivirals (skin) [updated Jan 2015]. In: AMH [Internet]. Adelaide: Australian Medicines Handbook Pty Ltd.; 2015 Jan. Accessed 2015 Jan 17 <www.amh.net.au>. 7. Spruance S, Aoki FY, Tyring S, et al. Short-course therapy for recurrent genital herpes and herpes labialis. The Journal of Family Practice. 2007; 56(1): 30-36 GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

CONTINUING PROFESSIONAL DEVELOPMENT

Non pharmacological strategies Hydrocolloid cold sore patches applied to the site of lesions may be an effective mechanism of obscuring the visibility of lesions, they may also minimize the risk of secondary bacterial infection and promote wound healing3,7. If triggers for cold sore outbreaks such as dry/ chapped lips or excess sun exposure have been identified as precipitating factors, taking steps to minimize these risks such as lip moisturizers and SPF 15+ lip sunscreens may be trialled.

Tailoring Solutions With the ease-of-access associated with community pharmacy and the key to successful management of cold sore outbreaks being hasty action at the first sign of symptoms, community pharmacy is well placed placed to support customers seeking tailored solutions for managing their cold sores! The key to providing tailored solutions for management is helping patients better understand the mechanisms of cold sore outbreaks and providing a realistic expectation of the outcomes associated with the various treatments available. Some key points for providing the best solutions to cold sore affected patients are;

•• Determine the timeframe for the first instance of symptoms when patients are presenting with cold sore symptoms, and explain how this can affect treatment strategies

•• Educate patients who suffer from cold sore outbreaks to become aware of the prodromal symptoms associated with an upcoming outbreak and how to act quickly with appropriate treatment(s).

•• Identify potential trigger points or risk factors affecting cold sore outbreaks in patients and suggest appropriate steps to minimize these factors.

•• Recognize patients in high-risk groups who might be susceptible to complications from cold sore outbreaks or patients who have frequently recurring cold sore outbreaks and refer to general practitioners.

•• Explore and address the key concerns of patients, if cosmetic appearance of lesions is a significant issue consider the use of hydrocolloid cold sore patches in addition to other appropriate pharmacological therapy to obscure the visibility of outbreaks.

ASSESSMENT QUESTIONS The assessment questions below can be found at the Guild Pharmacy Academy myCPD e-learning platform. Login or register at: www.mycpd.org.au

question 1

question 4

Which of the following statements regarding the pathogenesis of cold sores is incorrect?

Which of the following treatment strategies would be most appropriate for a patient who has 1-2 outbreaks of cold sores per year and is currently experiencing prodromal symptoms?

a. The primary cause of cold sores is the HSV-1 virus b. HSV-2 virus (the typical cause of genital herpes) may also cause cold sores if direct skin to skin contact occurs c. Once a cold sore outbreak has cleared, HSV-1 virus lays dormant in the tissue of the lip d. Primary infections typically show symptoms 2-20 days after first contact with the virus

a. Apply acyclovir 1% topical cream to the affected area 3-4 times daily for 4 days b. Apply penciclovir 5% topical cream to the affected area every hour for 5 days c. Take a single dose of 500mg oral famciclovir d. Take a single dose of 1500mg oral famciclovir

question 2

question 5

Which of the following are experienced during the prodromal stage of symptoms in a cold sore outbreak

Which of the following statements is correct, regarding complimentary medicines and non-pharmacological treatment strategies for cold sores?

a. Appearance of small, fluid filled lesions on the lips and gums b. Ulceration of the lip c. Localized tingling, burning, itching or pain d. Drying out of lesions, forming a scab

question 3 Which of the following patients would be at the highest risk of experiencing complications arising from a cold sore outbreak

a. There is evidence that long-term lysine supplementation is beneficial in preventing cold sore outbreaks b. Hydrocolloid patches are as effective as antiviral treatments when applied during the prodromal symptoms stage c. Zinc supplementation is warranted in all patients to reduce the frequency of cold sore outbreaks d. Hydrocolloid patches on cold sore lesions promote wound healing and may minimize the risk of a secondary bacterial infection

a. A patient who has high levels of emotional stress b. A patient diagnosed with Human Immunodeficiency Virus (HIV) c. A patient who spends an excessive time in the sun, often getting sunburnt lips d. A patient using methotrexate for rheumatoid arthritis treatment

So get out there and help your patients tackle the tingle with cold sores!

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

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PBS Information: Authority Required. Refer to PBS Schedule for full authority information. BEFORE PRESCRIBING, PLEASE REVIEW APPROVED PRODUCT INFORMATION AVAILABLE ON REQUEST FROM ALPHAPHARM ON 1800 274 276 OR www.ebs.tga.gov.au MINIMUM PRODUCT INFORMATION EpiPen® Adrenaline Auto-Injector 0.3 mg / 0.3 mL EpiPen®Jr. Adrenaline Auto-Injector 0.15 mg / 0.3 mL. The following are not a complete listing: Indication: For the emergency treatment of anaphylaxis (acute severe allergic reaction) due to insect stings or bites, foods, drugs or other allergens. Contraindications: Contraindications are relative, as this product is intended for use in life-threatening emergencies. Certain arrhythmias, cerebral arteriosclerosis, vasopressor drug contraindication, shock (except anaphylactic shock), certain types of general anaesthesia. Precautions: Sulfite allergy, intravenous administration, ventricular fibrillation, prefibrillatory rhythm, tachycardia, myocardial infarction, cardiovascular disease, organic heart disease, cardiac dilation, cerebral arteriosclerosis, prostatic hypertrophy, elderly, individuals with diabetes, hypertension, narrow angle glaucoma, hyperthyroidism, organic brain damage, psychoneurosis, phenothiazine-induced circulatory collapse, Parkinsonism. Avoid injection into hands, feet, ears, nose, buttocks, genitalia. Use in Pregnancy: Pregnancy Category A. Excreted in breast milk. Use with caution when maternal blood pressure is in excess of 130/80. Interactions: CNS medicines, alpha and beta adrenergic blockers, some general anaesthetics, hypoglycaemic agents. Adverse Effects: Anxiety, restlessness, tachycardia, respiratory difficulty, tremor, weakness, dizziness, headache, dyspnoea, cold extremities, pallor, sweating, nausea, vomiting, sleeplessness, hallucinations, flushing of face and skin. Psychomotor agitation, disorientation, impaired memory, potentially fatal ventricular arrhythmias, severe hypertension which may lead to cerebral haemorrhage and pulmonary oedema. Angina may occur in patients with CAD. Dosage: Single intramuscular injection into anterolateral aspect of thigh, repeat as directed if symptoms recur or have not subsided. Adults > 30 kg: EpiPen® Auto-Injector (0.3 mg adrenaline) Children 15–30 kg: EpiPen®Jr. Auto-Injector (0.15 mg adrenaline). The prescribing physician may choose to prescribe more or less than this amount; please refer to relevant guidelines. References: 1. Australian Register of Therapeutic Goods (ARTG) EpiPen® and EpiPen® Jr registration, 20/08/1993. Available at https://www.ebs.tga.gov.au/ accessed July 2014. 2. Pharmaceutical Benefits Schedule Item Reports http://medicarestatistics.humanservices.gov.au/statistics/pbs_item. jsp (items 3408J, 8697R, 3409K, 8698T). Accessed February 2015. 3. Pharmaceutical Benefits Scheme. Adrenaline Auto-Injectors. Available at www.pbs.gov.au/medicine/item/8697R-8698T. Accessed February 2015. 4. EpiClub ®, www.epiclub.com.au accessed July 2014. 5. ASCIA Action Plan for Anaphylaxis. Available at http://www.allergy.org.au/health-professionals/anaphylaxis-resources/ascia-action-plan-foranaphylaxis accessed July 2014. 6. ASCIA: Guidelines for Adrenaline Autoinjector Prescription 2012. Available at http://www.allergy.org.au/ images/stories/anaphylaxis/2012/ASCIA_Guidelines_adrenaline_autoinjector_script_2012.pdf accessed July 2014. EpiPen ® is a registered trademark of Mylan, Inc. EpiPen ® and EpiPen ® Jr. are distributed in Australia by Alphapharm Pty. Limited. ABN 93 002 359 739, Level 1, 30 The Bond, 30–34 Hickson Road, Millers Point, NSW, 2000. Phone: 1800 274 276, www.alphapharm.com.au inCeptiv ALP0653 Feb2015

down to business

Managing anaphylaxis: Pharmacists have a key role in education Dr Raymond Mullins

A/Prof Richard Loh

Ms Sandra Vale

Australasian Society of Clinical Immunology and Allergy

Allergies are one of the fastest growing chronic diseases in Australia. Anaphylaxis, particularly cases related to food allergy, continues to increase with 4-fold increases in hospital-related anaphylaxis admissions over the last 20 years1.

While anaphylaxis may result from exposure to medication, insect stings or less common triggers (e.g. natural latex), the major strategies for avoidance focus on food allergy due its relatively high prevalence in childhood (10% in infants aged 12 months based on challenge studies2; an estimated 4–8% in those aged less than 5 years and 2% in adults3) and high rates of accidental exposure, particularly in school and childcare settings. The majority of children will outgrow their food allergy; however, allergy to peanuts, tree nuts, sesame seeds and seafood (and occasionally other triggers) usually persists into adulthood4,1, where the risk of fatal

anaphylaxis is more common compared to other age groups. In some cases, allergy to egg and cow’s milk may not resolve until early adulthood4,5. While risk factors are starting to emerge from epidemiological studies, clear interventions to prevent the development of allergic diseases are currently lacking. Management thus centres on identifying and avoiding known triggers and developing an emergency action plan (ASCIA Action Plan) if accidental exposure occurs. Since pharmacies are a frequent source of first contact for health advice, pharmacists have an important role to play

Signs and symptoms of mild or moderate reactions

Signs and symptoms of anaphylaxis

•• Swelling of lips, face, eyes

•• •• •• ••

•• Hives or welts •• Tingling mouth •• Abdominal pain, vomiting (these are signs of a severe allergic reaction to insect stings)

Difficult/noisy breathing Swelling of tongue Swelling/tightness in throat Difficulty talking and/or hoarse voice •• Wheeze or persistent cough •• Persistent dizziness or collapse •• Pale and floppy (young children)

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

in patient education, in where best to obtain evidence-based investigation and management advice. As patients occasionally present to pharmacies with acute allergic reactions, pharmacists and their staff should know how to recognise an allergic reaction, including anaphylaxis, (Box 1) and know what treatment to provide, including at times administering an adrenaline autoinjector. Having a general ASCIA Action Plan for Anaphylaxis (orange version) on display may assist staff in responding appropriately (available from www.allergy.org.au). Allergic reactions (including anaphylaxis) are common; however the risk of fatal anaphylaxis remains very low6. Nonetheless, a number of risk factors have been identified including age (most fatalities occur in teenagers or young adults), location (most episodes occur when eating away from home), allergic triggers (peanut and tree nuts more commonly than other triggers), co-morbidity (most have asthma) and treatment-related factors (including delayed or no administration of adrenaline or upright posture during anaphylaxis7-10). Pharmacists can assist patients to optimally manage their risk by ensuring their asthma is well controlled and provide education when dispensing prescribed adrenaline autoinjectors.

down to business

Anaphylaxis Checklist for Pharmacists Available at: http://www.allergy. org.au/health-professionals/ anaphylaxis-resources/anaphylaxischecklist-for-pharmacists

How Pharmacists can assist patients 1. Advise patients with unconfirmed allergic reactions to see their medical practitioner

It is essential that patients at risk of anaphylaxis see their medical practitioner for diagnosis (and referral) and provision of an adrenaline autoinjector where indicated. However, all patients with suspected allergy should be assessed by their medical practitioner to help confirm the diagnosis, identify allergic triggers (if possible), and develop a management plan.

2. Educate patients that adrenaline is the first line treatment for anaphylaxis

Advise patients that if they suspect they are having an anaphylactic reaction, they should use their prescribed adrenaline autoinjector first and other medications later. Antihistamines should not be used as initial treatment for anaphylaxis. If using antihistamines to treat mild to moderate symptoms, non-sedating antihistamines should be used.

3. Teach patients how to use their prescribed adrenaline autoinjector

Education and demonstration has been associated with a 5-fold increase in ability to correctly use adrenaline autoinjectors11. Training must be brand specific as EpiPen and Anapen have different methods of administration. This situation may become even more complex if additional devices enter the market in the future. Ensure patients have the correct ASCIA Action Plan for their device and educate about always carrying the device and Action Plan, appropriate storage (avoid direct heat/sunlight and refrigeration due to risk of device jamming) and about the availability of expiry reminder clubs.

4. Optimise asthma management

Since those with food allergy and asthma are at increased risk of fatal anaphylaxis12, optimising asthma control is essential. Refer patients back to their medical practitioner if poorly controlled asthma is suspected. ASCIA has developed food allergy and anaphylaxis e-training courses for pharmacists, available free of charge from the ASCIA website (http://etrainingpharm.ascia. org.au/) which has been shown to enhance short and long-term retention of knowledge after completion13.

References 1 Mullins RJ, Dear K, Tang ML. Characteristics of childhood peanut allergy in the Australian Capital Territory 1995–2007. J Allergy Clin Immunol 2009; 123: 689–93. 2 Osborne NJ, Koplin JJ, Martin PE, Gurrin LC, Lowe AJ, Matheson MC, Ponsonby AL, Wake M, Tang ML, Dharmage SC, Allen KJ; HealthNuts Investigators. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol. 2011 Mar; 127 (3):668–76. 3 Woods RK, Stoney RM, Raven J, Walters EH, Abramson M, Thien FC. Reported adverse food reactions overestimate true food allergy in the community. Eur J Clin Nutr 2002;56 (1):31–6. See more at: http://www.allergy.org.au/health-professionals/ hp-information/asthma-and-allergy/food-allergy-andanaphylaxis-update-2014#sthash.DcSFWUQ0.dpuf 4 Savage JH et al. The natural history of egg allergy. J Allergy Clin Immunol 2007; 120 (6): 1413–7. 5 Skripak JM, Matsui EC, Wood RA. The natural history of cow’s milk allergy (CMA). J Allergy Clin Immunol 2007; 117 (2): S40. 6 Liew WK, Williamson E, Tang MLK. Anaphylaxis fatalities and admissions in Australia. J Allergy Clin Immunol 2008; 123 (2): 434–42. 7 Bock SA. Fatal Anaphylaxis. UpToDate. 2014. (http://www.uptodate.com/). Last accessed 5 February 2015. 8 Bock SA. Further fatalities, caused by anaphylactic reactions to food, 2001–2006. JACI 2007; 119 (4): 1016–1018. 9 Pumphrey RSH. Fatal posture in anaphylactic shock. J Allergy Clin Immunol 2003; 112 (2) 451–2. 10 Bock SA et al. Fatalities due to anaphylactic reactions to foods. JACI 2001; 107 (1): 191–3. 11 Arkwright PD and Farragher AJ. Factors determining the ability of parents to effectively administer intramuscular adrenaline to food allergic children. Ped Allergy Immunol. 2006; 17: 227–229. 12 Wang J, Liu AH. Food allergies and asthma. Current opinion in allergy and clinical immunology 2011;11(3):249–254. doi:10.1097/ACI.0b013e3283464c8e. 13 Slater SM, Vale S, Sanfilippo FM, Loh R, Clifford RM. Long term effectiveness of Online Anaphylaxis Education for Pharmacists. Am J Pharm Educ. 2014; 15; 78: 136.

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Optimisation of fertility and pregnancy outcome through nutrition Kelton Tremellen MB BS(Hons) PhD FRANZCOG CREI Gynaecologist, Professor of Reproductive Medicine

Pharmacists are in an ideal position to help clients optimise their reproductive health when seeking advice on preconception vitamins. However, with the myriad of supplements currently available, common questions posed by women are, “Which one is best for me? Folic acid (FA) alone, or a multivitamin supplement? What dose of FA do I need and when should I start and stop supplementation?” This article will briefly address each of these points. Given that we live in a wealthy country with abundant food, many health professionals and the public alike believe that deficiencies in micronutrients must be rare. However, studies have shown that women of reproductive age actually do consume diets containing inadequate levels of folate, iron, Vitamin D, and iodine, especially while pregnant.1 As it is impractical to undertake a meaningful assessment of any individual client’s diet, advice on supplementation must therefore be made based on average needs, focusing on common micro-nutrient deficiencies. A little known fact is that preconception supplementation with a multivitamin containing folate and iron can increase a woman’s chances of ovulating, and therefore her chances of successfully conceiving.2,3 Once pregnant, the aim of micronutrient supplementation is to optimise the health of the growing foetus and the mother. Daily supplementation with 400 mcg of FA (folate) has been proven to reduce the incidence of Neural Tube Defects (NTD); however, supplementation with higher dosages of FA, especially when combined with other micronutrients, has been shown to offer superior and more rapid protection against NTD than FA alone.4,5 Furthermore, both iron and FA are known to play a pivotal role in red blood cell production, thereby helping prevent maternal anaemia, which is common in the second and third trimester of pregnancy. The WHO guidelines, which for iron are applicable to both developing and developed

countries, recommend that all pregnant women take a supplement containing between 30 and 60 mg of iron per day.6 Furthermore, a recent Cochrane meta-analysis has shown that a multivitamin supplement is more effective at preventing low birth weight babies than just iron and FA supplements alone.7

The baby’s developing brain requires thyroid hormone, initially provided entirely from its mother, for optimal development. Australian recommendations now suggest that all pregnant women should take 150 mcg of iodine per day in order to optimise thyroid hormone production and foetal brain development.11

Deficiencies in Vitamin D during pregnancy are also increasingly common with one reason being avoidance of sun exposure to minimise skin cancer risk. However, Vitamin D deficiency has recently been linked with an increased risk of gestational diabetes, pre-eclampsia and preterm delivery and small for gestational age birth8, plus a reduction in the child’s language skills.9 However, it has yet to be conclusively proven that Vitamin D supplementation can prevent these adverse outcomes.10 Finally, Iodine deficiency, a micronutrient essential for optimal maternal thyroid function, has been linked with reduced neurocognitive development in the child.

In summary, current recommendations suggest that the use of a multivitamin supplement containing FA (containing at least 400 mcg), iron (30–60 mg), Iodine (150 mcg), Vitamin D, B group vitamins and other minerals should be taken for at least one month before conception, and continued throughout pregnancy and lactation, in order to optimise maternal and foetal outcomes, rather than simple FA or iron alone. Women at increased risk of having a child with a NTD (personal or family history of NTD, obesity, use of anticonvulsants, or malabsorption illness) are advised to take 5 mg of FA, in combination with a multivitamin supplement.

REFERENCES 1 Blumfield ML, et al.; Nutr Rev. 2013 2 Chavarro JE, et al; Obstet Gynecol. 2006 3 Gaskins AJ, et al; PLoS One. 2012;7(9 4 Czeizel AE, Dudás I. N Engl J Med. 1992 Czeizel AE, et al.; Birth Defects Res A Clin Mol Teratol. 2004 5 WHO 6 Haider BA, Cochrane Database Syst Rev. 2012 7 Wei SQ. Curr Opin Obstet Gynecol. 2014 Hart PH, et al.; Pediatrics. 2015 8 De-Regil LM, et al.; Cochrane Database Syst Rev. 2012 9 Mackerras DE, Med J Aust. 2012 10 De-Regil LM, Palacios C, Ansary A, Kulier R, Peña-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2012 Feb 15;2:CD008873. 11 Mackerras DE, Eastman CJ. Estimating the iodine supplementation level to recommend for pregnant and breastfeeding women in Australia. Med J Aust. 2012 Aug 20;197(4):238-42.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

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“A little known fact is that preconception supplementation with a multivitamin containing folate and iron can increase a woman’s chances of ovulating, and therefore her chances of successfully conceiving.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

Professional Review

Betadine launches on-the-go solution for relief of sore throats BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

Professional Review

Betadine, Australia’s leading sore throat gargle brand has launched a new product, Betadine Sore Throat Lozenges, that contain different active ingredients to the core Betadine range. As an entrenched supplier in the antiseptic market covering applications such as creams, sprays and lotions, this new product promises to provide pharmacists and consumers with a sound option in their battle against the dreaded sore throat.

We recently had the opportunity to speak with Mike Abbott – Head of OTC Marketing and Innovation with Sanofi Consumer Healthcare. Mike expanded a little more on the new antibacterial Sore Throat Lozenges.

Editor: Can you outline a little of the background in the development of the new lozenges? Answer: Betadine Sore Throat Lozenges were many years in the making. We wanted to choose the right formulation that met the high quality standards that consumers have come to expect from Betadine — a brand that Australian consumers know and love. Betadine Sore Throat Lozenges contain the antibacterial agents Dichlorobenzyl Alcohol and Amylmetacresol, and are iodine free. Speaking with consumers, we learnt that they use different sore throat products at different times of the day. In fact, the majority of consumers use a sore throat gargle at home, in the morning and at night. Consumers use lozenges predominantly during the day as it is more convenient to do so than a gargle. Therefore, there was an opportunity for Betadine to offer a sore throat solution for those on the go. This was how the idea of Betadine Sore Throat Lozenges was born — a convenient sore throat solution that not only relieves the discomfort of a sore throat, but helps to kill the bacteria that can cause sore throats during the day.

“Consumers can use Betadine Sore Throat Lozenges on the go to help kill the bacteria that can cause a sore throat and to relieve the discomfort and symptoms of sore throats.”

Editor: Betadine is firmly entrenched as Australia’s #1 sore throat gargle. Can you outline how the new lozenges will complement the existing antibacterial range? Answer: Betadine Sore Throat Gargle has a loyal consumer base and continues to be the #1 sore throat gargle brand.1 The reason for this is because of its powerful active ingredient, povidone-iodine, which is proven to kill the bacteria that can cause sore throats. It targets the site of a sore throat and is an aid in the treatment of sore throats. It just works. However, we understand that it is difficult for many consumers to use a gargle while out of the home. Consumers can use Betadine Sore Throat Lozenges on the go to help kill the bacteria that can cause a sore throat and to relieve the discomfort and symptoms of sore throats. Now, there is a new way in the Betadine range to help manage a sore throat — Betadine Sore Throat Gargle to treat in the morning and night, and Betadine Sore Throat Lozenges to relieve sore throats during the day.

Editor: In preparation for the sore throat season in May, what action would you recommend to Pharmacists and pharmacy staff now equipped with an even broader antibacterial suite of products? Answer: Training pharmacy staff to the benefits of the Betadine sore throat system is crucial so that the consumers understand the complementary benefit of a Betadine sore throat gargle and a lozenge. Our Sanofi Consumer Healthcare OTC representative and Naturopath will be training pharmacies on the differences between the Betadine gargle and new lozenge.

Pharmacies should also ensure that adequate POS is displayed throughout their store to ensure that the Betadine sore throat products are available to shoppers when they need them. Our Sanofi merchandisers can assist with building displays to help raise the awareness in-store.

Editor: Is there anything further you would like to advise Pharmacy staff surrounding this new product range? Answer: The NEW Betadine Sore Throat Lozenges are available from early May. There will be a major advertising campaign beginning in late May which includes TV and digital advertisements and a major public relations campaign. Pharmacies are welcome to speak with their Sanofi Consumer Healthcare OTC representative to find out more information.

About Betadine Sore Throat Gargle and Betadine Sore Throat Lozenges Betadine Sore Throat Lozenges contain antibacterial ingredients dichlorobenzyl alcohol and amylmetacresol with no povidone-iodine. Betadine Sore Throat Gargle contains the ingredient povidone-iodine.

About Betadine Betadine’s antiseptic range offers families support against minor infections through their first aid, sore throat and cold sore products. ® Betadine is a registered trademark under licence from Mundipharma B. V., Netherlands.

1 Aztec Scan Sales, National Market, MAT 30-11-14

For more information about the Betadine range, please speak to your Sanofi Consumer Healthcare representative

www.betadine.com.au

>> or call 1800 732 273

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

HEALTHY IRON LEVELS ARE ESSENTIAL FOR GROWING CHILDREN

nic a g r O of form iron

If a child is low in iron, it may affect their ability to concentrate and learn. FAB IRON is formulated to assist when children aren’t getting enough iron in their diet. FAB IRON gives children all the benefits of iron without the ‘iron’ taste. It contains an organic form of iron that’s gentle on their tummy, and has a natural fruity flavour from a blend of apple, beetroot and cherry juices. FAB IRON, an iron supplement for growing children. • Preservative free • Suitable for children from 2 years*

www.fabiron.com.au *For children under 2 years, consult your healthcare professional. Always read the label. Use only as directed. If symptoms persist, see your healthcare professional. Vitamin supplements should not replace a balanced diet.

tle Gen e h on t y m tum

down to business

The Most Important Health Service In Your Pharmacy —

Consistent Customer Service BY vanessa lontos Founder — The Care Project — Helping pharmacies build health and wellness services.

Every weekend my family and I visit our local French patisserie for our fresh bread and coffee. It’s become such a part of our routine that we now know everyone that works there, their names, some of their hobbies and, when we don’t see their familiar faces because we’ve had to do something else that day, we miss them and the experience they create. They know our order and often have our coffee ready before we even get to the register, they know our names and they always make us feel welcome and happy — even when they are ‘run off their feet, busy’. There are lots of cafes on the same street and even much cheaper coffees just across the road but we always go back because they have cracked the code for exceptional customer service — consistency at each point of our journey through the business.

“It doesn’t matter how much variety you have on offer, it’s what you do consistently that counts.”

While many pharmacists continue to understand and accept the importance of expanding their pharmacies, offering to include a wider range of health services, the most important health service you offer is one you have the opportunity to offer every day, right now, with each patient. While innovation and expansion is important, especially now, really understanding the customer’s journey through your pharmacy as it is right now is key. Have you ever walked through your pharmacy as if you were a customer? Have you ever

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

imagined taking a helicopter perspective of your pharmacy, watching each person as they move through? How long are they waiting at the counter? How quickly are they attended to? How loud are the voices of those serving them? A pharmacy with a wide range of health services is great, and can be likened to a French patisserie offering many different sweets and breads. However, it doesn’t matter how much variety you have on offer, it’s what you do consistently that counts.

down to business

Here are 3 simple ways to help you create consistent customer experiences.

Get the basics right first

The basic service offering in many pharmacies is providing medications and primary health care advice, in a manner that is friendly, timely and accurate. It’s helpful to spend some time determining metrics such as — How much time does a customer spend in your pharmacy? How long does it take for them to be attended to? How extensive is your staff’s product knowledge? Most people that visit pharmacies have an idea about what the basics are but often when we work in the same place day after day we forget to see these as integral parts of the consistent customer experience. They become our blind spots and we neglect to ensure their upkeep. Simple things like the number of baskets at the script counter and the number of pens at the till can significantly impact a customer experience if they are not managed consistently. Paying attention to detail helps you get the basics right first.

Focus on them, not you

Everything we do during our day is to ensure we are ready for our customers when they walk through the door. Spend some time thinking about each of the specific tasks you carry out and then ask yourself, “How does this ensure the customer receives a consistent experience?”. Sorting scripts, doing an order, checking expiry dates — can all be linked back to the customer and the customer experience. Focus on your customer with each one of your tasks. Amazon, with over 164 million customers has been built on an authentic customer-centric philosophy. CEO Jeff Bezos is well known for bringing an empty chair into meetings with Amazon chief executives and saying, “This represents the customer, the most important person in the room”.

Declare the pink elephants

Dominos pizza CEO Patrick Doyle is well known for the changes he made to Dominos pizza through asking customers on social media to post photos of their pizzas and to publically declare what they didn’t like. Dominos originally built their brand on the speed of delivery, but what everyone knew and didn’t say was that the pizza tasted terrible. So Doyle committed the entire company, over 10,000 stores globally, to improving the taste of their pizzas. This required training each pizza maker in a whole new recipe. This significantly improved the company both financially and in the eyes of the customer. He regularly quotes, “Each day you either get better or you get worse. You never stay the same”. Own your pink elephants. Where in your pharmacy are there areas that are impacting your ability to create a consistent customer experience?

Finally, in the words of Aristotle, “We are what we repeatedly do. Excellence then is not a single act, but a habit”. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

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The patient with food allergy and anaphylaxis: How can the pharmacist help? Dr Raymond Mullins Australasian Society of Clinical Immunology and Allergy

Ms Sandra Vale Australasian Society of Clinical Immunology and Allergy

Food allergy and anaphylaxis has become an increasing public and personal health burden in Australia and other developed countries in the last two decades. Pharmacists have an important role in the management of food allergy and anaphylaxis as patients often seek advice from them.

â&#x20AC;&#x153;At present, effective primary prevention strategies are lacking, and secondary prevention is limited to strategies to reduce the risk of unintentional exposure.â&#x20AC;?

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

down to business

Food allergy is increasing in Australia and affects 10% of infants, 4–8% of children under 5 years of age and up to 2% of the adult population.1 Food allergy and risk of anaphylaxis greatly impacts on the quality of life of patients and their families.2 At present, effective primary prevention strategies are lacking, and secondary prevention is limited to strategies to reduce the risk of unintentional exposure. Therefore, guidance on when to seek medical advice for diagnosis, and education on how to avoid known food allergens is critical to the management of food allergy.

Pharmacists can greatly assist patients with food allergy and risk of anaphylaxis in the following ways: 1. Infant formula selection

When breast feeding is not possible, pharmacists may provide appropriate advice regarding infant formula selection, including avoidance of goat or other animal’s milk in a child with cow’s milk allergy (due to allergenic cross-reactivity) and avoidance of all dairy products in those with likely cow’s milk allergy pending medical assessment. In those with suspected cow’s milk and soy allergy, medical review to assess the need for extensively hydrolysed or amino acid formulae is indicated.

2. Discouraging non-scientific allergy testing and unnecessary dietary restrictions

HOW YOU CAN HELP

Pharmacists have an opportunity to educate patients and their carers about appropriate allergy testing to minimise unnecessary dietary restrictions based on unproven methods (e.g. Vega testing, kinesiology, iridology, IgG food testing) that may impair nutrition without providing clinical benefit.

3. Referring patients for appropriate advice

Those with suspected food allergy may benefit from assessment from general medical or specialist and/ or dietetic advice, to minimise the risk of malnutrition, which is more prevalent in those with food allergy. For patients with food allergy and asthma, asthma management should be optimised as these patients are at greater risk of fatal anaphylaxis.3

4. Provide appropriate advice, appropriate medication and education

Since patients occasionally present to pharmacies with acute allergic reactions, pharmacists and their staff should know how to recognise an allergic reaction (including anaphylaxis) and how best to offer initial treatment, including at times administering an adrenaline autoinjector. It is important to teach patients how to use their prescribed adrenaline autoinjector as education increases the ability to correctly administer the device.4 It is also important to educate patients about carrying their device, appropriate storage (avoid direct heat/sunlight and refrigeration due to risk of device jamming), and about the availability of reminder clubs (e.g. EpiClub and Analert). Having a general ASCIA Action Plan for Anaphylaxis (orange version) on display may assist staff in responding appropriately. ASCIA Action Plans are available from the ASCIA website: www.allergy.org.au

References 1 Osborne NJ, Koplin JJ, Martin PE, Gurrin LC, Lowe AJ, Matheson MC, Ponsonby AL, Wake M, Tang ML, Dharmage SC, Allen KJ; HealthNuts Investigators. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol. 2011 Mar;127(3):668-76.e1-2. 2 Australasian Society for Clinical Immunology and Allergy. The economic impact of allergic disease in Australia: not to be sneezed at. ASCIA/Access Economics Report. November 2007 (http://www.allergy.org.au/ascia-reports/ economic-impact-of-allergies). 3 Munoz-Furlong A, Weiss CC. Characteristics of food-allergic patients placing them at risk for a fatal anaphylactic episode. Curr Allergy Asthma Rep. 2009 Jan; 9 (1): 57–63. 4 Arkwright, PD and Farragher, AJ (2006). Factors determining the ability of parents to effectively administer intramuscular adrenaline to food allergic children. Pediatric Allergy and Immunology, 17: 227–229. doi: 10.1111/j.1399-3038.2006.00392.x

Visit the ASCIA website for access to health professional and patient information as well as online training for pharmacists, available free of charge: www.allergy.org.au.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

DOWN TO BUSINESS

Having a Team that works Peter Saccasan FACP FCA CTA Director of Pharmacy Services, RSM Bird Cameron Chartered Accountants peter.saccasan@rsmi.com.au

All retailers know the value of providing strong customer service and pharmacies are no different. With the need to grow professional services and retail sales, there has never been a better reason for ensuring that your pharmacy team is on task. Having the right team in place is not just restricted to customer service — running a pharmacy today requires the right skill set more than ever and owners need to ensure that they are covering all management needs appropriately. The right Professional Services Team

“Owners should not underestimate the need for strong training in customer engagement. Translating knowledge to the store floor is not everyone’s forte.”

The provision of professional services through pharmacy is only heading one way — likely to grow even more under the 6th Community Pharmacy Agreement. This will require pharmacists and other health professionals on staff who can deliver these services to customers. Owners will need to:

•• Identify the services that will be provided. This will flow from identified customer needs, local demographic and overall store offer. •• Provide the right store environment to allow effective customer engagement •• Employ professionals with the right

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

background or additional training for existing team members •• Provide the right training for pharmacy assistants who might assist in these areas •• Implement an appropriate sales and marketing strategy •• Put in place the right KPIs to track these services. Owners should not underestimate the need for strong training in customer engagement. Translating knowledge to the store floor is not everyone’s forte. Professionals need to have empathy as well as professionalism in order to gain the customer’s confidence and achieve sales of services that are being provided for better health outcomes for the customer.

DOWN TO BUSINESS

The right Retail Team Donning the pharmacy uniform does not automatically imbibe its wearer with the ability to engage effectively with customers. Pharmacy assistants, and pharmacists alike, need to be able to win consumer confidence. This depends as much on the ability to be approachable and responsive as it does on product knowledge. Owners need to ensure they raise the confidence levels of retail staff by providing training in all areas — not only product knowledge (which can be very limited from my experience) but also in the areas of presentation, politeness and professionalism. A special word here in relation to forward pharmacy practices. Putting the pharmacist out front is certainly a great way to better engage customers with a knowledgeable health professional. I will always advocate that this person should be your best salesperson because of the ability to companion-sell products, prescriptions and professional services. A word of caution, however — make sure your pharmacist can carry that conversation. Many pharmacists are far more comfortable behind the counter with some, but limited, interaction and fulfilling their professional role in managing the prescribing process. Out on the store floor can be a different dynamic and can take a little getting used to.

The right Business Team Pharmacies are getting bigger, the marketing channels are broadening, stock levels are rising, and staff sizes are increasing — the numbers are just bigger. It will be a far different dynamic running a 400m2 store turning over $8m in sales to running a 40m2 medical centre pharmacy. Owners need to ensure that they have the right people in the right roles.

Starting at the top — the owners. Going into partnership is common, but not all partners will have the same skills — some are great in the dispensary, some enjoy retailing, while others are really good in managing the numbers of the business. It is a key requirement that partners sit down and have an honest discussion around this area and identify where their skills lie so that they can be doing the right job in the pharmacy. My observation and experience is that it works best if you think of your role of owner as a different one to the role you have working in the business. Your job description is agreed and you go off and fill that role, reporting to the person whose job it is to run the overall pharmacy. As an owner, you continue to hold your equity share in the business, regularly attend partners’ meetings and participate in higher level business decisions — not operational decisions which are the domain of the person in charge of that area. Owners need to ensure they get the right people doing some of the bigger roles in the pharmacy. I have set out below 10 areas that cover most of the pharmacy requirements. 1. Marketing and promotion, including social media and web-based platforms 2. Merchandising and store layout 3. Financial supervision and cashflow management 4. Reporting to the partners and arranging partners’ meetings 5. Inventory control and buying 6. Professional services management 7. Bank relationship 8. Wholesaler/Franchise relationship 9. Technology management 10. Human Resources management

“Owners need to ensure they raise the confidence levels of retail staff by providing training in all areas — not only product knowledge (which can be very limited from my experience) but also in the areas of presentation, politeness and professionalism.”

Some of these roles may or may not be undertaken by the partners. For many roles, it is more effective to buy in the right skills and have the effectiveness of the supplier monitored. Owners should be quick to recognise what is within their skill set, what is not, what is needed, and how they can address the need.

Bringing it all together Owners should spend the right amount of time assessing how the team is going. This should be part of a regular review of the business, including the overall store offer, the performance of the business and the vision — what the store should look like if it were fulfilling the mission that the team has set out to achieve. This review can be practical and become your Better Pharmacy Plan that can be a practical guide to the next steps you take in running a successful pharmacy.

HELPS KILL BACTERIA & RELIEVES SORE THROATS CHCANZ-BET-14-12-1169B-FEB-2015

GOLD CROSSpersist, PRODUCTS & SERVICES LTD : ITK ISSUE 41 : APRIL / MAY 2015 Always read the label. Use only as directed. If symptoms consult your healthcare PTY professional.

ASMI24536-0215

down to business

Guild Pharmacy Academy update!

Know and love your top 100 customers

PBS reform is hitting the dispensary hard, To subscribe to updates significantly reducing the gross profit per prescription earned by pharmacies. from the Academy and Industry experts have warned that some access this course, pharmacies could face a loss of up to $2.50 per prescription over the next two years. simply enrol your staff To buffer such a loss in gross profit per inGUILD the Guild’s online prescription through the dispensary alone, INTERN TRAINING pharmacy would need to increase its volume learning platforms myCPD of prescriptions by around 20% or a growth of 11% coupled with an increase in revenue from (for pharmacists) and the front-of-shop of around $1 per prescription. myLEARNING (for pharmacy One of the most overlooked opportunities for growth in community pharmacy, and one assistants) via our website that is accessible to all pharmacies regardless www.guild.org.au/academy of business model, is the value of your top 100 dispensary customers. Adopting a wholeof-pharmacy focus on the loyalty of these 100 customers has the potential to increase not only your script numbers and front-of-shop revenue, but also the uptake of pharmacy services.

Guild interns make the best interns because they have access to:

Estimates show that customer 100 will

• A program balanced with clinical and business generateknowledge around $3,500 in revenue for the

pharmacy and each customer higher in the list has the potential to generate significantly more than this. So at a minimum, your top 100 customers may already generate up to $350,000 in revenue each year. Increasing the loyalty and customer satisfaction of your top 100 dispensary customers will take you a long way towards successfully buffering the impacts of PBS reform. Like with all new initiatives in Thanks topharmacy, Linda and Jennyitfrom your is important that proper Werrington Pharmacy NSW for participating in theare photography processes in place so the approach is coordinated and evaluated. The Guild Pharmacy Academy has launched an online course for pharmacists on their myCPD site titled ‘Know and love your top 100 customers’. Free to Guild members and their employee pharmacists and $250 for non-members, the course will provide suggestions on how to identify your top 100 customers as well as suggest programs and services for growing customer engagement and loyalty.

• Comprehensive exam preparation • Visits from a clinical tutor providing on-site assistance and mentoring New free courses from the Guild Pharmacy Academy • Training in the latest professional programs and services under the 5th Community Pharmacy Agreement To find out more visit our website or call your local Guild branch.

www.guild.org.au/academy NSW & ACT - 02 9467 7124 / QLD - 07 3831 3788 / TAS - 03 6220 2955 / WA - 08 9429 4100

Vitamin K2 and bone health

Understanding the needs of customers travelling overseas

Pharmacist Only Health Solutions: Analgesics

An overview of the risk of calcium supplementation on cardiovascular health and the potential benefits of Vitamin K2. Available at myCPD.

The foundations for providing travel health services in pharmacy. Available at myCPD.

The evidence for and appropriate use of Pharmacist Only analgesics. Available at myCPD.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

Category Review

Cold Sores By Nate Hentschel Pharmacist, B.Pharm.

Cold sores (Herpes Labialis) is a term referring to a skin infection caused by the Herpes Simplex Virus type 1 (HSV-1). They can show up at inconvenient times and are often painful, unsightly and embarrassing for many people. Despite this, cold sores are very common, with some studies showing as many as 76% of Australians may be infected with HSV-1, although only a third of those are likely to present with cold sores.1 What are cold sores?

Spread

Cold sores are a symptom of infection with HSV. The virus is normally asymptomatic; however, during times of stress or other triggers, it can cause cold sores — usually small, painful blisters which appear on or around the lips, although they can also appear on the nose and inside the mouth. The patient may experience tingling, itching or pain in the area before the blister forms. Once the blister appears, it is likely to be painful and may make the surrounding area tender. There can be more than one blister at a time, and the patient might also have a sore throat, fever or headaches. Over the course of the infection, the blister will usually burst, crust over and heal.2

The disease is spread most often by contact with the saliva of an infected person, who is most infectious when a blister is forming or present, although it can also spread when no blister is present.

Someone carrying the virus is more likely to get cold sores if they are:

•• immune suppressed •• recently exposed to excessive sunlight or windy conditions •• stressed •• experiencing hormonal changes such as menopause •• recovering from a recent cold or flu.

The initial infection may present similar to a mild cold or flu, including fever, tiredness, sore throat, and blisters or ulcers in or around the mouth. Infected people with cold sores should try to minimise their risk of spreading the virus to others. Avoiding touching the cold sore, or washing their hands after touching the area is important. They should also avoid sharing any items which may come in contact with the infected area (bottles, toothbrushes) and any close contact with others, especially babies or young children.3

Treatment of cold sores There is no outright cure for HSV infection, and cold sores usually resolve spontaneously. Those who are immune-compromised or at risk of the blisters getting a secondary bacterial infection may benefit from treatment.

“The initial infection may present similar to a mild cold or flu, including fever, tiredness, sore throat, and blisters or ulcers in or around the mouth.”

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Patients who have spread the infection to their eyes need to be referred as soon as possible, as delaying treatment could result in eye damage. Symptomatic treatment is usually appropriate — paracetamol or ibuprofen may help with pain and fever, while products containing actives like lignocaine can be used for sore throats. Patients should be advised to avoid picking at the blister as this may cause scarring or delay healing, as well as possibly spread the infection. Antiviral treatment is available over the counter as topical products (such as acyclovir) or tablets (famciclovir) and have been shown to provide a modest benefit in reducing the time it takes for the cold sore to heal. These products are significantly more effective if used before the blister forms.4

Conclusion While cold sores will go away on their own with time, simple treatment options can relieve the symptoms and antiviral treatments may speed up recovery and healing. For social reasons, many patients will want some kind of treatment, making this an area where pharmacists are able to step out from the dispensary and provide a number of appropriate treatment options. References 1. Cunningham AL, Taylor R, Taylor J, Marks C, Shaw J, Mindel A. Prevalence of infection with herpes simplex virus types 1 and 2 in Australia: a nationwide population based survey. Sexually Transmitted Infections 2006;82(2):164–168. 2 Pica F, Volpi A. Public awareness and knowledge of herpes labialis. Medical Virology 2011;84(1): 132–137. 3 Herpes Simplex. American Academy of Dermatology. http://www.aad.org/skin-conditions/ dermatology-a-to-z/herpes-simplex 4 Opstelten W, Neven AK, Eekhof J. Treatment and prevention of herpes labialis. Canadian Family Physician 2008;54(12): 1

When quality counts

Where do you want to take your pharmacy career? Guild Training allows you to tailor your training to specialise in your area of interest Select individual electives or follow one of our specialist streams: Certificate IV in Community Pharmacy (SIR40112)

Certificate III in Community Pharmacy (SIR30112) Health

Specialist Product Knowledge

Marketing & Merchandising

Health Care Support

Dispensary

Front of Pharmacy Supervision Stock Control & Management

ENROLMENT IS EASY!

Dispensary

For more information on funding eligibility or to enrol contact your local Guild Training branch: NSW & ACT: 02 9467 7130 or training@nsw.guild.org.au VIC: 03 9810 9988 or training@vic.guild.org.au QLD: 07 3831 3788 or admin.training@qldquild.org.au

www.guild.org.au/academy

TAS: 03 6220 2955 or tastraining@guild.org.au SA: 08 8304 8388 or trainingsa@guild.org.au NT: 08 8944 6900 or office@ntguild.org.au WA: 08 9429 4100 or training@wa.guild.org.au

THE PHARMACY GUILD OF AUSTRALIA IS A REGISTERED TRAINING ORGANISATION (0452)

Category Review

Food Allergies Explained BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

Australia has one of the highest reported incidences of food allergies in the world and the numbers are growing at an alarming rate. In fact, 1 in 10 babies born in Australia today will develop a food allergy. Currently there is no cure for food allergy â&#x20AC;&#x201D; avoidance is the only way to prevent a reaction. What is a food allergy? Food allergy is an immune system response to a food protein that the body (mistakenly) believes is harmful. When a food that a person is allergic to is eaten, the immune system releases massive amounts of chemicals, triggering potentially life-threatening symptoms. Allergic reactions can range from mild to severe, with severe being named anaphylaxis. Symptoms usually appear within two hours of a person eating a food (even a small amount) they are allergic to. Mild to moderate symptoms include swelling of the face, lips and eyes, hives/welts or tingling mouth. Symptoms of anaphylaxis include difficult/noisy

breathing, swelling of the tongue, swelling/ tightness in the throat, difficulty talking/ hoarse voice, wheeze/persistent cough, persistent dizziness or collapse and in young children, pale and floppy. There are more than 170 known foods to cause allergies; however, 90 per cent of reactions are caused by nine common foods: milk, eggs, peanuts, tree nuts, sesame, fish, shellfish, wheat and soy. Food allergy is often confused with food intolerance but the two differ greatly. Unlike food allergies, an intolerance does not affect the immune system. An intolerance will usually have a slower onset, isnâ&#x20AC;&#x2122;t life threatening and can cause headaches, bloating, wind, nausea, mouth ulcers or hives.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

Why are food allergies so common? Hospital admissions for anaphylaxis have doubled over the last decade in Australia and for children aged 0 to 4 have increased fivefold. Despite this alarming increase and considerable research, there is currently no known cure, little definitive knowledge of the cause of food allergies and understanding of why they are increasing at such a rapid pace. The Australasian Society of Clinical Immunology and Allergy (ASCIA) has outlined some possible theories for the increase in food allergies.

Category Review

Food Allergy Week, an initiative by Allergy & Anaphylaxis Australia, is held from 17–23 May 2015. The aim is to raise awareness of food allergy and encourage people to be allergy aware. For more information visit www.foodallergyaware.com.au

They include:

•• Less exposure to infections during childhood

•• The delayed introduction to allergenic foods such as eggs and nuts •• Development of nut allergy after exposure to nut oils in skin creams when someone has eczema. President of Allergy & Anaphylaxis Australia, Maria Said, explains that genetic factors can increase the likelihood of a child developing an allergy. “Research has shown that if a child has a parent with an allergy the risk of the child developing an allergy increases by 30 per cent. That likelihood further increases to 40–60 per cent if both parents have a history of some allergic condition.”

as avoidance remains the safest form of management. Some simple preventative techniques include:

•• Always reading food labels •• Always disclosing food allergies and asking about food content when eating out •• Taking care to thoroughly wash contaminated utensils •• Making sure allergenic foods are clearly labelled. When an anaphylactic reaction does occur, the first-line treatment in the community setting is the administration of adrenaline via an autoinjector. The adrenaline helps counteract the chemical reaction causing cardiac and/or respiratory signs and symptoms in the body.

While fatalities as a result of food allergies are rare, every death is one that could have been prevented.

Adrenaline autoinjectors are prescribed for those at high risk of anaphylaxis. Currently, the only adrenaline autoinjector that can be purchased for use in Australia is the EpiPen® (Anapen® is currently out of stock). Those prescribed an adrenaline autoinjector on the Pharmaceutical Benefits Scheme can purchase two devices on an ‘authority’ script for approximately $36.

The day-to-day management of food allergies is vital in preventing reactions,

“It is important that those with an EpiPen purchase an EpiPen training

“They won’t necessarily develop the same allergy as the parents, what is passed on is the predisposition to have an allergy,” added Ms Said.

Management and Treatment

device and practise using it regularly. EpiPen Trainers can be purchased at low cost through the Allergy & Anaphylaxis Australia website,” explained Ms Said. Ms Said also explains that it is vital to be aware of the signs and symptoms of an allergic reaction and to be prepared in the event of a reaction. “With so many children and adults diagnosed with food allergy, increasing awareness is vital to preventing allergic reactions.” “Increased awareness can help people to better understand avoidance of the allergen, the signs and symptoms of a reaction and help them know what to do in an emergency, which can not only reduce hospitalisation rates but can also save lives,” concluded Ms Said.

For further advice or information on allergy please contact Allergy & Anaphylaxis Australia on coordinator@allergyfacts.org.au or visit allergyfacts.org.au.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

Professional Review

How to achieve the best deal on your retail lease BY Phillip A. Chapman Phillip A. Chapman is the Founder of Lease1 and Director of MiLease Strategic Lease Management, both of which are endorsed Gold Cross Member Services.

As a pharmacy owner seeking to secure a good deal on your lease, the better informed you are, the more empowered you will be in negotiations with the landlord. In considering the best way to deal with your landlord, it is clear that information is key. Even before entering negotiations, there are a number of important elements that must be taken into consideration.

a. Frame the conversation

You won’t be overstating the situation if you use a phrase such as, “A Real Game Changer”. The opening line to your landlord may be as simple as, “We need to discuss the future viability and changes that will be needed for my pharmacy to react and manage this risk in order to remain viable now and in the future.”

Be prepared to include your wholesaler, brand managers and/or franchisors into the conversation when discussing possible solutions with your landlord. Don’t be surprised if your landlord seeks to identify the level of financial assistance your brand/franchisor is providing. There will be an expectation

e. Be clear on what you want to achieve

c. Record, document, follow up and deliver

Open the dialogue around the real and direct impact being felt in community pharmacy due to the government intervention in the PBS through Simplified Price Disclosure. Be prepared to state that the current and financial impacts are significant. In all likelihood, you will be required to share your ScriptMAP report or elements of it to substantiate your claim/s.

b. Introduce other partners in your supply chain

that the landlord is not the only one involved in sharing the risk and effects from the outcome of lease negotiations.

It goes without saying, but you need to take notes, keep an accurate document trail and set effective follow-ups from any meeting you have with your landlord. A handy tip is to email/write to the landlord after each meeting confirming the points and views discussed. This will remove any doubt between each of the parties. It would come as little surprise that the major cause of disputes is due to parties not having a thorough record of the discussions held. Documentation of all your discussions is key — and be warned, if you don’t write them down, you won’t be able to prove at a later date that something was actually done, agreed or conceded.

d. Keep the dialogue flowing

As part of your ongoing lease management, you should conduct a quarterly review of your benchmarks for occupancy cost and turnover per square metre to ensure the processes you adopt to increase sales and manage lease costs are delivering improvements. If not, you will need to review with your landlord in order to explore other options for improvements in your pharmacy business to build resilience for your business.

Go into discussions with your landlord with a clear picture of what outcome you are realistically seeking to achieve. Possible outcomes to consider include (but are not limited to):

•• reducing your lettable area •• reducing your rental or occupancy costs •• seeking a waiver of a rent review (or series of rent reviews)

•• reducing an annual rent review •• seeking to have rent waived for early payment

•• seeking to have rebranding (or other such works like new signage) paid for by the landlord •• relocating the business •• renewing the lease early to value-add the landlord’s investment in lieu of a rent reduction

f. Do not be afraid to ask for changes in the lease agreement

Be very wary if, after you have settled on the business terms, the landlord or their representative presents you with the “execution copies” of the lease and asks you to sign them.

When negotiating a lease, you should keep in mind that there are no set terms in a lease. That means, just like the amount of rent to be charged, everything is negotiable, provided the issues are raised early in the negotiation phase.

The information and advice contained within this article is intended to inform and assist pharmacy owners. However, the article is necessarily generic and is not intended to provide specific advice on individual pharmacy lease arrangements. You should always exercise your own judgement and seek independent advice in relation to your commercial arrangements. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

TRAINING AND EDUCATION

Wagner MSM Joint Formula powder Formulated with 1500mg Glucosamine sulfate potassium chloride complex and 1200mg Chondroitin sulfate, WAGNER MSM JOINT FORMULA powder helps in the maintenance of elasticity, strength and resilience in joint connective tissues, working to provide symptomatic relief from the painful symptoms of arthritis and rheumatism.

1.0 INDICATION

4.0 BREASTFEEDING/PREGNANCY

7.0 COUNSELLING POINTS

Q. What is WAGNER MSM JOINT FORMULA powder used for?

Q. Can this product be used in pregnancy or breastfeeding?

Q. How to use the product?

A. Used in the management of rheumatism and mild arthritis, WAGNER MSM JOINT FORMULA powder is formulated to support a reduction in symptomatic joint pain associated with osteoarthritis when taken on a daily basis.

A. There are no known reasons why this product should not be used during pregnancy.

2.0 MODE OF ACTION Q. How does WAGNER MSM Joint Formula powder work? A. Glucosamine, Chondroitin, MSM and co-factors including Zinc are combined in this formula to target the symptomatic relief of pain associated with arthritis, as well as providing key nutrition to joint connective tissues including articular cartilage, tendons, ligaments and synovial fluid.

3.0 PRECAUTIONS/ CONTRAINDICATION/INTERACTIONS Q. Are there any patients who would not benefit from this product? A. Yes. This product is formulated using Glucosamine sulfate derived from seafood. For this reason, patients with seafood allergies should avoid this product. Q. Are there any herb-drug interactions or herb-condition interactions that should be considered? A. Patients should consult their doctor before taking this product if they are currently being treated for high blood pressure, or if they have kidney disease, due to the presence of 96.8 mg potassium per 15g serve.

5.0 SIDE EFFECTS Q. Are there any side effects to be aware of or is the product well tolerated? A. This product is well tolerated and does not cause the gastrointestinal erosion or acid producing side effects of other conventional osteoarthritis medications. Recent research suggests Glucosamine and Chondroitin are better tolerated and as efficacious as the standard NSAID used in the treatment of moderate to severe osteoarthritis without causing similar digestive disturbances1.

A. Mix one level scoop (15g serve) in water or juice twice daily. To find out if patients may benefit from taking a joint formula, ask: •

Are your joints stiff and sore in the morning on waking?

•

Do they feel better once they are moving but worse after sitting for long periods?

•

Do you have difficulty with activities of daily life including: − Walking up and/or down stairs? − Carrying shopping home? − Putting clothes on the line?

Q. With or without meals? A. This product should be taken before or with a meal, or as directed by your healthcare professional.

6.0 COMPARATIVE INFORMATION Q. What makes WAGNER MSM Joint Formula powder different/better? A. Formulated with 1500mg Glucosamine sulfate potassium chloride complex and 1200mg Chondroitin sulfate, WAGNER MSM JOINT FORMULA powder provides one of the best formulations of combined arthritis ingredients when taken as directed on a daily basis.

This powder format is easy to take for individuals unable to take tablets or capsules due to their size.

1 Hochberg MC, et al. Combined Chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double blind, non-inferiority trail versus celecoxib. Ann Rheum Dis 2015:0:1-8. Doi:10.1136/annrheumdis-2014-206792. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

down to business

Pharmacy’s involvement with immunisation services –

A focus on QPIP Jane Larter B.Pharm, AACPA, MPS Pharmacist – Trainer and Assessor; Pharmacy Guild of Australia QLD

“In the next few months, whether you are delivering an immunisation service or just getting prepared for the ‘flu’ season, make sure to promote the benefits of immunisation and infection control to both your staff and customers.”

It’s that time of year again where you’ll be starting to have customers present with prescriptions to get their influenza or ‘flu’ vaccine, and deciding how many of the 2015 vaccine have to be on backorder.

I believe one of the most important times of year in pharmacy is from April through to August where the weather starts to cool and viruses start to become more prominent with customers presenting with sniffling noses and hacking coughs. This has been — and still is — one of the biggest times where pharmacy is the primary healthcare destination for its customers. Over the years we have been a provider of cold and flu tablets, tissues and lifestyle advice but, as of last year, pharmacy has shown its ability to provide even more – vaccinations for influenza. The flu is of course a lot more serious than the common cold and pharmacy has been at the forefront of providing this health information to consumers for decades. Immunisation of people who are at risk of complications (such as the elderly, those with poor immune systems, and those with preexisting respiratory, cardiac and endocrine disease) is the most important method we have to decrease the number of infections and death. Due to certain criteria these people may be eligible for a free flu shot from their doctor. But what about those young, healthy people who never see a GP because they don’t have the time? Those who are not covered under the National Immunisation Program? Even these people can get the flu and miss out on work or transfer it to their family members who may be at risk such as the elderly and very young. The benefit of these people still getting a flu shot is so they don’t transfer the

flu to work colleagues or family. This is where pharmacy saw a need, knowing that countries such as the USA, UK, Ireland and Portugal have already implemented immunisation services. The Pharmacy Guild of Australia, Queensland Branch, has long advocated a role for pharmacists in immunisation services. The Queensland Pharmacist Immunisation Pilot (QPIP) — developed by the Guild and PSA, in conjunction with the Queensland Department of Health, Queensland University of Technology and James Cook University — aimed to investigate in its first phase last year the benefits of registered pharmacists providing influenza vaccines to members of the public in the setting of a community pharmacy. Based on their accessibility, the clinical skills of pharmacists and the high levels of trust placed in them by consumers, community pharmacies are a natural destination for immunisation services. Many Guild members are participating in the QPIP that was approved by Queensland’s Chief Health Officer, Dr Jeannette Young who stated in a news release 16/01/2014, “Trials are also an important part of improving healthcare delivery in Queensland. They help us to be innovative and use our health professionals to the best of their ability.” The approval allows pharmacists participating in the trial to administer the influenza vaccine to certain adults without a prescription. “The experience in Australia with this approach suggests that consumers

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

like having easy access to vaccinations, and that people who would not normally get vaccinated are taking up the offer,” states Dr Young. Pharmacists administering vaccinations as part of the pilot have undertaken approved training and are credentialed to provide the immunisation service. I was lucky enough to speak with two pharmacists whose pharmacies participated in the QPIP to see what made them get involved and how both staff and their local community have embraced the service. Martinique Aprile, Community Pharmacist at Healthpoint Chemist Group Mackay thought it was a great initiative that offers customers an easy and convenient way to be immunised. “The staff embraced the program and were very supportive of it. They were consistently notifying our customers about the pilot … the whole pilot was an excellent initiative of the Guild, PSA, JCU and QUT.” Amcal Pharmacy Cannonvale’s Pharmacist in Charge, Kirsty Gouldthorp, said it was a “brilliant opportunity as it is very difficult for customers to see the doctors in the area”. Kirsty said that Amcal Pharmacy Cannonvale owner, Lee McLennan, went and spoke to all doctors in the area and explained the gap they were trying to fill. The doctors were quite receptive to the idea of consumers who weren’t seeing them, were at least visiting the pharmacy. Kirsty also stated that “the customers loved the opportunity for a chat

down to business

about the rest of their medications or health while waiting after their vaccination”. This statement by Kirsty is in line with responses by consumers to the overall pilot with 60% of those vaccinated indicating they discussed “other concerns about their health”, 58% discussing “other medications they usually take” and 38% discussing their “general health”. The benefit of the QPIP – increased immunisation. An evaluation snapshot showed that the QPIP is reaching a high number of consumers who might not normally be vaccinated. 14% of respondents who were vaccinated in 2014 had never been vaccinated and when asked why, they gave three main responses: (1) they didn’t think it was necessary (2) it was inconvenient (3) they were too busy. The hard work by all those pharmacists and pharmacy staff in the QPIP is reaping rewards for the profession earlier than could have been hoped for. Following the success of Phase 1, an expansion to the QPIP was announced July 2014 to include measles and pertussis (whooping cough) vaccines for adults, as well as the 2015 influenza season. In the next few months, whether you are delivering an immunisation service or just getting prepared for the ‘flu’ season, make sure to promote the benefits of immunisation and infection control to both your staff and customers. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

training and education

Getting schooled on Fish Oil Purity and Quality Researchers have discovered that almost every corner of this beautiful planet has some degree of contamination from pollutants or toxins — even the snow falling in Antarctica may be polluted! With the oceans on our planet teeming with fish potentially exposed to toxins, it is important to ensure that the fish oil you are recommending is clean and pure. From beauty products to seafood, consumers are becoming more aware, and concerned, about their intake of heavy metals and contaminants. These are valid concerns, and with a sea of fish oil supplements available in Pharmacies, it is your role to recommend only quality, pure and therapeutic products. So, what is it that defines a fish oil’s purity, quality and efficacy?

Molecular distillation for purity. What is it? Molecular distillation produces the purest fish oils because this highly specialised purification method removes heavy metals and other toxins. Fish oils processed using this method are not subjected to high heat for long periods of time, unlike other processing techniques which can damage the sensitive omega-3 oils responsible for the health benefits of fish oil. Molecular distillation also ensures no trans-fats are created during the purification process. The Ethical Nutrients Hi-Strength Fish Oil range utilises the molecular distillation production technique and surpasses Australian purity standards for heavy metals, pesticides and PCBs.

Nitrogen flushing for quality. What is it? The delicate nature of omega-3 oils makes them prone to rancidity if stored under the wrong conditions. That is why every product in the Ethical Nutrients Hi-Strength Fish Oil range undergoes nitrogen flushing. This important quality process increases the stability of the fish oil throughout its shelf life and limits any oxidation that could otherwise occur whilst stored. This helps ensure that, up until expiry, every Ethical Nutrients Hi-Strength Fish Oil product is as pure and stable as it was at the time of manufacture.

Therapeutic dosing for efficacy Ethical Nutrients are proud supporters of Arthritis Australia1, an independent organisation with a vision to bring quality of life to all people with mild arthritis. Arthritis Australia suggests the dose of fish oil needed to help reduce the joint inflammation associated with mild arthritis is 2.7 g omega-3 (EPA and DHA) daily2. This can be achieved by 1 teaspoon or 4 capsules of Ethical Nutrients Hi-Strength Fish Oil, making therapeutic

“When choosing a fish oil supplement, be aware what sets quality, pure, therapeutic fish oils apart from the rest and be confident in recommending the smart choice.”

1 Arthritis Australia is an independent organisation and does not endorse any particular brand of fish oil. 2 Omega-3 has not been studied in all forms of arthritis. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

dosing more convenient. Every bottle of Ethical Nutrients Hi-Strength Fish Oil proudly displays the Arthritis Australia logo.

How does Ethical Nutrients ensure sustainability? Ethical Nutrients use oily cold-water fish for the Hi-Strength Fish Oil range sourced from fisheries who stringently follow sustainable fishing methods. Every bottle of Ethical Nutrients Hi-Strength Fish Oil proudly displays the Friend of the Sea certification, guaranteeing you and your customers an eco-friendly, high quality fish oil product that:

•• •• •• ••

Never over-exploits target fish stock Does not by-catch endangered species Does not impact on the seabed Offsets its carbon footprint

So when choosing a fish oil supplement, be aware what sets quality, pure, therapeutic fish oils apart from the rest and be confident in recommending the smart choice. Always read the label. Use only as directed. If symptoms persist contact your healthcare professional.

For more information on Ethical Nutrients High Strength Fish Oil visit www.ethicalnutrients.com.au

training and education

FAB IRON, an iron supplement for growing children Evidence-based complimentary medicine Healthy iron levels are essential for growing children. Iron plays a crucial role in both physical and cognitive development during childhood. If a child is low in iron, it may affect their ability to concentrate and learn. Indication Fab IRON Liquid Iron is a liquid iron supplement that is formulated to assist when children aren’t getting enough iron in their diet. FAB IRON Liquid Iron gives children all the benefits of iron without the ‘iron’ taste. Fab IRON Liquid contains liquid ferrous gluconate which is an organic form of iron that is gentle on the stomach and easy to digest with Vitamin C to assist with maximum iron absorption. It also has a natural fruity flavour from a blend of apple, beetroot and cherry juices.

•• A low dose iron supplement with high absorption

•• 5mg of elemental iron per dose of 5mL

Active ingredients: Each 10mL contains: Iron (from Ferrous gluconate) 5mg, Vitamin B1 (Thiamine as hydrochloride) 0.275mg, Vitamin B2 (Riboflavin as sodium phosphate) 0.35mg, Vitamin B3 (Nicotinamide) 4mg, Vitamin B6 (Pyridoxine as hydrochloride) 0.35mg, Vitamin B12 (Cyanocobalamin) 1.25mcg, Vitamin C (Ascorbic Acid) 30mg.

Herbal liquid extracts equivalent to dry: Rosa canina (Rose hip) fruit peel 0.08mg, Matricaria chamomilla (Chamomile) flower 0.08mg, Melissa officinalis (Balm) leaf 0.08mg, Elymus repens (Quack grass) root 0.08mg, Equisetum arvense (Horsetail) herb 0.08mg. Fab IRON does not contain: preservatives, lactose, gluten, artificial colours or sweeteners.

Clinical evidence: A study conducted on 40 women aged 20–35 with iron deficiency during and immediately after pregnancy presenting with HB<10 gr/dl, Ht<33% and serum iron <60µg/dl were divided into four treatment groups of 10 patients each and were treated as follows: Group A with oral liquid ferrous gluconate (75 mg per diem in 2 vials a day); Group B with solid ferrous gluconate (80 mg per diem in a single effervescent tablet); Group C with solid ferrous sulphate (105 mg per diem in a single tablet); and Group D with ferric protein succinylate (80 mg per diem in 2 vials a day). The tolerance of the 4 treatment protocols was assessed by the analysis of any side effects such as nausea, vomiting, epigastric pain, diarrhoea, constipation or other disorders reported by patients during treatment.

As to safety, only Group A patients reported no side effects and produced no drop-outs. Gastrointestinal and other nonspecific side effects caused 1 drop-out each in Groups Band C and 2 drop-outs in Group D. The study concluded that preparations containing ferrous salts (+2) are more easily absorbed than those containing ferric salts (+3) since the former can be immediately absorbed by the duodenal mucosa. The study reported here reveals that oral ferrous gluconate in liquid form is more effective and above all better tolerated than other solid or liquid formulations containing elementary iron. The effect of Vitamin C supplementation on iron balance was tested on multiple radio absorption tests and performed on 63 male subjects. The increase in iron absorption from a semi-synthetic meal was directly proportional to the amount of ascorbic acid added over a range of 25 to 1,000 mg. The ratio of iron absorption with/without ascorbic acid at these two extremes was 1.65 and 9.57, respectively.

Interactions: No known interactions.

Visit: www.fabiron.com.au.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

TRAINING AND EDUCATION

Murine launches new Eye Mist spray for dry and tired eyes Dry eyes are a common problem with many possible causes, including air-conditioned or windy environments, extended computer work, wearing contact lenses, long-distance travel, ageing and medication.

Indication Our eyes have a natural moisturising barrier over their surface called the tear film layer. This is further made up of three layers:

•• An outer lipid layer •• An aqueous layer •• A mucous layer The lipid layer stabilises the tear film and helps prevent your aqueous layer from evaporating. If there is a deficiency in this outer layer, your tears evaporate too quickly and your eyes become dry. 80% of dry eye sufferers have dry eyes because of a disruption to the tear film layer. The tear film layer lubricates and protects the surface of the eye. Each time you blink, you are helping to spread your tears across the surface of the eye to form a film. The film acts to reduce evaporation of moisture from the eye, helping it to stay hydrated. If this film layer is disrupted, your eyes can start to feel dry, tired and itchy. Gaps in the tear film layer allow moisture to evaporate from the aqueous layer beneath. Dry eyes can occur when we either don’t produce enough tears or when a gap in the tear film layer allows moisture to be lost (evaporate from the aqueous layer).

Air-conditioned, windy or heated environments can cause the tear film layer to break up, reducing moisture. Concentrating while reading, working at a computer for extended periods of time and long-distance travel can reduce the rate at which you blink, resulting in fewer tears being spread across the surface of your eye. Ageing, medication and wearing contact lenses also cause a disruption to the eye’s natural protective layer.

Mode of Action Murine Eye Mist restores and stabilises the natural tear film, reducing moisture loss. The Eye Mist applies liposome particles onto the closed eyelids that refresh and maintain the natural moisture in and around the eyes. Murine Eye Mist is formulated to gently moisturise and refresh dry and tired eyes. It’s preservative free and can be used as often as needed. And it’s suitable for use with contact lenses and eye make-up.

Precautions/Contraindications/ Interactions •• If irritation persists, discontinue use and consult a healthcare professional.

•• Do not use product if container is damaged.

“The Eye Mist applies liposome particles onto the closed eyelids that refresh and maintain the natural moisture in and around the eyes.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

Breastfeeding/Pregnancy •• Murine Eye Mist is safe to use during breastfeeding/pregnancy.

Side effects •• No known side effects.

Counselling points How to use the product •• Murine Eye Mist is easy to use. •• Simply hold the spray 10 cm away from the eye. Close eyes and spray directly onto each eyelid 1 to 2 times. Keep eyes closed for 4–5 seconds. This allows the liposome particles to spread onto the surface of the eyes and combine with the natural lipids of the tear film layer. The liposomes spread onto the surface of the eye, restoring and stabilising the natural tear film, reducing moisture loss.

Comparative Information How is it different/better? Murine Eye Mist is preservative free and can be used as often as needed. www.murine.com.au RRP:$16.95

Stockists information, please call 1800 788 870 For more information about Murine Eye Mist, please visit www.murine.com.au

TRAINING AND EDUCATION

Achieving Dispensary Efficiency Doesn’t Have to be Expensive Q. Why is an efficient and effective dispensary system more important than ever? A. The current catchcry in pharmacy is service. Pharmacists are interfacing more frequently with customers to provide professional advice. This often equates to an increased responsibility on pharmacists and dispensing technicians to accurately dispense medications. To maintain the integrity of the system, improved dispensary design and efficient dispensary systems are more important than ever. Further, industry changes are impacting on dispensary costs, margins, and profit, making it even more important to increase the level of dispensary productivity.

Q. Does this necessitate a complete refurbishment of the dispensary? A. Definitely not, as there are many ways to improve dispensary efficiency without an expensive refurbishment. Pharmacists need to audit the dispensary system to determine what changes are needed to make the dispensary more efficient. This can include better ranging of medications and a well organised dispensary will reduce errors and improve customer safety.

Q. Are there any low cost options to improve the dispensary? A. Creating a modern and more workable layout need not be expensive. Simply positioning product dividers between medications can greatly improve shelf management. This will make stocking, selection, and picking more accurate. Further, it prevents intermixing and makes identification easier and script preparation faster. If space is limited, requiring medications to be packed vertically, higher product dividers can be placed between medications to prevent stacks falling over. These product dividers can be fitted to any flat shelves.

“Industry changes are impacting on dispensary costs, margins, and profit, making it even more important to increase the level of dispensary productivity.”

Q. Are there any other ways to improve efficiency with existing systems? A. Several other means are available to create a quicker and more convenient prescription service. For example, the open ends of the finger system can be used to dispense fast movers. Pull-out shelving can be fitted on wall stripping in the open cabinets facing the dispensary bench. Up to three hundred frequently dispensed medications can be placed directly behind the dispensing bench, greatly reducing dispensing time and improving workflows.

Faster moving lines can also be located close to the dispensing bench by placing a row of wall units with pull-out shelving immediately behind the dispensing bench. Four wall units can position up to 450 medications for faster dispensing. The pull-out shelving improves stock rotation and is a low cost way to improve dispensary systems.

Q. How can space be freed up to better range medications?

Q. Are there other ways to improve the dispensary without new building works? A. One very effective way to make the dispensary more efficient is to place a knock down rear-loaded cabinet directly behind the dispensing bench. The cabinet is an affordable way to place up to 400 medications in close proximity to the dispensing bench. This creates the best stock rotation as non-clinical staff can load at the rear as clinical staff dispense from the front.

Q. Where can these Dispensary systems be sourced? A. FlowSell specialises in custom-made dispensary solutions that are tailormade to your requirements. The flexible Dispensary systems can be freestanding, wall mounted, recessed in cabinet shells, under-bench drawers or drawer cabinets. This flexibility can be used to create the most optimal and costeffective dispensary solutions.

A. Under-bench drawers are a perfect way to store all creams and lotions. The drawer cabinet can be placed under the dispensary bench. Twelve drawers can hold up to 200 of these small medications. This provides extra space to better range tablets and capsules. This dispensary technique has proved popular with many pharmacists. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

training and education

Break free from medically diagnosed IBS symptoms DO YOUR CUSTOMERS FEEL TRAPPED BY THE SYMPTOMS OF MEDICALLY DIAGNOSED IBS? Medically diagnosed irritable bowel syndrome (IBS) affects one in five people1. From abdominal pain and bloating, through to alternating constipation* and diarrhoea**, IBS symptoms are varied and have no proven identifiable structural or biochemical cause, leaving many sufferers feeling trapped by its symptoms. Triggers can vary from person to person, and successful management of this condition often begins with identifying specific triggers, such as food sensitivities and stress. Specific probiotic strains, such as Lactobacillus plantarum (299v) found in Ethical Nutrients IBS Support, have been shown to reduce the symptoms of medically diagnosed IBS and improve customers’ wellbeing.

WHICH PROBIOTIC STRAIN IS CLINICALLY PROVEN TO GET RESULTS? A ‘probiotic’ refers to any strain of bacteria or yeast, that when consumed, may have a beneficial effect on your health. However, not all probiotics are the same. Each strain can have very different actions in the body, which

is why it is vital you recommend the right probiotic strain for your customer’s condition, for targeted results. Ethical Nutrients IBS Support contains the specific probiotic strain Lactobacillus plantarum (299v) which has been studied in over 80 clinical studies and 7 human trials. In a double blind, controlled, randomised study on patients with IBS, the probiotic strain Lactobacillus plantarum (299v) was shown to significantly reduce the symptoms of medically diagnosed IBS over 4 weeks2. With such a well-studied strain you can feel confident in recommending Ethical Nutrients IBS Support, to help reduce symptoms such as abdominal pain, bloating, diarrhoea and constipation and to promote healthy digestion and maintain normal bowel function.

WHAT IS THE ROLE OF THE FODMAP DIET IN MEDICALLY DIAGNOSED IBS? Foods high in fermentable sugars and specific carbohydrates (known as FODMAPS) can exacerbate medically diagnosed IBS symptoms in some people. In fact, it has been shown that avoiding these specific foods can reduce IBS symptoms in 3 out of 4 people3. FODMAPS are

“Not all probiotics are the same. Each strain can have very different actions in the body, which is why it is vital you recommend the right probiotic strain for your customer’s condition, for targeted results.”

Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols which are fermentable sugars. FODMAPS can be poorly absorbed by some people and may produce inflammation in the small intestine, leading to water retention in the gut, which can alter bowel motions and lead to uncomfortable symptoms such as abdominal pain, bloating, gas and diarrhoea. The IBS diet is a tool that sufferers can use to quickly identify FODMAPS via an easy-to-understand listing of foods, divided into foods to enjoy and foods to avoid. Used in conjunction with strain specific Ethical Nutrients IBS Support, the IBS diet can be used to strengthen outcomes for IBS sufferers. Always read the label. Use only as directed. If symptoms persist contact your healthcare professional. *Drink plenty of water. ** If diarrhoea persists for more than 6 hours in infants under 6 months, 12 hours in children under 3 years, 24 hours in children aged 3–6 years or 48 hours in adults and children over 6 years, seek medical advice.

For more information on Ethical Nutrients IBS Support, or to read more about the IBS diet, visit www.ethicalnutrients.com.au

1 Ibis-australia.org. Irritable Bowel Information & Support Association - Welcome [Internet]. 2014 Available from: http://www.ibis-australia.org/index.htm 2 Niedzielin K, Kordecki H, Birkenfeld B. A controlled, double-blind, randomised study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2001 Oct; 13(10):1143-7. 3 Shepherd SJ, Gibson PR. Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. J Am Diet Assoc. 2006 Oct;106(10):1631-9. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

TRAINING AND EDUCATION

Betadine Sore Throat Range Sore throats Sore throats are a common symptom and usually one of the first signs of an URTI. Most cases of an acute sore throat are generally not serious and are self-limiting, usually improving within one week. A scratchy, irritated sore throat is usually a sign of a viral infection, and is most likely caused by the actions of prostaglandins and bradykinin on sensory nerve endings in the airway, and the sensation of pain is mediated by the cranial nerves supplying the nasopharynx and pharynx.1

What treatments are available for a sore throat? Antibiotics are not commonly needed for sore throats as the majority of sore throats are self-limiting and of a viral origin. Bacteria account for up to 20% of sore throats, so correct diagnosis is important to determine if antibiotics are required. More serious conditions require this treatment; however, prescribing antibiotics for all sore throats is not always recommended, therefore overthe-counter (OTC) medication as a treatment option is becoming increasingly important.2 Betadine Sore Throat Gargles contain povidone-iodine, an antiseptic with a broad antimicrobial spectrum that includes many types of bacteria and other microorganisms that can cause sore throats. Povidone-iodine is a complex of the polymer polyvinylpyrrolidine and iodine, which retains all the antibacterial properties of elemental iodine without the disadvantages.

What products are in the Betadine Sore Throat Range? •• Betadine Concentrated Sore Throat Gargle is a concentrated povidone-iodine solution that kills most bacteria that can cause sore throats within 30 seconds.*

•• Betadine Ready-To-Use Sore Throat Gargle also kills most bacteria that can cause sore throats within 30 seconds* but does not require dilution before use.

•• Betadine Sore Throat Lozenges are designed for the temporary relief of the symptoms of sore throats. They are iodinefree and contain two other antibacterial agents and are available in three pleasant tasting flavours – soothing honey and lemon, fresh menthol and eucalyptus or orange.**

** There is no clinical evidence that an antibacterial agent in lozenges will make throat infections less severe, or help them get better more quickly.

What is the difference between Betadine Sore Throat Gargle and the Betadine Sore Throat Lozenges? Betadine Sore Throat Concentrated and Ready-to-use Gargles have the advantage of targeting the site of the problem. They contain the active ingredient povidoneiodine which kills the bacteria that can cause sore throats within 30 seconds.*

Who is the Betadine Sore Throat Range suitable for? Adults and children over 6 years. Betadine Sore Throat lozenges can be used in combination with a Betadine Sore Throat Gargle.

Safety information Betadine Sore Throat Gargles are contraindicated in patients with iodine hypersensitivity and thyroid disease, not recommended for use in pregnancy or lactation, or for prolonged or excessive use.

For more information about the Betadine range, please speak to your Sanofi Consumer Healthcare representative or call 1800 732 273

Betadine Sore Throat Lozenges are iodine-free and work differently to Betadine Sore Throat Gargle. Because they are iodinefree, they may be suitable for those who are sensitive to iodine products. *In laboratory studies

“Betadine Sore Throat Gargles contain povidone-iodine, an antiseptic with a broad antimicrobial spectrum that includes many types of bacteria and other microorganisms that can cause sore throats.”

*In laboratory studies

1 Eccles, R. Understanding the symptoms of the common cold and influenza. Lancet Infect Dis 2005; 5: 718–725 2 Oxford, J et al. The international journal of clinical practice. Acute sore throat revisited: clinical and experimental evidence for the efficacy of over-the-counter AMC ⁄ DCBA throat lozenges. Blackwell Publishing Ltd Int J Clin Pract, 2011: 524–530 GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

WHAT’s NEW & company news

“The Glucojel range has been extended to include Glucojel Mint, launched this year.”

GOLD CROSS Glucojel Mint Gold Cross Products & Services is a fully owned subsidiary of the Pharmacy Guild of Australia. Our Charter is to endorse pharmacy only products and services with the Guild’s icon logo, the Gold Cross, which provides an income stream to the Guild and its branch network. Gold Cross offers pharmacies a range of pharmacy specific promotional products such as calendars, paper bags and medication wallets. In addition, pharmacies can benefit from a range of services at discount prices such as Qantas Club, a vehicle buying service, leasing assistance and rent-a car. It also has a range of Gold Cross branded OTC products in the cough and cold, pain management and allergy categories. A list of Gold Cross products and services can be found on our website www.goldx.com.au. Gold Cross is also responsible for the marketing of Australia’s favourite jelly beans – Glucojel. Glucojel is a pharmacy only product and has been available for nearly 75 years, in fact, in 2016 we will celebrate the 75th birthday of Glucojel Jelly Beans.

The Glucojel range has been extended to include Glucojel Mint, launched this year. There is a great deal of 5% discount for orders of 3 or more cartons available to pharmacies until 30 April. To launch the range Gold Cross will be conducting a social media campaign, launching 1 May so visit our Glucojel Face Book page to find out more – www.facebook.com/GlucojelJB. In addition, Gold Cross has commenced the change from artificial colours to natural colours, starting with the Glucojel Mint packet and by mid-2015 all Glucojel packets will be All Natural Colours. Glucojel Jelly Beans are available through all wholesalers, and May will see our popular 5% for 3+ cartons at 5% and 12+ cartons at 7.5% discount deal. Lookout for the order form in the April edition of Community Pharmacy. For more information on Gold Cross Products & Services or Glucojel Jelly Beans, please contact us through enquiries@goldx.com.au or call on (02) 6270 8950.

BioRevive

RB STRENGTHENS S3 CATEGORY FOR PHARMACY

BioRevive are proud to announce a new innovation in their Milky Foot range. Milky Foot Active is a an at-home foot care treatment that contains ExMilac (milk ferment filtrate) and almond-based Mandelic Acid to peel away hardened, dead skin and soften feet and Tannic Acid (tea derivative) to combat foot odour. Standing all day, restrictive shoes, |nylon stockings and exercising in sport shoes can contribute to funky feet issues like hardened, rough skin and bad foot odour. In just one simple application, Milky Foot Active removes hardened dead skin AND fights foot odour to reveal softer and fresh-smelling feet. In 7 days or less, feet can be transformed from rough, tough and stinky to beautiful, milky, soft and fresh.

RB (Reckitt Benckiser) is introducing new Pharmacist-Only (S3) pain reliever Nuromol® with Synchro-Tech™, a powerful combination of paracetamol and ibuprofen to provide healthcare professionals an effective treatment solution for patients experiencing acute pain. The unexpected efficacy of Nuromol® is driven by Synchro-Tech™, a unique patented formulation technology available exclusively to Nuromol®. Synchro-Tech™ enables ibuprofen and paracetamol to dissolve simultaneously into the blood stream. Nuromol® with SynchroTech™ provides, fast pain relief1 which lasts up to eight hours2,3. Nuromol® with Synchro-Tech™, is effective for the temporary relief of acute pain and/or inflammation, and the aches and pains associated with colds and flu. The recommended dose is one tablet, three times per day with a glass of water5, and it should not be taken for more than three days at a time.4 For more information on Nuromol® with Synchro-Tech™, readers can visit www.rbhealthhub.com.au Nuromol® 12 pack RRP: $8.99, Nuromol® 24 pack RRP: $15.99

For more information visit www.milkyfoot.com.au References: 1. Tanner T et al. The pharmacokinetic profile of a novel fixed-dose combination tablet of ibuprofen and paracetamol. BMC Clin Pharmacol 2010;10:10. 2. Daniels SE et al. Pain 2011; 152(3):632-42 3. Mehlisch DR et al. Clin Ther 2010; 32 (5): 882-95 4. Nuromol Approved Product Information

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

WHAT’s NEW & company news

Covidien to distribute Thuasne orthopaedic support range in Australia

Pain expert professor Andrew Moore joins Health Hub Expert series RB has launched two further additional CPD accredited modules in the Health Hub Expert Series, “Tension Type Headaches (TTH)” and “Analgesia FAQs for pharmacists” now available at www.rbhhealthhub.com.au. Both modules feature a video presentation by international pain expert Professor Andrew Moore from the University of Oxford UK, who explores the topics of pain management and over-thecounter analgesia. Professor Moore explains in the Health Hub, pharmacists are often the first health professional a patient consults for advice about their headache, and therefore it’s important they have an up-to-date understanding about headache treatment. Moore also challenges the widespread misconception that NSAIDs must always be taken with food. Vanessa McCutcheon, RB Marketing Manager – Health Care Professional comments, “The Health Hub Expert Series is shaping up as a valuable online resource for pharmacists looking to increase their knowledge and confidence in both the pharmacological and clinical approach to treating minor ailments. Offering expert insights from both physiotherapist Andrew Gallagher and Professor Andrew Moore, the modules provides pharmacists with a broader understanding of the treatment options available and the role they can play in caring for their customers experiencing acute pain.” To start the CPD accredited modules, “Tension Type Headaches (TTH)” and “Analgesia FAQs” visit www.rbhealthhub.com.au and select the module under “Health Hub Experts”.

Global healthcare products leader, Covidien, has announced the launch of the Thuasne orthopaedic support range which will be distributed via pharmacies throughout Australia. The extensive, high-quality range which includes wrist, thumb, elbow, ankle, knee and lumbar braces will be available on shelf from February 2015. Thuasne, a European leader in healthcare products and services, operates in more than 20 countries worldwide, distributing eight million products each year. In collaboration with orthopaedic experts, Thuasne develops innovative and effective orthopaedic aids. With fifteen models in the range, customers will easily be able to identify which support works best for their injury or condition with a specially designed in-store app. The product selection app allows users to select the type of condition they are experiencing or the body part affected before being directed to the right product. Thuasne will also be providing significant product training to pharmacy staff through clinical presentations and events to educate on the full range. The Thuasne range will be exclusively available through pharmacies nationwide. For more information, please visit www. healthcareessentials.com.au For distribution enquiries, contact Covidien on www.covidien.com or 1800 252 467.

obesity epidemic National Heart Foundation CEO, Mary Barry said the Second Lancet Series on Obesity adds weight for a comprehensive approach to the obesity epidemic and further highlights the need for a national obesity strategy. The papers report the debate is becoming increasingly polarised and shows why government needs to act now to:

•• Renew and strengthen the national food reformulation program to reduce excessive sugar, fat and salt in processed food;

•• Move as quickly as possible to make the new Health Star Rating system compulsory for packaged food products;

•• Reduce exposure of children to all marketing and promotion of junk food; and

“The Health Hub Expert Series is shaping up as a valuable online resource for pharmacists looking to increase their knowledge and confidence in both the pharmacological and clinical approach to treating minor ailments.”

•• Explore a tax on sugar sweetened beverages. “The average Australian man now weighs 85.9kg, that’s 6.5kg more than 25 years ago and the average woman has gained 5.7kg now tipping the scales at 71.1kg. “In comparison to 1980, the proportion of obese adult Australians has tripled, while the number of people in the healthy weight range has almost halved. “Carrying too much body fat puts people at risk of cardiovascular and numerous other health problems. “We need to not only halt but we need to reverse the obesity pandemic. It is one of the most important challenges that must be tackled collectively by Government, community and the individual. “These papers are a reminder for all those in government and positions of power that spending on health is an investment, and the key is investing in prevention,” Ms Barry said.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

WHAT’s NEW & company news

Betadine launches new range of antibacterial Sore Throat Lozenges Betadine, Australia’s #1 sore throat gargle brand1 has launched new Betadine Sore Throat Lozenges to provide consumers with another option in their battle against a sore throat. ‘Australians told us they want an on the go solution for relief of sore throats,’ said Mike Abbott, Head of OTC Marketing and Innovation for Sanofi Consumer Healthcare (the Australian distributor of Betadine).

Advances in CoQ10 with Ubiquinol Ubiquinol, produced by Kaneka Corporation, is the solo manufacturer selling Ubiquinol ingredient sold around the world and has made its way to Australia. Developed in 2006, the patented technology supports essential levels of Ubiquinol, the active and reduced form of Coenzyme Q10 (CoQ10), the powerful antioxidant shown in over 1000 studies to help support cellular energy production while providing essential antioxidant support. Ubiquinol is naturally sensitive to air and light and easily gets oxidized back to Ubiquinone (CoQ10). Kaneka have been able to successfully establish technology to deliver a stabilised form of Ubiquinol which is more bioavailable.

‘In response Betadine now offers Betadine Sore Throat Lozenges an antibacterial, on the go solution for fast, soothing and effective relief from the discomfort of a sore throat.’ Mr Abbott said Betadine Sore Throat Lozenges are a great companion product to Betadine Sore Throat Gargle. ‘People can use Betadine Sore Throat Lozenges throughout the day for effective relief and to help kill bacteria which can cause sore throat and minor mouth infection. Betadine Sore Throat Gargle can be used morning and night, which may treat the cause of a sore throat.’ In the lead up to the sore throat season in May, special offers will be available. Speak to your Sanofi Consumer Healthcare representative or call 1800 732 273. Betadine Sore Throat Lozenges come in three flavours, Soothing Honey & Lemon, Orange, Fresh Menthol & Eucalyptus. RRP $6.29 16 pack, $9.99 36 pack.

As we age, the concentration of Ubiquinol in the body decreases year by year, indicating that it has a close relationship with ageing.

UBIQUINOL BENEFITS: •• Strong antioxidant - helps soak up oxidative stress and •• •• •• ••

free radicals Support the heart - helps maintain a healthy heart and vascular system Cholesterol Support - helps maintain healthy LDL cholesterol levels in healthy people More easily absorbed into the body compared to standard CoQ10 Powers Your Cells - helps your body’s cells convert energy

Ubiquinol is now available through leading Australian nutritional supplementation brands, including BioCeuticals, Swisse, NutraLife, Herbs of Gold, Eagle, MediHerb. http://www.kanekaqh.info/

“As we age, the concentration of Ubiquinol in the body decreases year by year, indicating that it has a close relationship with ageing.”

Discover More, Ask Your Pharmacist Market research into the Guild’s new consumer campaign, Discover More. Ask Your Pharmacist has found the combination of beautiful animation, heart-warming story and loveable characters is winning over Australian consumers. The positive news for the Guild and members is that the results show the Discover More campaign is successfully encouraging people to visit community pharmacies more often for healthcare advice. One key finding that supports this is that customers who use a pharmacy less frequently (between two and six times a year) were more likely to consider using a pharmacy for advice and/ or treatment for a non-emergency illness, injury or medical condition after seeing the commercial. Recognition of the gold cross logo as a symbol of trust, service and advice, jumped from 44% to 54% over the first phase of airing the advert and is expected to climb as the campaign continues to run from February 8 to April 4. Discover more. Ask Your Pharmacist represents an opportunity to connect with a multi-million dollar, multi-channel campaign promoting a positive message about your pharmacy business on a national level. For information on how you can be involved, order free campaign posters, badges or a gold cross tile visit: www.guild.org.au/consumercampaign

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

Business directory

Business Directory AFT Pharmaceuticals

Gold Cross

Level 1, 296 Burns Bay Road Lane Cover NSW 2066 Tel: 02 9420 0420 >> www.aftpharm.com

Level 3, 10 National Circuit Barton ACT 2600 Tel: 02 6270 8950 >> www.goldx.com.au

Bayer

FLOWSELL

Head Office PO Box 903 875 Pacific Highway Prumble NSW 2073 Tel: 02 9391 6000 >> www.bayer.com.au

1/13 Network Drive Carrum Downs VIC 3201 Tel: (61-3) 9708 2276 >> www.flowsell.com.au

HEALTH WORLD BioRevive Pty Ltd 182 Stawell Street Burnley, VIC 3121 Tel: 1300 790 978 >> www.biorevive.com

CARE PHARMACEUTICALS Suite 302 Level 3 75 Grafton Street NSW 2022 Tel: 02 9300 1900 >> www.carepharma.com.au

741 Nudgee Road Northgate QLD 4013 Tel: 07 3117 3300 >> www.healthworld.com.au

Sanofi Talavera Corporate Centre Building D 12-24 Talavera Road Macquarie Park NSW 2113 Tel: 02 8666 2000 >> www.sanofi.com.au

Vitaco Level 1, 82 Waterloo Road North Ryde NSW 2113 Tel: 02 9490 0300 >> www.vitaco.com.au

Would you like to advertise in our new Business Directory?

LEASE1 Retailer House – Level 1, Unit 3 321 Kelvin Grove Road Kelvin Grove QLD 4059 Tel: 1300 766 369 >> www.lease1.com.au

Contact Jess O’Connor on Ph: 07 3040 4415 or Email: jessica.oconnor@goldx.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

PRODUCT SPOTLIGHT

ADVANCED JOINT PROTECT AND REPAIR (NEW) – CHOCOLATE FLAVOUR VEGETARIAN GLUCOSAMINE + MSM POWDER Ethical Nutrients Advanced Joint Protect and Repair is a comprehensive joint formula to protect customers’ joint health and relieve mild arthritis symptoms. Containing 1500 mg of vegetarian Glucosamine sulfate, 1500 mg of OptiMSM®, in addition to vitamin D, manganese, silica, borax and vitamin K. Always read the label. Use only as directed. If symptoms persist consult your healthcare professional.

THYROID ASSIST (NEW) – ONE A DAY TO ASSIST HEALTHY THYROID FUNCTION For customers looking to assist healthy thyroid function, Ethical Nutrients now has a comprehensive herbal and nutritional formula Thyroid Assist; containing milk thistle, rhodiola, ginger, rosemary, zinc, iodine and selenium. Thyroid Assist provides the key nutrients required for thyroid hormone production and to assist in healthy thyroid function. Always read the label. Use only as directed. If symptoms persist consult your healthcare professional. >> www.ethicalnutrients.com.au

>> www.ethicalnutrients.com.au

Glucojel Mint Jelly Beans Gold Cross has launched a new flavour – Glucojel Mint. Available in a 70gm packet (36 packets in a carton) Glucojel Mint is available from your preferred wholesaler. Order before 30 April to get a 5% discount for 3 or more cartons. >> www.goldx.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

PRODUCT SPOTLIGHT

Super B Premium Formula Nutra-Life Super B Premium formula is a high potency B formula which contains B1, B2, B3, B5, activated B6, folic acid and B12. It is formulated to support methylation, energy production and encourages healthy cardiovascular function through homocysteine regulation. It also supports healthy nervous system function. Always read the label. Use only as directed. >> www.nutralife.com.au

Betadine Sore Throat Lozenges New Betadine Sore Throat Lozenges helps to kill the bacteria which can cause sore throats. Helps provide fast, soothing and effective relief from the discomfort of sore throats. Iodine free, available in great tasting soothing honey & lemon, fresh menthol & eucalyptus and orange flavours. Always read the label. Use only as directed. If symptoms persist, consult your healthcare professional. ASMI 24387-0115 >> www.betadine.com.au

The Medihoney® Natural Eczema Care Range: The Medihoney® Natural Eczema Care Range is the first independently certified natural eczema skin care range and has been specially developed for those prone to eczema, dermatitis, psoriasis or dry skin. The hero product in the range is Medihoney® Antibacterial Wound Gel™, with the key ingredient Medihoney® medical-grade Manuka honey. RRP $ 13.95 – $26.95 >> Free Call 1800 466 392 >> www.medihoney.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

PRODUCT SPOTLIGHT 60 SECONDS WITH... I decided to become a pharmacist because... I wanted to learn more about how medicines work and to be involved in helping people manage their medicines.

I have been working as a pharmacist for... Only one year!

What I like best about my job is... I like that you can be faced with loads of different problems in such a short period of time, so every day always brings a different set of challenges.

My favourite hobby is... Hiking, there are lots of breathtaking places to see.

Nate Hentschel

Chemist Warehouse

My favourite book is... Any from the series “A Song of Ice and Fire”

My best getaway ever was... I spent a month couch surfing around central Europe which was an exciting experience.

How I keep myself updated to the market news... I subscribe to a lot of pharmacy emails, and also read any industry magazine that finds its way into my workplace.

Over the next 3 years in pharmacy, I predict... A greater focus towards e-scripts and paper-free dispensing, hopefully. We will also embrace and accept the rising use of digital technology in automation and electronic systems in pharmacies.

If I could give any advice to someone starting a career in pharmacy, it would be... Don’t be afraid to implement new services in an old pharmacy.

Tired and Tense? Help relieve your customers’ symptoms with Ethical Nutrients Mega Magnesium Low energy, muscular cramps and spasms and a decreased resilience to stress could all be symptoms of magnesium deficiency. Magnesium is an essential mineral that is used in over 300 different biochemical processes in the body1. Because it is so widely used by the body, it can easily become depleted. Deficiency is surprisingly common with some research indicating 60% of people have low levels2*. Poor diet and lifestyle, stress and some medications are the most common causes of depletion3.

Scientifically studied Meta Mag® for enhanced absorption When selecting a magnesium supplement choose a form that is well absorbed, to ensure the highest possible uptake of magnesium,

which means better results, and less chance of gastric upset. Ethical Nutrients Mega Magnesium contains exclusive Meta Mag® magnesium diglycinate which is a highly absorbed, nutritionally functional form of magnesium. The key to its enhanced absorption is its shape, comprising of a central magnesium molecule covalently bound to two glycine molecules. This form allows Meta Mag® to be absorbed through amino acid absorption channels, rather than competing with other minerals for uptake. For more information visit ethicalnutrients.com.au. Always read the label. Use only as directed. If symptoms persist contact your healthcare professional.

References 1 Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride 1997:190-249. 2 Lukaski HC. Magnesium, zinc, and chromium nutriture and physical activity. Am JClin Nutr 2000; 72: 5855-935 3 http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Muscle_cramp 4 *US population GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

After Hours

AFTER HOURS April/May 2015

ANZAC DAY Why is this day special to Australians? When war broke out in 1914, Australia had been a federal commonwealth for only 13 years. The new national government was eager to establish its reputation among the nations of the world. In 1915 Australian and New Zealand soldiers formed part of the allied expedition that set out to capture the Gallipoli peninsula in order to open the Dardanelles to the allied navies. The ultimate objective was to capture Constantinople (now Istanbul in Turkey), the capital of the Ottoman Empire, an ally of Germany. The Australian and New Zealand forces landed on Gallipoli on 25 April, meeting fierce resistance from the Ottoman Turkish defenders. What had been planned as a bold stroke to knock Turkey out of the war quickly became a stalemate, and the campaign dragged on for eight months. At the end of 1915 the allied forces were evacuated, after both sides had suffered heavy casualties and endured great hardships. Over 8,000 Australian soldiers had been killed. News of the landing on Gallipoli had made

a profound impact on Australians at home, and 25 April soon became the day on which Australians remembered the sacrifice of those who had died in the war. Although the Gallipoli campaign failed in its military objectives, the Australian and New Zealand actions during the campaign left us all a powerful legacy. The creation of what became known as the “Anzac legend” became an important part of the identity of both nations, shaping the ways they viewed both their past and their future. However, Anzac Day goes beyond the anniversary of the landing on Gallipoli in 1915. It is the day on which we remember Australians who served and died in all wars, conflicts, and peacekeeping operations. The spirit of Anzac, with its human qualities of courage, mateship, and sacrifice, continues to have meaning and relevance for our sense of national identity.

The Dawn Service The Dawn Service observed on Anzac Day has its origins in a military routine which is still followed by the Australian Army today. During battle, the half-light of dawn was one

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

of the most favoured times for an attack. Soldiers in defensive positions were woken in the dark before dawn, so by the time first light crept across the battlefield they were awake, alert, and manning their weapons; this is still known as the “stand-to”. As dusk is equally favourable for attacks, the stand-to was repeated at sunset.

The Anzac Day Ceremony At the Australian War Memorial, the ceremony takes place at 10.15 am in the presence of people such as the prime minister and the governor general. Each year the ceremony follows a pattern that is familiar to generations of Australians. A typical Anzac Day ceremony may include the following features: an introduction, hymn, prayer, an address, laying of wreaths, a recitation, the Last Post, a period of silence, either the Rouse or the Reveille, and the national anthem. After the Memorial’s ceremony, families often place red poppies beside the names of relatives on the Memorial’s Roll of Honour, as they also do after Remembrance Day services.

CLASSIFIEDS FOR SALE Shopfittings - approx 50 pieces of wall stripping varying lengths in good condition (some rust but mainly on back) and hundreds of brushed silver 30cm wall brackets that fit into the stripping also in good condition. $150 for the lot. Alchemy Pharmacy, located in a storage shed in East Brisbane. Ph: Roma 0419 837 838 or info@alchemydirect.com.au Xeloda 500mg 120 tablets x 2 boxes. Expiry: 12/2015 at $250.00 per box Contact: Chittaway Centre Pharmacy (02) 4388 4722 20% off the wholesale price off the following: 6 x Prograf XL 5mg cap 30 ( 1 x exp 10/15; 1 x exp 08/15; 2x exp 02/19; 2x exp 06/16) 1 x Prograf XL 1mg cap 60 (exp 08/16) 2 x Prograf 0.5mg cap 100 (exp 10/16)

1 x Invega 6mg (28 tabs) EXP 08/2015 $100 1 x Imojev Vaccination EXP 27/11/2016 $230 Contact: Day and Night Chemist, Newtown, Ibrahim Edelbi Ph: 02 9557 1376 2 x Andriol Testocaps 40mg x60 exp: 6/15 $20.00 each 3 x Levetiracetam SZ 500mg x 60 exp:04/17 $30.00 each. Contact: Kieraville Pharmacy, Shayne, Ph: (02) 4229 5548, 50 Grey Street Keiraville 2500 For sale, all 10% off list price. Includes postage. 2 x Abilify 30mg x 30 tabs - exp 11/16 and 12/16 cost $245.00 each 1 x Invega sustenna 150mg x 1 inj - exp 01/16 cost $365.00 each 1 x Zeldox 40mg x 60 caps – exp 12/16 cost $115.00 each 1 x Zeldox 80mg x 60 caps – exp 06/16 cost $230.00 each Contact: Ladhope Compounding Pharmacy, 131 Wickham Terrace Brisbane. Peter or Karina, ph: 07 3831 3242 or ladchem@bigpond.net.au

1 x Certican 0.25mg tab 60 (exp 05/16) 3 x Certican 1mg tab 60 ( exp 09/16) 2 x Dipentum 500mg tab 100 (exp 05/16) 1 x Neotigason 10mg cap 100 (exp 06/15) 1 x Abilify 20mg tab 30 (exp 01/16)

PLACE YOUR FREE CLASSIFIED ADVERT If you would like to place your free classified ad, forward any items for sale to Jess O’Connor. Email: jessica.o’connor@goldx.com.au

6 x Aranesp 60mcg/0.3mLx4 (exp 06/15; 02/16) Contact: Croydon Park Pharmacy, Rowena (02) 4625 1460 or Jenny (02) 9798 8417

BROUGHT TO YOU BY:

GLUCOJEL MEANS BUSINESS

AND IT IS MADE IN AUSTRALIA Still in the top ten when it comes to over-the counter pharmacy sales, and in pharmacy only. And that means good business for you. Order from your preferred wholesaler: PRODUCT

API

SYMBION

SIGMA

70gm Glucojel x 36

598410

125946

078675

150gm Glucojel x 36

475254

193380

328179

1kg Glucojel x 6

594326

250937

686055

70gm Black Glucojel x 36

698229

591432

487637

Extra Strong Mints x 24

618934

119105

244210

or contact Gold Cross Products and Services for product enquiries. T 02 6270 8950 F 02 6270 8999 enquiries@goldx.com.au

HEALTH CALENDAR

HEALTH CALENDAR APRIL / MAY 2015

World Autism Awareness Day

Food Allergy Awareness Week

2nd April

17th – 23rd May

The eighth annual World Autism Awareness Day is April 2, 2015. Every year, autism organizations around the world celebrate the day with unique fundraising and awareness-raising events. World Autism Awareness Day shines a bright light on autism as a growing global health crisis. WAAD activities help to increase and develop world knowledge of the autism epidemic and impart information regarding the importance of early diagnosis and early intervention. Additionally, WAAD celebrates the unique talents and skills of persons with autism and is a day when individuals with autism are warmly welcomed and embraced in community events around the globe.

Australia has one of the highest reported incidences of food allergies in the world, and the numbers are growing at an alarming rate. In fact, one in 10 babies born in Australia today will develop a food allergy. An allergic reaction can quickly become life threatening and people can die from food allergy. While the risk cannot be removed, it can be managed. It’s up to all of us to be allergy aware – to know how to minimise the risk of a reaction, to know what to do if a reaction happens, and to understand and support family, friends and colleagues living with food allergies.

>> www.autismspeaks.org

Macular Degeneration Awareness Week

>> www.foodallergyaware.com.au

24th – 30th May

Pay It Forward Day 30th April There is tremendous power and positive energy in giving – it is a shame that not enough people have experienced it to the fullest. Pay It Forward Day is about all people, from all walks of life giving to someone else and making a positive difference. In 2014, people from 70 countries participated in Pay it Forward Day with individuals working on proclamations in 36 states & 41 cities. For this year’s international Pay it Forward Day (PIFD) we are aiming to inspire over 3 million acts of kindness around the world. Imagine the difference that would make! >> www.payitforwardday.com

Heart Week

Macular degeneration is the leading cause of blindness and severe vision loss in Australia with more than 1.15 million Australians over the age of 50 having some evidence of the disease. Without appropriate prevention and treatment measures, this number is set to increase to 1.7 million by 2030; due to the rapidly ageing population. Risk factors for macular degeneration include being over the age of fifty, a direct family history, and smoking. This Macular Degeneration Awareness Week the Foundation is urging all Australians over 50 to use the three-step approach for early detection of macular degeneration: Test the eyes and macula as early detection can help save sight, monitor for changes in vision don’t dismiss these as a part of getting older and respond to changes to your vision with an urgent appointment with your eye care professional. >> www.mdfoundation.com.au

3rd - 9th May Each year the Heart Foundation uses Heart Week as an opportunity to shine a spotlight on the problem of heart disease and to help improve the heart health of all Australians. Each year, almost 10,000 Australians die of a heart attack. And more than 1 million Australians aged 30-65 are at high risk of having a heart attack or stroke — but they may not even know they’re at risk. That’s why we are urging all Australians to learn the warning signs of a heart attack and reduce their risk of having one.

Australia’s Biggest Morning Tea

>> www.heartfoundation.org.au

>> www.biggestmorningtea.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 41 : APRIL / MAY 2015

28th May Cancer Council is putting on Australia’s Biggest Morning Tea; it is an opportunity for friends, family or work-mates to get together over a cup of tea (or a skim latte!) and enjoy a bite to eat and good company while raising money to help Cancer Council beat cancer. Despite its name, you can choose to hold an afternoon tea, a BBQ or a dinner if you prefer.

Tony Ferguson goes open! â&#x153;&#x201D; All Pharmacies â&#x153;&#x201D; All Customers (No Supermarkets)

Contact Julie-Ann today to discuss stocking the leading pharmacy weight loss brand. m 0410 417135 e julie-ann.wharley@tonyferguson.com

% 5 DISCOUNT

for orders of 3 cartons or more

coordinate.com.au | GCPS35442

Ends 30 April 2015.

Enjoy the cool, fresh taste of Glucojel Mint jelly beans. Made with all natural colours and especially formulated for instant glucose power, Glucojel Mint jelly beans are refreshingly good. Proudly made in Australia since 1941, Glucojel jelly beans have been a favourite for generations. We hope you too enjoy the taste Australia loves.

AVAILABLE NOW SO ORDER TODAY | www.goldx.com.au | www.facebook.com/GlucojelJB