ITK December/January 2014 - Edition 33 by Gold Cross Products & Services

ISSUE #33 : DECEMBER 2013 / JANUARY 2014

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 C o m m u n i t y P h a r m a c i s t

• Business Profile • News from the New Guild President • Smoking Cessation Feature

• isowhey.com.au •

FOR HEALTHY LIVING

• The Value of Buying Correctly • Vitamin D and Sunscreen • Weight Management

LOW-CARB FORMULA 15g OF PURE WHEY PROTEIN PER SERVE 23 VITAMINS & MINERALS PROBIOTICS, PREBIOTICS & DIGESTIVE ENZYMES NO ARTIFICIAL COLOURS, FLAVOURS, OR SWEETENERS GLUTEN FREE

• isowhey.com.au •

FOR HEALTHY LIVING

CONTENTS SPECIAL FEATURE – SMOKING CESSATION 6

Tobacco Control - Cancer Council Report

8 CPD – the season for quitting 14 Smoking Cessation Service 16 The associated risks with smoking during pregnancy 18 Category Review – The pivotal role of the Pharmacist

20 CPD – Varenicline an oral therapy option for quitting smoking

MERRY CHRISTMAS

24 Which way to quit?

PROFESSIONAL REVIEW 32 A glaring opportunity – sunglasses in pharmacy 34 Vitamin D and Sunscreen

BY SEAN TUNNY

OTHER ARTICLES

Editor, Gold Cross Products & Services Pty Ltd

26 Celebrity Slim Pharmacy Reference Guide to assisting customers to lose weight fast and keep it off

Wow, where has 2013 gone? As this edition of ITK is being delivered to Pharmacists throughout Australia, one of the busiest seasons in retail and life in general is well upon us, that time being the exciting and festive Christmas and holiday season. This edition of ITK is proud to present a range of editorials on smoking cessation in Pharmacy. The support of the Pharmacist for customers who are wishing to quit smoking is the theme of a number of the comprehensive editorial pieces within this edition. We would like to thank the contributors and commercial supporters of this key pharmacy category—Quit smoking is one of the Top 5 New Year’s resolutions. In drawing a festive close on this welcome, I would like to extend a sincere thank you to all our contributors and many partners in 2013; the success of our publication is due, in no small part, to your overwhelming support. A very Merry Christmas and happy holiday season to you and your families and we wish one and all a very prosperous 2014. Best Regards, Sean Tunny Editor

28 Category Review – Weight Management

GUILD NEWS 4 News from the New Guild President

40 My CPD – New Online CPD accredited modules available

BUSINESS PROFILE 30 Sunshades Eyewear

DOWN TO BUSINESS 38 The Value of Buying Correctly

REGULARS 51

60 Seconds Interview

52 Classifieds 51 Health Calendar 47 Product in Action 50 Product Spotlight 42 What’s new and Company news

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

BROUGHT TO YOU BY:

PROUDLY AUDITED BY:

Circulation: 5,736 CAB Audit Period: April 2013 to Sept 2013.

PUBLISHED BY: Gold Cross Products & Services. PO Box 505 Spring Hill Qld 4004. Contact Candice Radford Email: Candice.radford@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 constitue 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.

2nd BioCeuticals Research Symposium Unravelling 21st Century Epidemics

Registrations now open! Sofitel Sydney Wentworth 11 - 12 April 2014 Themes: • • • •

New research and cutting edge interventions for better clinical outcomes Revealing the real causes of chronic disease Uncovering critical risk factors which commonly undermine patients’ health Critical strategies for complex cases

Topics include: • • • • • • • • •

Dyslipidemia, hypertension and cardiovascular disease Cancer development and progression Nutrigenomic and epigenetic influences on chronic lifestyles An individualised approach to type 2 diabetes Renal nutrition and the role of synbiotics for treating kidney disease Advanced strategies for obesity management Infant probiotics for allergy prevention Inflammatory/immune regulation through the gut and gut bacteria A wholistic approach to silent inflammation

We warmly invite our valued practitioner clients to join us in hearing the latest in clinical research, effective approaches to treatment, and most importantly, relevant and practical information from around the world.

www.bioceuticals.com.au/education/events Packages are available for groups of 10 or more guests. Please contact Felicity Nevin, Event Manager at Felicity_Nevin@fit.net.au to receive a quote. * BioCeuticals will be seeking CPD & CPE accreditation for this event. More information on the qualifying associations and points breakdown will be provided soon.

NEWS FROM THE GUILD PRESIDENT

News from the New Guild President George Tambassis National President of The Pharmacy Guild of Australia

This is an interesting time to take on a leadership role in community pharmacy, and as the new National President of the Pharmacy Guild I’m looking forward to the challenge. There are plenty of aspects of the pharmacy horizon that are daunting, but I prefer to think of the future as a big opportunity for us to progress the profession, and work together towards achievable outcomes for pharmacists and for patients. The ultimate aim of everything I do in the industry will be to maintain the relevance of community pharmacy in the healthcare sector. I want to make sure pharmacy maintains its place in our ever-changing world by continually advancing the profession and providing the public with services, value and advice they will not get elsewhere. I am proud to have been in community pharmacy for 25 years as a Melbourne-based pharmacist, and joined the Guild Branch Committee in Victoria in 2005. My pharmacies are varied in business style and structure, and they include locations in

shopping centres, strip shops, medical centres and rural towns. Some trade under various brands and others are independents. We certainly promote pharmacotherapy in most of my pharmacies as well as specialising in areas such as wound care and professional programs. I understand wages pressures through award changes and the difficulty in operating day & night pharmacies with penalty rate provisions. The complexity in dealing with various pharmacy brands is also an area that I get involved with to better deal with the competitive nature of open sellers in categories that are available in other establishments. Landlords and leases are also another area in pharmacy that I tend to get involved in as I deal with various landlords, and types of landlords in my pharmacies.

“The ultimate aim of everything I do in the industry will be to maintain the relevance of community pharmacy in the healthcare sector.”

As I contemplate the challenges and opportunities ahead, these are some of my thoughts:

•• Community pharmacy operates in an everchanging environment which means we need to be thinking ahead and anticipating some of the impact of that change. •• The medium and long-term future of the profession depends on the next generation, and we must do everything possible to attract them to our industry, nurture them, teach them and ultimately make way for them. •• The fear of change should not scare people, rather, we must embrace change and adapt to it. •• My view is to never waste a good crisis. While we need to be realistic, we must also deal in hope so we can spot opportunities as they come along. I have travelled quite frequently to the United States where I have family and friends, and I certainly would not like to see the Australian community pharmacy environment head towards what is happening there. Access to professional pharmacy care and advice in Australia seems quite luxurious compared to the American model. It is a great system we have here for patients – we should keep it and nurture it. I look forward to the opportunity to meet more people from the industry across Australia. I believe we have a vibrant, essential industry doing great things for healthcare consumers.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 33 : DECEMBER / JANUARY 2014

The pivotal role of the Pharmacist PAGE

Smoking during pregnancy PAGE

Tobacco Control PAGE

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Cancer council report

The role of community pharmacy in

Tobacco control

Pharmacists are among the most frequently visited health professionals in Australia, making them well-positioned to encourage smokers to quit and play a key role in the fight against tobacco. Pharmacists also have a professional responsibility and legal duty of care to protect the health of their patients, demanding an active role in smoking cessation12. Evidence shows that pharmacists and their staff can play an effective role in facilitating smoking cessation with patients3,4. Smoking rates in Australia

“Pharmacists have a central role to play in providing patients with brief advice to stop smoking, which can have an immediate and positive impact.”

Tobacco remains the leading cause of preventable death in Australia. Currently 15.1 per cent of the population (14 years and over) are daily smokers and about 15, 500 people die from tobacco related disease every year5,6.

Providing advice to quit Pharmacists have a central role to play in providing patients with brief advice to stop smoking, which can have an immediate and positive impact. It is important that every smoker is asked about their smoking when interacting with a health professional as we know this increases their chance of quitting successfully. While this is often thought to be time consuming, it is possible to support your patients to quit smoking by providing very brief advice.

2As and R framework The 2As and R framework is a briefer alternative to the commonly used 5As approach to brief intervention. This may be

an easier approach to use when you are busy, while still ensuring you are asking all smokers about their tobacco use. Ask

‘Do you use tobacco?’

Advise

Give a strong message to seek help in quitting, ‘Quitting tobacco is one of the best things you can do for your health. I strongly encourage you to quit.’

Refer

Refer to Quitline – 13QUIT or health professional

Useful information on NRT The aim of Nicotine Replacement Therapy (NRT) is to reduce the withdrawal symptoms associated with nicotine addiction by replacing some of the nicotine obtained from cigarettes. Blood nicotine levels are lower in people using NRT compared to people who smoke. This means that for heavy smokers, the standard doses of NRT may not be sufficient to manage nicotine cravings and withdrawal symptoms which may result in relapse.

The following graph illustrates the differences in blood plasma levels of nicotine over 24 hours for an ‘average’ smoker (25 cigarettes/day) compared to different forms of NRT. The graph shows that NRT provides a level of nicotine in the blood, which is less than that provided by cigarettes. It is important to explain this to smokers so they understand how much support NRT will provide. Heavy smokers may also require combination therapies such as patches and gum.

or combustion, the vapor produced from the e-cigarette delivers nicotine and a physical sensation similar to that of inhaled tobacco. E-cigarettes are being marketed as a healthy alternative to smoking and an effective product to use to assist with quitting smoking. E-cigarettes have not been approved by the Therapeutic Goods Administration in Australia as there is a lack of evidence on the safety of these products. If clients ask whether they should try the e-cigarette to help them quit smoking, please warn them against its use as there is not enough evidence to show that they are an effective tool for quitting smoking. Instead, encourage nicotine dependent clients to try a proven, effective, safe and legal form of NRT.

Refer your patients to join the QUEST and reduce their cancer risk Ref: Quit South Australia Factsheet ‘NRT’ accessible: http://www.quitsa.org.au/cms_resources/NRT%20 -%20Feb%202011.pdf

What are e-cigarettes? The electronic cigarette, or e-cigarette, is a battery-powered product that has a similar shape and size of a regular cigarette and is used as an alternative to smoked tobacco. Although there is no tobacco smoke

Cancer Council Queensland is pleased to provide a world-first program to encourage and enable Queenslanders to make small, long-term changes to their everyday lives to encourage healthy behaviours and ultimately, reduce the risk of cancer. Whether it’s support to quit smoking, maintaining a healthy weight, eating healthily, getting active or protecting their skin from the sun, the QUEST program can support your patients to reduce their cancer risk. Visit www.quest.org.au to find out more.

(Endnotes) 1 Australian Government Department of Health and Ageing. The national strategy for quality use of medicines: Executive summary. Canberra: Commonwealth of Australia, 2002. 2 Pharmaceutical Society of Australia. Competency standards for pharmacists in Australia 2003. Canberra: PSA; 2003. Available at: www.psa.org.au/site.php?id=643 3 Dent L, Harris K and Noonan C. Tobacco interventions delivered by pharmacists: a summary and systematic review. Pharmacotherapy 2007;27(7):1040–51. Available from: http://www. atypon-link.com/doi/abs/10.1592/phco.27.7.1040 4 Sinclair HK, Bond CM and Stead LF. Community pharmacy personnel interventions for smoking cessation. Cochrane Database of Systematic Reviews 2004. (1)DOI: 10.1002/14651858. CD003698.pub2 Available from: http://www.mrw. interscience.wiley.com/cochrane/clsysrev/articles/ CD003698/frame.html 5 Australian Institute of Health and Welfare. 2010 National Drug Strategy Household Survey: survey report. Drug statistics series no. 25, AIHW cat. no. PHE 145. Canberra: AIHW, 2011. Available from: http://www.aihw.gov.au/publication-detail/?id=322 12254712&libID=32212254712&tab=2 6 Begg S, Vos T, Barker B, Stevenson C, Stanley L and Lopez A. The burden of disease and injury in Australia 2003. PHE 82. Canberra: Australian Institute for Health and Welfare, 2007. Available from: http://www.aihw.gov.au/publications/index. cfm/title/10317

CONTINUING PROFESSIONAL DEVELOPMENT

The season for

Quitting BY ANTHONY TASSONE B.Pharm (Hons), Cert IV (TAA), Dip Mgt, AACPA, President of the Pharmacy Guild of Australia (Victorian Branch)

From reading this article you will be able to: • identify available NRT products • understand the benefits of combination and pre-quit therapy • appreciate that some products may be more suitable in certain patient groups than others

The festive season brings a time of celebration of indulgence. For many, particularly as part of a New Year’s resolution, it will also involve an attempt to quit smoking. Although smoking rates among adults in Australia have declined over the past 20–30 years, it still remains a major social cost to the Australian community with estimates of total social costs of tobacco use being $31.5 billion in 2004/05.1

Smoking is the leading cause of preventable death for Australians, and it is well documented as being a major cause of: heart disease, stroke, different forms of cancer and a wide variety of other health problems. In the latest Australian survey from 2006, the age group of 24–29 year olds had the highest rate of smoking with a higher percentage of Australian men smoking compared to women in all age groups.1

NICOTINE REPLACEMENT THERAPY (NRT)

NRT PATCHES

It is also important for pharmacists to reassure patients that NRT products will increase their chances of quitting even if they don’t completely control their cravings for nicotine; however, NRT products have been shown to reduce the severity of cravings.3 Cravings for nicotine are most present in those showing some addiction to nicotine, signs of which can include:4

The transdermal patches generally come in two forms, a 16-hour patch (e.g. Nicorette® in 3 strengths delivering: 15mg, 10mg and 5mg of nicotine over 16 hours – applied in the morning and removed at night) and a 24-hour patch (e.g. Nicabate®, Quit-X®, Nicotinell® in 3 strengths delivering: 21mg, 14mg and 7mg of nicotine over 24 hours, applied in the morning and removed the next morning).

•• smoking the first cigarette within 30 minutes of waking up

Community pharmacies form a perfect destination point for individuals considering quitting smoking with not only clinically proven and effective over-the-counter treatments in the form of Nicotine Replacement Therapy (NRT), but also the coupled expert advice of a pharmacist.

•• smoking more than 10 cigarettes per day

All forms of NRT, whether it be a transdermal patch, gum, lozenge or inhaler have been proven to help individuals quit smoking.2

Commercially available NRT products on the market include transdermal patches, chewing gum, lozenges, mini-lozenges and inhaler devices.

(there is no difference in terms of the strength of nicotine in the cigarette) •• suffering withdrawal symptoms such as cravings, irritability, anxiety, depression, restlessness and poor concentration within 24 hours of stopping smoking

The 21mg 24-hour patch and the 15mg 16-hour patch are also listed on the Pharmaceutical Benefits Scheme (PBS) on prescription, with the possibility of one 12-week course of patches (up to four weeks with two repeats) being available through the PBS per year. However, to be eligible for the prescription, the patient needs to take part in a support program (such as that provided by Quitline – more information available at: www.quit.org.au).

CONTINUING PROFESSIONAL DEVELOPMENT

There are clear or transparent patches also available that are less visible than conventional transdermal patches, depending on patient preference. Transdermal patches help to slowly release nicotine which is absorbed into the blood stream and assist with reducing withdrawal symptoms when quitting smoking. However, they may not stop all of these symptoms completely, and combination NRT therapy (e.g. a transdermal patch plus a lozenge or chewing gum) may be required.5 Combination therapy has been shown to be better at suppressing cravings than a single nicotine product, with some experts advising that most addicted smokers may benefit from using combination therapy.4 This is discussed more, later in the article. Importantly, people who use nicotine patches are nearly twice as likely to quit smoking and stay stopped than with no therapy at all.2 Transdermal patches release the nicotine at a much slower rate than smoking, making it less addictive and easier to ‘wean off’ nicotine from patches than using cigarettes.3 Cigarette smoking results in high levels of nicotine reaching the brain within seconds; however, nicotine blood levels slowly rise after application of a transdermal patch with peaks between 2–10 hours (depending on the brand used).4 Research has shown that a 16-hour patch works as well as a 24-hour patch.2 There may be preferences, however, amongst some patients between a 16 or 24-hour patch. For example, 24-hour patches may have a greater incidence of sleep disturbances as an adverse effect due to the stimulant effects of nicotine being released overnight. However, a 24-hour patch may assist with morning cravings better than a 16-hour patch as there is still nicotine in the system the next morning and there has not been ‘withdrawal’ from overnight.5 In general, the product information for transdermal patches will recommend starting on the highest strength (e.g. 15mg of 16-hour or 21mg of 24-hour) and then gradually reducing the strength over a period of time; however, depending on smoking habits and body weight, a doctor or pharmacist may recommend a lower strength to commence with.4

THE ‘PRE QUIT’ STAGE A relatively new product on the market is a ‘Pre-Quit’ patch range which is a 21mg over24-hour patch. It is targeted towards people who smoke 15 or more cigarettes per day to help them reduce their smoking for 2 weeks prior to their pre-determined ‘quit date’. On the quit date, pharmacists may suggest to use a regular patch or combination therapy. There is evidence to suggest that the ‘pre-quit’ method can improve the chances of quitting, by setting pre-determined and realistic goals over starting NRT from a quit date.3 When considering the notion of ‘pre-quitting’, it also brings up the notion of smoking during the use of NRT which has previously been advised against due to potential ‘overdose’ of nicotine or increasing the risk of adverse effects. Although there are certain patient groups who should definitely

not smoke whilst using a patch, (individuals who smoke less than 15 cigarettes a day, have cardiovascular disease or weigh less than 45kg)6 evidence suggests that smoking while using a patch is safe for ‘eligible smokers’ and may improve overall chances of quitting (by working towards a final quit date) with symptoms of nicotine overdose being rare.6 The most commonly reported adverse effect of transdermal-patches is a rash on the site of application (moving the patch to new areas of the skin each day will reduce skin irritation).7 Some users may experience sleep disturbances or vivid dreams, particularly with the high dose 24-hour patch, and in these cases it’s recommended to either take off the 24-hour patch just before bedtime or switch to the 16-hour patch.6 Less common side effects include: headache, nausea and indigestion, with most users rating these as mild.7

“Community pharmacies form a perfect destination point for individuals considering quitting smoking with not only clinically proven and effective overthe-counter treatments in the form of Nicotine Replacement Therapy (NRT), but also the coupled expert advice of a pharmacist.”

CONTINUING PROFESSIONAL DEVELOPMENT

“Combination therapy of NRT (using two types of nicotine products, such as a patch with gum or lozenge) has been shown to increase the chances of quitting over one product alone.” NRT GUM NRT chewing gum comes in two strengths, 2mg and 4mg (e.g. Nicorette®, Nicotinell® and Quit-X®) whilst lozenges also come in 2mg and 4mg strengths (e.g. Nicabate®) and mini-lozenges 1.5mg and 4mg strengths (Nicabate®). It has been shown that people who use the nicotine gum are about one and a half times more likely to quit and stay stopped, whilst those who use the lozenge are approximately twice as likely to quit and stay stopped.2 Chewing gum, lozenges and mini-lozenges will all release nicotine at a slower rate than smoking a cigarette, with peak levels being reached in 35–40 minutes for chewing gum8, and an hour for lozenges.9 Mini-lozenges dissolve more quickly than regular lozenges—in 10–13 minutes compared to 20–30 minutes.10 In terms of the strength of gum or lozenge to use, a general guide can be to recommend the 2mg strength if less than 20 cigarettes are smoked per day and 4mg for over 20 cigarettes.11 8 There is also research to suggest that using a 4mg product may be more suitable for those who usually smoke within 30 minutes of waking.12 When using the gum, it is critical that patients understand the ‘chew-rest’ technique of chewing the gum until a tingle is felt (the nicotine being released) and then resting on the side of their mouth (between their teeth and cheek)

until the tingle goes, then repeat chew and rest. This process could take half an hour – but it is important that patients understand not to use it like regular chewing gum.8 Lozenges should not be chewed or swallowed. Patients should be advised to avoid eating or drinking (except water) fifteen minutes prior to and during use of nicotine gum or lozenges. Acidic foods or drinks may reduce the absorption of nicotine across the buccal mucosa and reduce overall effectiveness.13 8 Common adverse effects of NRT chewing gum include: hiccups, sore mouth or jaw, headache, indigestion and nausea; however, most users rate these reactions as mild.6 Some of these symptoms may be relieved by chewing the gum more slowly and resting the gum. Common adverse effects of the lozenge include: hiccups, indigestion, sore throat and mouth irritation.13 When discussing quitting smoking with women it’s important to consider appropriateness and safety in pregnancy and breastfeeding. In the first instance, it is recommended to try and quit smoking without any medication. However, this may not be possible. Although NRT products are not entirely risk free for pregnant or breastfeeding women in terms of delivering nicotine, it would still be preferred over smoking – and advice should be sought from a doctor. For pregnant women, non-patch products should be considered first as they deliver an ultimately lower level of nicotine and reduce exposure to the fetus. However, if nausea occurs, a patch may be used, but is only recommended for use during the day— removing before bed.7 14

For breastfeeding women, it is not recommended to use a patch, but rather use a gum, inhaler or lozenge product.15 15 If gum, inhaler or lozenges are used, it is recommended to breastfeed first then use the NRT product in accordance with directions to minimise nicotine exposure to the baby.7 15

COMBINATION NRT As mentioned earlier, combination therapy of NRT (using two types of nicotine products, such as a patch with gum or lozenge) has been shown to increase the chances of quitting over one product alone. Combination therapy has been approved for the use of 15mg 16-hour patch or 21mg 24-hour patch with the 2mg gum or lozenge (or 1.5mg mini-lozenge).4 After applying the patch to reduce withdrawal symptoms, nicotine gum or lozenges are used to relieve cravings. Product information recommends using at least four pieces of gum or lozenges per day and no more than 12 pieces per day. 7 15 Although all forms of NRT have been clinically proven to improve the chances of quitting smoking, and that combination therapy is better at suppressing cravings and may provide additional benefit, ultimately, research has also shown that people have the best chance of quitting when using NRT if they are also supported by their doctor, pharmacist or other trained advisor (e.g. through Quitline).2 Pharmacists are perfectly placed through their accessibility and knowledge of NRT products and applying that knowledge to suitability of people trying to quit to provide that support and ultimately improve the health of the community.

“Pharmacists are perfectly placed through their accessibility and knowledge of NRT products and applying that knowledge to suitability of people trying to quit to provide that support and ultimately improve the health of the community.”

CONTINUING PROFESSIONAL DEVELOPMENT

Accreditation number: G2102158 The activity is approved for 1 hour activity:

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

Question 1

Question 4

Which of the following statements is MOST appropriate in relation to effectiveness of 16-hour and 24-hour nicotine patches?

Which of the following is MOST appropriate in relation to a general guide to recommending a strength of gum or lozenge?

a. The 16-hour patch has been found to be more effective in all patient groups.

a. 2mg if less than 20 cigarettes are smoked per day.

b. The 24-hour patch has been found to be more effective in all patient groups.

b. 2mg if more than 20 cigarettes are smoked per day.

c. Both the 16-hour and 24-hour patches have been shown to be effective—there may be individual preference or response to adverse effects.

c. 4mg if less than 20 cigarettes are smoked per day.

d. The 16-hour patch is most appropriate for breastfeeding mothers. e. The 24-hour patch is most appropriate for pregnant mothers.

Question 2 In which patient group/s is a ‘Pre-Quit’ regime NOT appropriate? a. Individuals who smoke less than 15 cigarettes a day b. Individuals who smoke more than 15 cigarettes a day

0.5 Group 1 CPD credit suitable for inclusion in an individual pharmacist’s CPD plan OR 1.0 Group 2 CPD credit suitable for inclusion in an individual pharmacist’s CPD plan upon successful completion of assessment. Suggestions for elements of competency addressed as defined by the National Competency Standards Framework for Pharmacists in Australia 2010: Domain 4

Review and supply prescribed medicines

Standard 4.2

Consider the appropriateness of prescribed medicines

Standard 4.3

Dispense prescribed medicines

Domain 6

Question 5

Deliver primary and preventive health care

Standard 6.1

Which of the following is the LEAST appropriate in relation to recommending an NRT product for a breastfeeding woman?

Assess primary health care needs

Standard 6.2

Deliver primary health care

Domain 7

Promote and contribute to optimal use of medicines

c. Breastfeeding should occur before using the gum or lozenge product.

Standard 7.1

Contribute to therapeutic decision-making

d. A patch is the most preferred option.

Standard 7.2

Provide ongoing medication management

d. Any of the above e. None of the above

a. A patch is not generally recommended. b. Nicotine gum can be considered for use.

e. Nicotine lozenges can be considered for use.

c. Individuals who have cardiovascular disease d. Individuals who weigh less than 45kg e. Choices a, c and d

Question 3 Which of the following statements is MOST appropriate about the effectiveness of nicotine gum and lozenges? a. Nicotine gum has been shown to be one and a half times more likely to quit. b. Nicotine lozenges have been shown to be approximately twice as likely to quit. c. Nicotine lozenges are more effective than gum for most patients. d. Nicotine gum is more effective than lozenges for most patients. e. Choices a and b

(Endnotes) 1 Quit website: www.quit.org.au (accessed: 9/10/12) 2 Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.:CD000146. DOI: 10.1002/14651858. CD000146.pub3 3 Kozlowski LT, Giovino GA, Edwards B, Difranza J, Foulds J, Hurt R, et al. Advice on using over-thecounter nicotine replacement therapy-patch, gum, or lozenge-to quit smoking. Addictive Behaviors 2007;32(10):2140-2150. 4 Zwar N, Richmond R, Borland R, Litt J, Bell J, Caldwell B, et al. Supporting smoking cessation: a guide for health professionals. Melbourne: The Royal Australian College of General Practitioners; 2011. 5 Henningfield JE, Fant RV, Buchhalter AR, Stitzer ML. Pharmacotherapy for nicotine dependence. CA: A Cancer Journal for Clinicians 2005;55(5):281-299; 325. 6 Fant RV, Buchhalter AR, Buchman AC, Henningfield JE. Pharmacotherapy for tobacco dependence. Handbook of Experimental Pharmacology 2009;(192):487-510 7 GlaxoSmithKline Consumer Healthcare. Nicobate, Nicobate Clear and Nicobate Pre-Quit. Rate controlled nicotine transdermal patches [product information]. Ermington, NSW: April 2008

8 Johnson & Johnson Pacific. Nicorette(R) chewing gum 2mg & 4mg [product information]. Ultimo, NSW: January 2007. 9 Choi JH, Dresler CM, Norton MR, Strahs KR. Pharmacokinetics of a nicotine polacrilex lozenge. Nicotine & Tobacco Research 2003;5(5):635-644 10 GlaxoSmithKline Consumer Healthcare. Nicobate mini lozenges [product information]. Ermington, NSW: November 2008. p.10 11 GlaxoSmithKline Consumer Healthcare. Nicobate soft gum: 2 mg and 4mg nicotine. Consumer medicine information [package insert]. Ermington, NSW: July 2007. 12 Fagerstrom K. Time to first cigarette; the best single indicator of tobacco dependence? Monaldi Archives for Chest Disease 2003;59(1):91-94. 13 GlaxoSmithKline Consumer Healthcare. Nicobate lozenges: 2 mg and 4 mg nicotine. Consumer medicine information [package insert]. Ermington, NSW: August 2008 14 Johnson & Johnson Pacific. Nicorette(R) patch [product information]. Ultimo, NSW: January 2007 15 GlaxoSmithKline Consumer Healthcare. Nicobate, Nicobate Clear and Nicobate Pre-Quit. Rate controlled nicotine transdermal patches [product information]. Ermington, NSW: April 2008

Help your customers become quitters! The range is indicated for the treatment of nicotine dependence, as an aid to smoking cessation and as part of an effective behavioural therapy program.

Nicotine Patches Nicotine Patches 21mg x 7 Active Ingredients: Nicotine 52.5mg RRP: $29.00

Nicotine Patches 14mg x 7 Active Ingredients: Nicotine 35mg RRP: $27.00

Contains: Adhesive (Acrylic/Acrylate Copolymer), preservatives. Does not contain: Paraffin, animal products, sucrose, gluten or lactose.

Nicotine coated chewing gum Nicotine coated chewing gum, mint flavoured 2mg x 96 Active Ingredients: Nicotine 2mg RRP: $28.00

Nicotine coated chewing gum, fruit flavoured 2mg x 96 Active Ingredients: Nicotine 2mg RRP: $28.00

Contains: Sorbitol, xylitol, mannitol, artificial sweetner (saccharin), saccharin sodium and preservatives. Does not contain: Gluten.

www.chemistsown.com.au Always read the label. Use only as directed. Incorrect use could be harmful. If symptoms persist, see your healthcare professional. ÂŽ Registered trademark of Aspen Pharma Pty Ltd, 34-36 Chandos Street, St Leonards NSW 2065. Chemistsâ&#x20AC;&#x2122;Own Pty Ltd. (A member of the Aspen Group of Companies) Aspen Pharma Pty Ltd., 34-36 Chandos Street, St Leonards NSW 2065. Email: custservice@chemistsown.com.au *RRP = Recommended Retail Price. The Recommended Retail Price (RRP) referred to in this document are recommended only and there is no obligation on the retailer to comply with these recommendations. 24832

HEALTH PROMOTION

IMPLEMENTING A

Smoking Cessation

Service BY HELEN STRACHAN Pharmacy Practice Officer The Pharmacy Guild of Australia, Queensland Branch.

Quitting smoking can be one of the most difficult and rewarding things a person can do. Most smokers would like to quit and have usually tried a few times. Some are successful the first time but others try a number of times before achieving success or regrettably, giving up completely.

“The Quality Care Pharmacy Program (QCPP) provides templates for a smoking cessation service.”

Implementing a smoking cessation service in community pharmacy Community pharmacies are often the first place a person will visit when deciding to quit smoking. This is usually a personal decision and sometimes quite a nervous experience. With this in mind, staff need to show empathy and provide support.

A smoking cessation service provides customers with the following:

Statistics ••

Over 19% of Australians smoke (more men smoke than women).

••

Over 9000 Australians are diagnosed with lung cancer each year.

••

Almost 350,000 hospitalisations are due to lung disease.

••

COPD is the second leading cause of avoidable admissions in Australia.

••

More than 7500 Australians die from lung cancer each year.

•• •• •• •• ••

personal support resources product selection a quit smoking plan access to other services including screening and risk assessment and disease state management, which may include lung testing, blood pressure monitoring, device technique, educational advice and other health care professional referrals.

HEALTH PROMOTION

Be prepared to quit

• Identify the reasons for quitting

• Create a plan • Put the plan into action

How to implement the service The Quality Care Pharmacy Program (QCPP) provides templates for a smoking cessation service. The QCPP Requirements Manual outlines requirements for this service under template T3E. Other templates to support this service include Screening and Risk Assessment T3C, Disease State Management Service T3I and Interprofessional Collaboration template and policyT2E/P2I.

A smoking cessation service should include the following: •• staff involved in the service are to be

•• ••

•• •• •• ••

trained in the elements of smoking cessation resources used in the pharmacy and this training is to be documented on staff training record cards T15B access to relevant resources equipment of therapeutic devices comply with Australian Standards and are listed on the Australian Register of Therapeutic Goods equipment is to be maintained and calibrated (if required) follow store procedure system for communicating with other health care professionals recording system maintained

References: 1. Lung Foundation Australia

2. www.quitnow.gov.au

Planning a health promotion for Quit Smoking If your pharmacy is registered for Health Promotion under PPI priority area of Primary Health Care, refer to template T3H, ensuring you document the following:

•• the target audience •• promotion material e.g. window •• •• •• •• •• •• ••

2 3 Methods Available

• Quit packs • Nicotine replacement products

• Cold turkey • Hypnotherapy

STEPS TO QUITTING

displays, bag fillers and local media resources required length of the promotion venue staff involvement training requirements evaluation of the promotion recording system

Support • • • • •

The benefits of quitting

Family and friends Community Pharmacy Doctor Quit coaches Online support

Without stating the obvious there are many benefits for quitting smoking:

HOURS

5 DAYS

Excess carbon Most nicotine monoxide is out of the is out of the body blood

3. The Heart Foundation

WEEK

MONTHS

YEAR

YEARS

Taste and smell improves

Lung function improves

The risk of heart disease is halved

The risk of stroke has dramatically decreased

The risk of heart attack and stroke is almost the same as someone who has never smoked

A pack-a-day smoker will have saved over $4000

Professional review

The associated risks with

Smoking during pregnancy Melissa Antonel B.Pharm

Tobacco smoking is still the leading cause of preventable illness and premature death in Australia1, and one of the leading motivators to quit smoking is pregnancy. In Australia approximately 20% of women report that they smoked while pregnant and or breastfeeding.2 This percentage is alarming as tobacco use during pregnancy is associated with numerous obstetrical, fetal and developmental complications.3 High-level evidence identified in the NICE guidelines indicates a significant association between smoking in pregnancy and adverse outcomes.

Effects on the pregnancy include: •• •• •• •• •• •• •• •• ••

•• •• •• •• ••

perinatal mortality placental abruption preterm premature rupture of membranes ectopic pregnancy placenta praevia preterm birth miscarriage Effects on the baby include: reduced birth weight (with babies born to smokers being a consistent 175–200g smaller than those born to similar nonsmokers) birth defects including cleft lip and palate small-for-gestational-age baby stillbirth fetal and infant mortality sudden infant death syndrome

Although studies into long-term effects report conflicting results, there is evidence of an association between low birth weight and coronary heart disease, type 2 diabetes and adiposity in adulthood, fourfold increased risk of having allergic skin disease by 18 months of age and childhood respiratory disorders such as asthma and wheezing.2,4 According to a recent study, Australian children of mothers who smoked while pregnant are approximately 42% more likely to be obese by their early teens compared to mothers who did not smoke while pregnant.2 Maternal exposure to passive smoke may also result in premature birth and lower birth weight for their babies. There is emerging evidence that the risk of some childhood cancers increases as a result of the mother’s exposure to passive smoke during pregnancy.2, 4 Cigarettes contain nicotine and other intentional and unintentional additives, which are by-products of growing, handling,

and manufacturing tobacco and include pesticides and herbicides. In addition, when ignited, the chemicals combust leading to additional poisonous by-products including carbon monoxide, nickel, arsenic, lead, free radicals and other carcinogens.1,5 As nicotine is addictive, smoking cessation is often difficult and quitters experience nicotine withdrawal symptoms (craving, anxiety, irritability) once the plasma nicotine level drops below a threshold. Nicotine replacement therapy replaces some of the nicotine from cigarettes without being exposed to the harmful constituents of tobacco smoke. It is an effective therapy designed to keep the patient’s nicotine levels just above the threshold.1 Pregnant women are strongly encouraged to stop smoking without any pharmacological aids however nicotine replacement therapy may be recommended, but the potential risks and benefits must be explained and understood and the doctor should be consulted.1 It is considered to be of benefit

Professional review

if the mother-to-be is highly dependent and has been unable to quit smoking by other means.3 As the effects of sustained low level nicotine exposure upon the human fetus are unclear, short-acting products are preferable, for example using either gums, inhalators, mouth sprays or the lozenges.8 However, patches can be used if the patient is suffering from nausea and must be removed at night.8 All nicotine replacement therapies have the Australian pregnancy category D. Pharmacists have an important role in assessing smoking status and exposure to passive smoke, advising and providing information to women about the risks associated with smoking in pregnancy, with support and motivate efforts to stop smoking.4 It is important to provide this advice in a very positive, encouraging and informing way that is non-judgmental. Tell the mother-to-be that quitting smoking is the best thing you can do for your baby as when you smoke, you breathe in over 4,000 chemicals from the cigarette.7 If the woman smokes, emphasise the benefits of quitting as early as possible in the pregnancy. If cessation occurs by 16 weeks of gestation, birth weights are similar to those of a nonsmoker.5 Other support services include Quitline (phone 131 848) and the Pregnancy, Birth and Baby helpline (phone 1800 82 436 or view the website www.pregnancybirthbaby.org.au).

References 1. Sansom LN, ed. Australian pharmaceutical formulary and handbook. 22nd edn. Canberra: Pharmaceutical Society of Australia, 2012 [cited 2013 October 25] 2. Smoking harms unborn babies [Internet]. Australian Government; [updated 2012 May 30; cited 2013 October 26]. Available from: http://www.quitnow. gov.au/internet/quitnow/publishing.nsf/content/ warnings-b-babies 3. Bruin J, Gerstein H, Holloway A. Long-Term Consequences of Fetal and Neonatal Nicotine Exposure: A Critical Review. Toxicological Sciences. 2010 April 2;116(2):364-374. doi: 10.1093/toxsci/ kfq103 4. Australian Health Ministers’ Advisory Council 2012, Clinical Practice Guidelines: Antenatal Care – Module 1. Australian Government Department of Health and Ageing, Canberra. http://www.health. gov.au/antenatal 5. Forinash A, Pitlick J, Clark K, Alstat V. Nicotine Replacement Therapy Effect on Pregnancy Outcomes. The Annals of Pharmacotherapy. 2010; 44:1817-21. 6. Rossi S. Australian Medicines Handbook [monograph online]. Adelaide, Australian Medicines Handbook Pty Ltd; 2012 [cited 2013 October 22] 7. Health direct. Smoking [Internet]. 2013 [cited 2013 October 22].

“Pregnant women are strongly encouraged to stop smoking without any pharmacological aids however nicotine replacement therapy may be recommended, but the potential risks and benefits must be explained and understood and the doctor should be consulted.”

Category Review – smoking cessation

Smoking Cessation

The pivotal role of the Pharmacist

“A Pharmacist is easily accessible to anyone in the community which makes them an excellent point of contact to start quitting.”

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

Every year in Australia, tobacco smoking causes an estimated 19,000 deaths and it is reported, up to 10% of hospital admissions in people over 35 years and over. Tobacco smoking continues to be the main preventable cause of morbidity and mortality in Australia.

Pharmacists have superior clinical expertise in areas involving assessment of nicotine dependence and indications, dosages, adverse effects, contraindications, drug interactions and combinations of available pharmacotherapies. The Pharmacist, as a trusted health care professional, is a pivotal interface with customers seeking to quit smoking. We recently had the opportunity to speak with Nate Hentschel regarding the smoking cessation category in Pharmacy.

Editor: What makes Nicotine so addictive? Nate: Nicotine, which is found naturally in tobacco used in cigarettes, is a chemical stimulant which acts on several receptors within the brain. From a pharmacological point of view, nicotine elicits its effect on nicotinic acetylcholine receptors. Activity on these receptors is thought to increase several neurotransmitters in the brain,

particularly dopamine within the pleasure and reward pathway. This results in the powerful addictive properties of nicotine. On top of this, prolonged exposure to nicotine results in receptor up-regulation, which leads to the body functioning on a certain level of nicotine. When nicotine levels in the body fall below this threshold, withdrawal symptoms occur, making it even harder for a smoker to quit. Withdrawal symptoms can be irritation, tiredness and a lack of ability to concentrate, and will subside when the body is exposed to nicotine again, giving a smoker more reason to continue smoking.

to quit as well as helping them to determine what, if any, pharmacological therapy (such as Nicotine Replacement Therapy) might be appropriate. A Pharmacist is easily accessible to anyone in the community which makes them an excellent point of contact to start quitting. Pharmacists can use the Fagerström Nicotine Addiction scale to help assess the level of addiction of a patient and their willingness to quit, and provide information and counselling to ensure a successful attempt at quitting smoking. Pharmacists also provide a pivotal role

Editor: The support of a Pharmacist for customers wishing to quit smoking, particularly around Christmas and New Year is incredible. What kind of role does a Pharmacist have when a customer makes a decision to quit smoking?

in encouragement and referral, with some

Nate: Pharmacists provide an integral role for many smokers looking to quit, primarily in evaluating the readiness of an individual

and one month after their last cigarette,

patients better off seeing their doctor before beginning quitting smoking. A lot of the time, if a Pharmacist has initiated a quitting regime with a patient, it is a good idea for them to suggest the patient come back one week just to talk with the Pharmacist and make sure they are handling the change well.

Category Review – smoking cessation

Editor: At a seminar I attended recently, a professor outlined that just one puff of a cigarette for a reformed smoker can lead to taking the habit up again. How does a customer ensure this does not occur? Nate: Relapse is a massive problem for many smokers trying to quit, as even years later an ex-smoker can easily become addicted once again. The easiest thing to suggest to a patient is to delay the urge to smoke for as long as possible; often the craving will become less prominent after several minutes, at which point the patient may be able to avoid falling into the addiction again. Pharmacists can play a big role in making sure that the patient quits and continues to be nicotine free. For many patients, having something to do also tends to form part of the addiction. Some may recommend chewing gum or sucking on lollipops to help control the urge to smoke and ease the cravings. Short acting nicotine replacement therapy also has a role here, for example the nicotine sprays, lozenges and gums generally help to stop the cravings and prevent the patient from lighting another cigarette. Sometimes, it may be necessary to avoid situations where they are likely to relapse – being around other smokers, drinking alcohol as well as caffeine may also trigger cravings resulting in the patient smoking again.

“Persistence and willpower are the keys to complete success when quitting smoking, and having the right support and frame of mind for this is essential.”

Often it is recommended to suggest these situations be avoided as much as possible while the patient first begins to quit smoking.

Editor: The provision of nicotine and non-nicotine pharmacotherapies in Pharmacy along with the support of external professionals is comprehensive. How does a Pharmacist manage the vast array of services and products available in this category? Nate: There’s a lot of information out there for Pharmacists wishing to focus on this category. The APF has an entire section dedicated to quitting smoking which many Pharmacists will find useful, as well as patient centric resources like QuitLine. Some patients may want to see their doctors to look into the use of Varenicline (Champix) or Buproprion (Zyban) for quitting smoking. While success rates may be slightly higher when quitting with these medications, appropriateness does need to be assessed by the prescriber. Most replacement therapies are generally fairly straightforward; however, they require a step 1, 2 or 3 patch over the recommended

12 weeks to provide a baseline level of nicotine which is gradually reduced. This helps to reduce daily cravings. If a patient experiences vivid or unusual dreams, they may either take off the patch before bed, or use a 16-hour patch instead of a 24-hour patch. On top of the patch, it is essential that some form of short acting nicotine therapy be provided to help with immediate cravings. These come in the form of lozenges, sprays and gums. Recommending how much, how frequently, and what strength to take generally depends on the patients smoking status and level of addiction. It is important for the patient to gradually reduce the amount they smoke as well as gradually reducing the amount of nicotine replacement therapy they are using. The Pharmacist should also give the patient realistic expectations – many people will not be able to quit completely the first time, or even after multiple attempts. Persistence and willpower are the keys to complete success when quitting smoking, and having the right support and frame of mind for this is essential.

CONTINUING PROFESSIONAL DEVELOPMENT

Varenicline: an Oral therapy option for quitting smoking BY ANTHONY TASSONE B.Pharm (Hons), Cert IV (TAA), Dip Mgt, AACPA, President of the Pharmacy Guild of Australia (Victorian Branch)

From reading this article you will be able to: • identify varenicline’s mechanism of action • understand varenicline’s place in therapy and relative efficacy • advise on varenicline’s recommended dose, duration of therapy and time to quit timelines.

In the other quit smoking feature article of this edition ‘Don’t quit on quitting’, there was an extensive discussion on Nicotine Replacement Therapy (NRT) options for quitting smoking. It is also important to consider prescription-only oral therapies for quitting smoking which include varenicline (Champix®) and bupropion (Zyban®). Varenicline is more effective than bupropion, evidenced by findings in randomised trials with a 12-week treatment period finding that abstinence rates were higher with varenicline than with sustained release bupropion or placebo at 12, 24 and 52 weeks.1 Due to this distinct superior efficacy finding, varenicline will be concentrated on for this piece on oral therapies.

How does varenicline work? Varenicline is a nicotinic acetylcholinereceptor partial agonist used for smoking cessation.2 In the absence of nicotine, varenicline partially activates nicotinic acetylcholine receptors (displaying agonist activity), and in the presence of nicotine, varenicline blocks nicotine’s ability to bind with these receptors (displaying antagonist activity).2 It is through this action that varenicline is thought to reduce craving and withdrawal symptoms, and further reduce any satisfying or enjoyable effects from smoking nicotine.

Who is it indicated for? Varenicline is a non-nicotine based therapy for assisting in quitting smoking in motivated individuals. The component of patient motivation is significant to overall success of varenicline in quitting smoking (as is any therapy).

Although data for varenicline demonstrates that it can double the chances of successful smoking cessations for up to 12 months compared to no pharmacotherapy, the clinical trials of varenicline generally had subjects who were otherwise healthy, motivated quitters who received regular support and advice.3 4 There is no evidence that varenicline is as effective for smoking cessation without counselling and support, making counselling and support for people attempting to quit smoking essential to maximise their chances of quitting. This has also been considered in the PBS Authority listing of varenicline which states:

Short-term therapy for smoking cessation, as an aid for motivated people who wish to quit smoking. •• First 4 weeks: smoking cessation for people who wish to stop smoking and have entered a comprehensive support and counselling program for smoking cessation, or enter such a program at the time of the request. Details of the program must be specified in this request. •• Further 8 weeks: continuation of smoking cessation for people who have completed the first 4 weeks of therapy with varenicline.

•• Extra 12 weeks: extension of smoking cessation therapy for people who have stopped smoking* and have completed 12 weeks of therapy with varenicline. *Not defined under the PBS listing. In a relevant clinical trial, ‘stopped smoking’ was defined as a self-report of no smoking or use of nicotinecontaining products within the past 7 days — as well as having an end-expired CO 10 ppm.2

Comparable effectiveness As stated earlier, varenicline is more effective than bupropion. It is also more effective than placebo, found in a meta-analysis of clinical trials demonstrating varenicline having a higher continuous abstinence rate than placebo at 24 weeks or more.5 There is limited comparison between varenicline with NRT – in an unblinded comparison with NRT, more people were abstinent during the last weeks of a 12-week course of varenicline than they were with a 10-week course of NRT patches (56% vs. 43%); however, this difference in abstinence rates was smaller at 52 weeks (26% vs. 20%).3 Clinical trials have shown that abstinence rates from varenicline may decline over time during non-treatment follow up (after 6 months and 1 year). However, abstinence rates from varenicline have been shown to be higher than with placebo or bupropion over time.1

CONTINUING PROFESSIONAL DEVELOPMENT

Varenicline’s effect on relapse and abstinence rates beyond 12 months has not been studied. Combining varenicline with NRT is not recommended as it may cause an increase in nausea, headache, dyspepsia, fatigue and dizziness.2 There are no studies available that assess the use of varenicline where there has been use of bupropion or NRT within the previous month.6 Combined use of varenicline with bupropion is also not recommended.

How is it taken? Prior to commencing varenicline, it is important to set a date to quit smoking. Varenicline should be started 1–2 weeks before the proposed quit date,2 with the dose titrated as follows:

•• days 1–3; 0.5mg daily •• days 4–7; increase to 0.5mg twice daily •• Continue with 1mg twice daily from day 8 to the end of a 12-week treatment course. For people who successfully stop smoking at the end of 12 weeks, a further 12 weeks therapy, continuing with 1mg twice daily, is recommended by the manufacturer to increase the chance of remaining abstinent at 1 year. Research has indicated that an additional 12 weeks of varenicline for successful quitters (24 weeks of varenicline in total) produced a small improvement in continuous abstinence rates for up to 1 year compared to placebo.6 It is recommended that an appointment or follow-up 2–3 weeks after the original prescription is required to provide the second prescription and to monitor progress and provide additional support. This also allows for the patient to gain a prescription for the second supply (follow-on 8 week treatment).

Are there any patients that should not use varenicline? The safety of varenicline has not been established in pregnancy or breastfeeding and is therefore not recommended. Its safety has also not been demonstrated in patients younger than 18 years of age. NRT, on the other hand, can be considered for some patients under 18 years of age and in pregnancy, and in some forms for breastfeeding. Varenicline should be avoided in patients with a serious psychiatric or mental illness (e.g. depression, schizophrenia or bipolar disorder). The FDA has previously received reports of suicidal thinking and suicidal behaviour in people who started varenicline. When there was an indication of the timing

of the onset of these symptoms, the median time was at 2 weeks. About half of these reports were in patients who did not have any history of psychiatric illness.7 It should be considered to recommend that patients see their doctor for a follow-up after 2–3 weeks of commencing treatment as a precaution and as part of ongoing support. However, a UK cohort study could not find any clear evidence of increased risk of self-harm, suicidal thoughts and depression with varenicline compared with NRT.8 Bupropion may be considered a more suitable treatment option for patients with depression.9 Varenicline should also be avoided in patients with some serious medical conditions, including cardiovascular disease, epilepsy and COPD. Patients with these conditions were not included during initial clinical trials. Cardiovascular events (including myocardial infarction and cerebrovascular accident) have been reported during use with varenicline. The FDA has previously advised that varenicline may be associated with a small increased risk of certain cardiovascular events in patients who have cardiovascular disease (based on a trial involving approximately 700 subjects with stable cardiovascular disease).10 The dose of varenicline should also be reduced in renal disease. For patients with a creatinine clearance <30 ml/min, the recommended daily dose is 1mg daily (after an initial dose titration of 0.5mg for 3 days).2 Varenicline should be avoided in end-stage renal failure with other approaches of smoking cessation preferred. Dosage adjustment is not normally required in the elderly or those with hepatic impairment. For a full list of contraindications and precautions, refer to the full product information and consumer medicines information leaflet.

Common adverse effects to be aware of Common adverse effects reported more frequently with varenicline than placebo include: nausea, insomnia, abnormal dreams, headache and constipation.2 During clinical trials, nausea occurred in approximately 30% of smokers, and was the most common reason for treatment withdrawal.8 This makes the initial dose titration important, and slower dose titration

may be useful for those who are unable to tolerate the varenicline maintenance dose. The feeling of nausea has been found to settle over time and patients should be advised to take varenicline with food and a full glass of water to reduce nausea.11 Dizziness and sleepiness can occur in some patients – caution should be exercised by patients who are driving or operating machinery until it is known how varenicline affects them. Weight gain, following quitting smoking, is often a concern for patients. Varenicline does not cause weight gain directly, with approximately 75% of people who stop smoking with any method experiencing a small amount of weight gain (between 2–4kg).12 In clinical trials with varenicline, some subjects experienced a weight gain of approximately 3kg.4 For a full list of adverse effects and post-marketing adverse effects, refer to the full product information and consumer medicines information leaflet. Like any relatively new therapy available on the market, more will be learned in time with regards to its place in therapy and comprehensive advantages and disadvantages over other treatments. Providing information regarding potentially serious side effects of any medicine is critically important, with varenicline no exception. This makes the provision of a Consumer medicines information leaflet essential when counselling on varenicline. It is important for pharmacists to understand that whilst varenicline is a clinically-proven, effective treatment for people trying to quit smoking, counselling and support are essential – the dose titration period is also important to minimise side effects with a quit date set and the 2-week follow up with the prescribing doctor.

CONTINUING PROFESSIONAL DEVELOPMENT

ASSESSMENT QUESTIONS

Accreditation number: G2102161

The assessment questions below can be found at the Guild Pharmacy Academy myCPD elearning platform. Login or register at: www.mycpd.org.au

The activity is approved for a 15 minute remote learning activity:

Question 1

Question 4

Which of the following best describes varenicline’s mechanism of action?

Which of the following statements is the MOST appropriate in relation to comparable efficacy of varenicline?

a. It is a Nicotine acetylcholine receptor agonist. b. It is a Nicotine acetylcholine receptor antagonist. c. It is a Nicotine acetylcholine receptor partial agonist. d. It works to replace nicotine in the body. fe None of the above

Question 2 Which of the following is the LEAST appropriate statement? a. Varenicline is not recommended for combined use with NRT. b. Varenicline may be used in combination with bupropion.

a. Varenicline is equally as effective as bupropion. b. Varenicline was not found to be more effective than placebo. c. Abstinence rates are lower with varenicline than placebo and bupropion.

Assess primary health care needs

Standard 6.2

Deliver primary health care

Question 5

Standard 6.3

Contribute to public and preventive health

Which of the following is the recommended duration of therapy with varenicline?

Domain 7

Promote and contribute to optimal use of medicines

Standard 7.1

Contribute to therapeutic decision-making

Standard 7.2

Provide ongoing medication management

e. Varenicline and NRT should be combined for therapy due to additive benefits.

a. 4 weeks

d. 10 weeks

a. 1–2 weeks before b. 2–3 weeks before c. 1–2 days before d. 2–3 days before e. It does not matter when quit date is proposed.

Suggestions for elements of competency addressed as defined by the National Competency Standards Framework for Pharmacists in Australia 2010:

Standard 6.1

d. Varenicline is commonly associated with nausea.

How long is it recommended that varenicline is commenced before the planned quit date?

0.5 Group 2 CPD credits suitable for inclusion in an individual pharmacist’s CPD plan upon successful completion of assessment.

Deliver primary and preventive health care

b. 6 weeks

Question 3

Domain 6

d. A 12-week course of varenicline has produced higher abstinence rates than a 10-week course of NRT.

c. Varenicline has been found to be more effective than bupropion.

e. Varenicline has an initial starting dose of 0.5mg once daily for 3 days.

0.25 Group 1 CPD credits suitable for inclusion in an individual pharmacist’s CPD plan

c. 8 weeks e. 12 weeks

(Endnotes) 1 Jorenby D, Hays J, Rigotti N, et al. Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustainedrelease bupropion for smoking cessation: a randomized controlled trial. JAMA 2006;296:56–63. 2 Pfizer Australia Pty Ltd. Champix product information. 10 Dec 2010 3 Aubin HJ, Bobak A, Britton JR, et al. Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomised open-label trial. Thorax 2008;63:717–24. 4 Gonzales D, Rennard SL, Nides M, et al. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA 2006;296:47–55 5 Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2010;12:CD006103 6 Tonstad S, Tønnesen P, Hajek P, et al. Effect of maintenance therapy with varenicline on smoking cessation: a randomized controlled trial. JAMA 2006;296:64–71

7 US Food and Drug Administration. Postmarket reviews: The smoking cessation aids varenicline (marketed as Chantix) and bupropion (marketed as Zyban and generics): Suicidal ideation and behavior. FDA Drug Safety Newsletter 2009;2 8 Gunnell D, Irvine D, Wise L, et al. Varenicline and suicidal behavior: a cohort study based on data from the General Practice Research Database. BMJ 2009;339:b3805 9 NPS News 68 – Helping smokers quit: accessed from www.nps.org.au (on 28/10/12) 10 US Food and Drug Administration. FDA Drug Safety Communication: Chantix (varenicline) may increase the risk of certain cardiovascular adverse events in patients with cardiovascular disease, 16 June 2011 11 Pfizer Australia Pty Ltd. Champix consumer medicine information. December 2010 12 US Department of Health and Human Services. Clinical Practice Guideline: Treating tobacco use and dependence 2000

ADVERTORIAL

Which way to quit?

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Most smokers attempt to quit at least once (on average 3.5 times), but despite good intentions, as few as 3% of unassisted quit attempts succeed in a given year.1,2 With the average quit attempt only 5 weeks in duration (rather than the recommended 12 weeks), it is clear how quickly relapse can occur.1,3 Given these difficulties, many quitters aim to increase their chances of cessation with the use of nicotine replacement products. However with a broad range of options available, many quitters feel confused about which product to purchase. In fact, it has been found that around 35% of smokers who intended to buy a smoking cessation product walked away when they felt their shopping experience was too hard.2

•• Managing cravings as they occur – gradually

This is where the advice of community pharmacists and their staff can be hugely effective in assisting with nicotine replacement product recommendations. By asking the customer about their smoking habits and goals for quitting, a personalised quitting plan can be suggested, whether they are a first-time quitter or have relapsed.4 Preference of quitting strategy varies from person to person, so understanding how your customer would like to quit should be a key consideration when recommending a smoking cessation product.

•• Actively managing cravings – quitting

For many smokers, as they progress through various quit attempts, they may want to adopt a different strategy for quitting. There’s no right or wrong approach, it’s about finding out what works best for each individual.

Nicabate offers a range of quitting options to suit the individual needs of your customers Because there is more than one way to quit, Nicabate® provides more than one way to help customers quit smoking depending on which quitting strategy your customer has chosen to adopt:

•• Getting started – easing into quitting for two weeks before a specified quit date using Nicabate® Pre-Quit Patch. This type of strategy can suit customers who smoke more than 15 cigarettes per day and are anxious about giving them up all at once.

cutting down the number of cigarettes by managing cravings, one at a time, with an oral delivery product (e.g. Nicabate® Minis 4mg, which relieve cravings in minutes5). This type of strategy can be ideal for customers who would like to quit smoking at their own pace, or for those prone to sudden ‘cue-provoked’ cravings. cigarettes all at once and actively managing cravings on a day by day basis, with Nicabate® 24 hour patches (delivers nicotine fast6). This type of strategy can suit people who have struggled to quit in the past.

Fast relief of cravings is important Many quitters don’t just experience a steady level of background cravings, they also experience moments of acute cravings which may be intense as a result of exposure to triggers such as alcohol, social situations, or emotional stress.7 Moments of intense cravings are often associated with immediate relapse.7

Nicabate® Minis 4mg – Australia’s No.1 quit smoking brand8 offers fast relief from cue-provoked cravings in minutes5 Nicabate® Minis are small, fast dissolving lozenges that release nicotine quickly, helping quitters in moments when breakthrough cravings take hold. Nicabate Minis (4mg) can provide rapid relief within minutes,5 helping your customers to stay in control when intense cravings strike.3,9 By using Nicabate Minis, your customers can double their chance of quitting compared to quitting alone (cold turkey).10 What’s more, they come in a handy, pocketsize pack that can be taken anywhere, so instead of reaching for a cigarette like they usually would, they can reach for a Nicabate Mini 4mg and relieve their cravings within minutes.5

Stop smoking aid. Contains nicotine. NICABATE and NICABATE MINIS are registered trade marks of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington, NSW 2115. References: 1 Cancer Institute NSW. New South Wales Smoking and Health Survey 2009;Sydney:Cancer Institute NSW, November 2009. 2 Data on file. 2011 market research GlaxoSmithKline. 3 Nicabate Mini Lozenges Approved Product Information. 4 The Pharmaceutical Society of Australia and the Pharmacy Guild of Australia. A practical guide to providing smoking cessation services in pharmacy 2002:Available at: http://www.ashaust.org.au/ pdfs/PharmCessGuide.pdf. 5 GSK. Data on file. 6 Nicabate Approved Product Information. 7 Ferguson SG et al. J Subst Abuse Treat 2009;36:235-43. 8 Nielsen Australian Grocery and Pharmacy Scan data. MAT August 2013. 9 Piper M et al. Arch Gen Psychiatry 2009;66:1253-62. 10 Stead LF et al. Cochrane Database of Systematic Reviews 2008:CD000146.

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Pharmacy reference guide to assisting customers to lose weight fast and keep it off BY Kate Polk Brand Marketing Manager. Probiotec Limited

The Celebrity Slim Program is a simple, flexible and nutritionally balanced weight management program designed to help people lose weight, get slim and stay that way for good. Our program has been established in pharmacy for over eight years with proven results.

We are pleased to present this easy-to-follow Pharmacist reference guide in this edition of ITK

Each product contains several important nutrients that can help improve health, including:

Celebrity Slim in action

•• 25 Essential Vitamins & Minerals

Celebrity Slim is an easy to follow program, based on regular snacks and healthy eating. There are three different phases of the program depending on an individual’s goals. These phases include the Trim Phase, Maintain Phase and Rapid phase. Once a customer has reached their goal weight, the Maintain Phase will assist in easing them back into a healthy lifestyle routine, ensuring sustained weight loss results in the longer term. At Celebrity Slim, we do not believe in a ‘quick fix’ solution that will send weight yo-yoing. Celebrity Slim is all about changing the way people think about food and changing eating habits long term.

Celebrity Slim Superior Formulation Each Celebrity Slim meal replacement shake sachet or bar contains a nutritionally balanced combination of protein, carbohydrates, fats, vitamins, minerals and soluble fibre to sustain energy while keeping hunger at bay. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 33 : DECEMBER / JANUARY 2014

•• Green Tea Extract •• Dairy Calcium •• Caseinate •• Whey Protein Concentrate •• Soy Protein Isolate •• BioFibre™

Using this Guide A significant hurdle people encounter when trying to lose weight is achieving satiety. That is why Celebrity Slims’ superior formulation is so effective. It’s been formulated specifically to keep customers feeling full and satisfied for longer. This guide has been designed to provide a comprehensive reference source for the program, the products and most importantly, the three (3) vital phases for success. On behalf of the team at Celebrity Slim we thank you for your tremendous and ongoing support.

www.doseinnovations.com

Category Review

Weight “Fundamentally, it is trust, service and advice that remain the pillars of support customers seek.”

management brought to you BY celebrity slim

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

Australia is ranked as one of the most overweight nations in the developed world. The prevalence of obesity in Australia has more than doubled in the past 20 years. With obesity well documented and an increasing health concern for Australians, more people are visiting local community pharmacy for weight loss support. The majority of pharmacies offer professional weight management product/s and service/s reinforced by a sustained message of healthy eating and moderate exercise. Statistics indicate that people who are overweight or obese are more likely to have higher blood pressure and higher blood cholesterol levels, and are more disposed to developing heart disease, diabetes or a stroke. One of the primary ways to lose weight and improve health is to change eating habits and increase physical activity.

Simple guides for assessing body weight and the amount and distribution of body fat include:

•• Body Mass Index (BMI) – the ratio of weight to height (kg/m2)

•• Waist circumference – a measure of abdominal fat

•• Waist to Hip Ratio (WHR) – the ratio of waist circumference to hip circumference. Customers will enter a pharmacy seeking advice, support, programs and products for a variety of reasons, including rapport and support, along with a trusted relationship with their pharmacist. Pharmacists often provide ongoing support which is so important when considering long-term weight loss.

It is not surprising that customers cite a variety of reasons for choosing their local pharmacy as there are a range of weight loss programs and product choices available. Fundamentally, it is trust, service and advice that remain the pillars of support customers seek. Pharmacy provides a trusted and dedicated backdrop for an important category, with trained staff often using purpose-built consulting rooms for customers wishing to lose weight. While weight management is a key pharmacy position throughout the year, it is usually in the early part of the year that customers will seek the counsel of pharmacy to assist with weight management.

BUSINESS PROFILE

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

Beginning in 1969, Sunshades Eyewear has grown into an international licensor and distributor of fashion eyewear, selling in excess of 3 million pairs of sunglasses a year across 30 countries. We spoke with Peter Playford, Sunshades Eyewear Sales Manager, about the company, its strategies for the year ahead and its growing footprint in the pharmacy industry. Editor: Sunshades is one of the oldest and largest eyewear companies in Australia. Can you give us a little background about Sunshades Eyewear? Peter: Sunshades Eyewear was founded by iconic businesswoman and entrepreneur Betty Lasse over 40 years ago in North Bondi. Betty was considered a pioneer in the eyewear industry; she started out as a small-scale supplier of unbranded sunglasses to local pharmacies, and then left to focus on building her eyewear company. From just three employees in 1980, today the Sydney-based business employs more than 100 staff and is at the forefront of the Australian and global eyewear industry designing, manufacturing, selling and distributing brands (both Australian and international) such as Sass & Bide, Oroton, Le Specs, Karen Walker, Minkpink, Seafolly, and one of Australia’s leading brands, Cancer Council. Sunshades Eyewear sells in excess of 3 million pairs of sunglasses a year in over 30 countries. In my opinion, it’s the leading eyewear partner in the marketplace. Sadly, in 2006 Betty Lasse passed away, but her inspirational messages and passion for business and the industry live on. Sunshades Eyewear proudly remains an Australian familyowned and operated company headed up by Betty Lasse’s son, Rodney Grunseit, who has been in the business for over 18 years and maintains the Sunshades spirit.

Editor: Under the guidance of Rodney Grunseit, Sunshades Eyewear has firmly cemented its name in the eyewear industry. Can you tell us briefly about the success of the business over the years? Peter: Sunshades’ ongoing goal is to be admired internationally for our brands, our designs, along with our fun, yet professional approach to doing business.

The key to our success is an ability to continually evolve and adapt to the ever-changing conditions of the market. With a strong portfolio of brands ranging from $19.95 to $350RRP, amazing and unique designs and powerful marketing initiatives, Sunshades has been able to position itself in a vast section of the market that sees it achieve remarkable year-on-year growth. Adding to this success is a combination of unique designs, quality products, custombuilt fixtures, online platforms, electronic ordering and sales support. Sunshades continues to invest heavily into its retail partners to help them build, develop and grow their eyewear category within their business. We’re a one-stop shop for all things eyewear, offering a complete eyewear solution and end-to-end management of our customers’ eyewear category. It is through this approach that Sunshades has managed to build strong and successful relationships with some of Australia’s largest retailers like Sportsgirl, Witchery, David Jones, Luxottica, Priceline, Cue, and Miss Shop.

Editor: What are the core values and goals for Sunshades Eyewear and how this is implemented throughout the company? Peter: We’ve built our fundamental core business values around hard work, a fearless approach to design and dedication to build relationships with stakeholders across every aspect of the global eyewear market. At Sunshades, product is often the first touch point a customer has with our brand partners, therefore the company will continue to reinvest and bring focus to technology, staff and procedures. Our goal is to ensure that first impressions become strong, long-term alliances between brands and their customers.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 33 : DECEMBER / JANUARY 2014

Editor: In 2008 Sunshades successfully tendered for the Cancer Council eyewear business. Please tell us a bit about this partnership. Peter: From an overall company perspective, the addition of the Cancer Council brand to the Sunshades brands portfolio was a great acquisition for the business. From a strategic point of view, it added a strong and trusted Australian brand to the fold, which gave us a premium product offering at an entry price point that has also given us access to new opportunities in the marketplace. The partnership with the Cancer Council is a very special one for all the Sunshades staff – over the 5 years we have had the brand, we have fully immersed ourselves in it, helping out at every possible opportunity. Baking cakes for the Biggest Morning Tea and helping collect money for Daffodil Day have become regular occurrences on the Sunshades calendar. From a sales and brand viewpoint, the Cancer Council brand has had a massive impact on our key retailers through quality product, a revival of design, and marketing investment and sales support. The brand has helped position Sunshades as the leader in the sub $100 sunglass market and as a premium offering for certain channels of our business.

Editor: Can you tell us about your partnership with the Pharmacy industry in Australia? Peter: The arrival of the Cancer Council brand into the business meant a new and exciting channel opportunity presented itself to the business. There are over 5000 pharmacies in Australia, and over the past 5 years Sunshades has worked tirelessly to increase the footprint of the Cancer Council brand. There are now over 1500 pharmacies that support the Cancer

BUSINESS PROFILE

She wears KATOOMBA He wears STRATFORD

Official Partner

Council sunglass brand, and there is still significant opportunity for us to further grow and assist retailers in positioning their eyewear category in line with a strong premium brand like the Cancer Council. Further, we have recently added Avid Reading Glass collection, a premium reading glass range starting at a $19.95RRP to our offering, meaning we can now offer the Pharmacy market a complete eyewear solution. Pharmacy in Australia represents the largest growth opportunity in the Sunshades business currently, and we will be investing heavily into making sure our customers receive the best product, designs and marketing support possible. We have already invested in our sales team, expanding it to 13 full-time members across Australia, with three in New South Wales, Victoria and Queensland, two in South Australia and two in Western Australia. We also have a large merchandise team supporting our large retailers across the country, so we are well-prepared for the growth we are anticipating in this channel.

“We’ve built our fundamental core business values around hard work, a fearless approach to design and dedication to build relationships with stakeholders across every aspect of the global eyewear market.”

Editor: To close Peter, what are your goals for the coming year? Peter: The Sunshades business is built on three key pillars: 1. Australia & New Zealand business 2. Our brand portfolio 3. International business The main goals are to focus on our existing accounts, add new accounts to the business across Australia and New Zealand, and continue to build and invest into the pharmacy channel with our complete eyewear offering. Expanding in the international market is a primary goal in the coming year with three

successful new brand launches adding to an already impressive portfolio, such as Preen, Jonathan Saunders and Sophie Hulme. We will carefully and strategically grow the international business through selecting key agent and distribution partners as well as positioning our brands in the world’s key retailers. We currently work with Liberty, Saks, Colette, and many more, getting the Sunshades’ spirit and name out there. With over 50 brands under the Sunshades’ brand portfolio and a range of new initiatives about to hit the market, I can confidently say that the future looks incredibly bright for Sunshades Eyewear.

For orders and customer service AUSTRALIA T: +61 2 8303 7300

www.sunshadeseyewear.com.au

E: enquiries@sunshadeseyewear.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 33 : DECEMBER / JANUARY 2014

PROFESSIONAL Review

A glaring opportunity Sunglasses in Pharmacy BY Pat Gerry Optometrist and Sports Specific Consultant at Eyeman www.eyeman.com.au

“The Eye Protection Factor (EPF) is to non-prescription sunglasses what the Sun Protection Factor (SPF) is to sunscreen.”

Advising customers about sunglasses requires a little dose of specific knowledge and a lot of common sense. While Australians are provided with qualified information regarding the dangers of UV exposure to the skin, we are perhaps less aware that the eyes are vulnerable to UV damage anytime of the day, any season of the year.

Interestingly, it also seems to be that sunglasses are most effective in the mornings and afternoons when the angle of the sun is lower, and can be at an angle that is directly towards the eyes.

Picture A

Changes to structures of the eyes that have been associated to UV exposure include pterygium (Picture A), cataracts, conjunctival inflammation and retinal damage such as macular degeneration.

The sunglasses standard The quality of sunglasses does not necessarily relate to their darkness or cost, so you must check the label to ensure they meet Australian Standards. Sunglasses need to fit well and transmit very little UV radiation to ensure the eyes are protected. The Optometrists Association of Australia recommends the following as a sound guideline regarding sunglasses when choosing a product that provides the best UV eye protection:

Picture B

•• meet the Australian Standards for UV protection by checking that they are labelled as category 2, 3 or 4 •• are marked EPF (Eye Protection Factor) 9 or 10

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•• have a bridge setting as close to the eyes as possible without touching your eyelashes •• have side protection (wrap-around style) to block outside glare The Eye Protection Factor (EPF) is to non-prescription sunglasses what the Sun Protection Factor (SPF) is to sunscreen. EPF is a scientifically applied rating designed to help your customers compare the efficiency of sunglasses protecting your eyes from UV. Ensure your sunglasses are labelled as offering EPF 9 or 10. Sunglasses labelled EPF10 exceed the requirements of the Australian Standard and may provide even greater protection. While a deal is often made regarding damage to the main internal structures of the eyes such as the lens and retina, it should also be remembered that sunglasses are providing UV protection to the structure around the eyes such as the lids and skin. As with all UVrelated lesions of the skin, these changes have the potential to become malignant. Pigment changes in these regions (example in Picture B) need to be protected and sunglasses are easily the best form of protection when a lesion is close to the eyes.

PROFESSIONAL REVIEW

Vitamin D & Sunscreen HAVE WE GOT THE BALANCE RIGHT? BY Margaret Robinson Adjunct Associate Professor – School of Pharmacy University of Queensland

The occurrence of melanoma and non-melanoma skin cancer in Australia is among the highest in the world. Two in three Australians will be diagnosed with skin cancer by the time they are 70. From 1998 to 2007, GP consultations to treat non-melanoma skin cancer increased by 14%, to reach 950,000 visits each year.

“There is an insidious but significant consequence of sun avoidance and this is the growing incidence of low vitamin D levels in Australians.”

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PROFESSIONAL REVIEW

Vitamin D levels in Australia While the work of researchers and public campaigners has made Australians aware of the dangers of sunburn and the development of skin cancers, there is an insidious but significant consequence of sun avoidance and this is the growing incidence of low vitamin D levels in Australians. Vitamin D status has now emerged as a significant public health issue in Australia. An estimated 31% of adults in Australia have inadequate vitamin D status. This percentage rises to more than 50% in women during winter–spring and in people residing in southern states. It has been shown that below 35° south latitude, little or no vitamin D3 can be produced in winter months.

It is also common to find Vitamin D deficiencies in patients with autoimmune diseases - rheumatoid arthritis (RA), multiple sclerosis (MS), and irritable bowel syndrome (IBS).

Sources of Vitamin D While Vitamin D does occur in foods, it does not occur in sufficient levels to provide the only source of Vitamin D for adequate nutrition levels. It is thus sourced mainly from exposure to the sun. It has to be formed from UVB rays – the rays that also cause sunburn. There is very little vitamin D in foods – mainly from oily fish or some fortified foods. However, there are even considerable differences in the Vitamin D content of oily fish depending whether they are wild or farmed. Furthermore, frying fish in vegetable oil substantially reduces the Vitamin D content. Thus supplementary vitamin D is important to maintain adequate Vitamin D levels.

Conclusions Adequate intake of vitamin D is unlikely to be achieved through dietary means, particularly in the groups at greatest risk, although vitamin D fortified foods may assist in maintaining vitamin D status in the general population. Dark-skinned people, veiled women and older people (particularly those in residential care) have reduced exposure to sunlight and thus have increased vitamin D requirements. Current levels of vitamin D food fortification are insufficient to prevent deficiencies. Vitamin D supplementation and/or increased exposure to sunlight, must be considered for at-risk groups. There is a need to sensibly balance the risks of acquiring vitamin D deficiency by sun avoidance against the risk of developing skin cancer with sun exposure.

Vitamin D content of fish Type of fish

Functions of Vitamin D in the body It is widely understood that adequate levels of Vitamin D are necessary to guard against the development of osteoporosis. Vitamin D is converted in the kidney to calcitriol. Calcitriol is important in the maintenance of plasma calcium, phosphorus, and magnesium – all of which are important in maintaining bone health. However, Vitamin D deficiency is not only associated with the risk of developing osteoporosis. Researchers have found that low Vitamin D levels in pregnancy has been associated with infantile rickets, low birth size, poor childhood growth, and later risk of hip fracture as the children mature into older adults. Diabetes type II is most prevalent in people with obesity (vitamin D is poorly absorbed and circulated in people with obesity). Patients with DM type II are also found to have a lower serum 25-(OH)D concentration compared to controls without diabetes.

IUD of Vitamin D per 100G serving 249 981 415 342 447 80 371

Farmed salmon Wild salmon Bluefish Mahi Swordfish Cod Farmed trout

The Australian Scene Whole body exposure of 10–15 minutes of midday sun in summer (about 1 minimal erythemal dose [MED] or the amount of sun exposure which just produces a faint redness of skin) is comparable to taking 15 000 IU (375 μg) of vitamin D (cholecalciferol) orally. On this basis, exposure of hands, face and arms (around 15% of body surface) to around 1/3 MED should produce around 1000 IU of vitamin D. This is sufficient for adequate levels.

“Current levels of vitamin D food fortification are insufficient to prevent deficiencies. Vitamin D supplementation and/ or increased exposure to sunlight, must be considered for at-risk groups.”

Recommended sun exposure times (minutes) which result in 1/3 MED for people with moderately fair skin* at different times of day Dec–Jan Region

At 1000 or 1400

Jul–Aug At 1000 or 1400

At 1200 midday

Northern Australia Cairns

6–7

15–19

Townsville

5–7

20–28

Central Australia

Most cells including heart cells have vitamin D receptors. Because of these receptors, vitamin D is reported to be involved in the pathogenesis of many cardiovascular problems.

Brisbane

5–7

26–28

Perth

5–6

25–38

Sydney

6–8

26–28

In at-risk cancer patients, higher Vitamin D levels have been shown to protect against the development of colo-rectal cancer and breast cancer.

Adelaide

5–7

25–38

Melbourne

6–8

32–52

Hobart

7–9

40–47

Southern Australia

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PROFESSIONAL REVIEW

REVIEW QUESTIONS Question 1

Question 3

Which of the following statements regarding Vitamin D is TRUE:

Researchers have found that low Vitamin D levels have been linked to the risk of developing a. Osteoporosis

b. Most people can maintain sufficient vitamin D serum levels by eating oily fish

b. Rheumatoid arthritis

c. Obese patients are more at risk of low vitamin D serum levels because of the inability of the skin of obese people to synthesise vitamin D

d. *Type 1 diabetes

d. *Women should be especially encouraged to maintain higher serum levels of vitamin D due to their risk for osteoporosis post-menopause

Question 2 A mother comes into the pharmacy with her 6 month old baby. It is the middle of summer and she lives in Brisbane. She tells you that she has been told her daughter needs to be out in the sun to get sufficient vitamin D. Part of your advice would be: a. Sun exposure in Brisbane would be too dangerous in a 6 month old baby and she should give her adequate vitamin D supplementation b. *This baby needs only to have exposure to the sun for 5-7 minutes at 10am or 2pm at this time of year to get sufficient vitamin D and she only has to uncover face, arms and hands not the whole body c. She needs to use products such as oily fish in the baby’s diet rather than resort to sun exposure d. Babies do not have sufficient cholesterol in the skin to synthesise vitamin D thus babies of this age use supplements

c. Irritable bowel syndrome

Question 4 In Australia, Vitamin D levels: a. *Are inadequate in 31% of all Australians b. Are inadequate in 50% of all Australians c. Are inadequate in 31% of people living in southern parts of Australia but normal in northern parts Are inadequate in 31% of all Australians d. Are deficient in the elderly, babies and women over 55 years

Question 5 Which of the following is TRUE a. Farmed salmon has higher Vitamin D levels than wild salmon b. *Cooking oily fish in vegetable oil can substantially reduce Vitamin D levels c. Current levels of Vitamin D fortification in food is sufficient to maintain adequate Vitamin D levels d. Of most oily fish, cod has the highest level of Vitamin D

ANSWERS:

a. Low Vitamin D levels are associated with a higher risk of developing melanoma.

Question 1 – d / Question 2 – b / Question 3 – d / Question 4 – a / Question 5 – b

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 33 : DECEMBER / JANUARY 2014

RETAIL FOCUS

The Value of Buying Correctly BY SIMON HAMBRECHT Director of Pharmacy Essentials

I could not tell you how many times I have been asked, “What are your trading terms?” While certainly being an important part of the equation, I do not believe they really should govern it.

After all, if you aren’t selling the stock you purchase, your trading terms are redundant as there is no need to replenish with more stock.

would lose less than $500 discount on every $100,000 of revenue in trading terms. I’m sure you would agree this is marginal.

The other element that too much emphasis is placed, in my opinion, is regarding terms we achieve with the wholesalers. Why is it that we place such a high emphasis on minute percentages? The wholesalers have no choice but to review the level of discount they give out each time PBS reform occurs. The margins they are operating on are very skinny. Imagine having to run a business that size (any size for that matter) on such a low margin yet we get upset when they reduce our terms. Realistically, in the future there potentially may no longer be wholesale terms.

The trading terms I recommend we focus on are the ones that can be achieved directly through the supply channel and work on initiatives to achieve them. Direct trading terms can be substantial and allow you to tangibly increase your competitiveness or margin – depending on your situation.

I recently had the opportunity to conduct an analysis on a business looking to move from a major banner to Pharmacy Essentials. The drop in wholesaler discount meant they

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 33 : DECEMBER / JANUARY 2014

So what is the best way to set these up? I believe you need to look at your overall business and ascertain who/what you are going to support in terms of product ranging in the first instance. One thing I realised very early on is that you can’t be everything to everyone and it is unsustainable to achieve the best terms with every supplier. When speaking with suppliers, I frequently hear about the issues they have with various

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banner groups and brands when it comes to poor compliance and as a result the suppliers are left with no option but to reduce trading terms to them. Perhaps the best approach is to analyse each category, ascertain who the key players are in it and negotiate terms with these suppliers. You need to be aware though there are 2 sides to every trading term agreement and therefore an expectation of compliance on your behalf. To maintain your terms, you need to ensure you live up to your end of the bargain and if you don’t, know there are consequences. We, at Pharmacy Essentials, achieve better trading terms than some major groups due to the unique nature of our supplier relationships. We work exceptionally closely with each of our suppliers and this is testimony to the high growth we achieve when benchmarked to the industry. You will find you can achieve more with suppliers when you get them involved in your business – whether it be through team training and/or other aspects. Once you have your terms in place, the next step is to make sure they are being followed. I have seen time and time again, discounts being missed due to the wrong quantities being ordered. This is a business expense and will immediately impact the financial performance of your business. It is for this reason that

“One thing I realised very early on is that you can’t be everything to everyone and it is unsustainable to achieve the best terms with every supplier.”

I believe it is vital that the Team Members accountable for ordering stock fully understand the requirements of your trading terms as it is quite often more complex than discount and quantity. There can be other terms and conditions associated with the terms. Two ways you can safeguard your business and ensure financial performance is to conduct invoice audits and to subsequently cross-reference against your established terms. A second method is to set up your ordering requirements directly into your point-of-sale system.

to benefit and develop your own retail strategy. I have shared with you some of our inside tips; however if you wish to implement all of our strategies you may wish to contact us through our website (www.pharmacyessentials.com. au/pharmacists/free-information-pack/) to arrange a consultation with myself. I would like to take this opportunity to wish you all a safe, prosperous and Merry Christmas and I look forward to presenting a new range of features in 2014.

Well, that’s it for this series in 2013. I hope you and your team have been able GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 32 : NOVEMBER 2013

MY CPD

Guild Pharmacy Academy update!

New online CPD accredited modules available login or register at: www.mycpd.org.au Please make sure your pop-up blocker is disabled before launching any online courses on myCPD. For assistance with disabling pop-up blockers, read the help guides under the ‘Help’ tab. Difficult conversations in the workplace – Employee and Managers course Two online e-learning courses that have each been CPD accredited for two (2) Group 2 CPD credits with successful assessment are now available on myCPD. They have been made available thanks to the Fair Work Ombudsman (FWO) and are titled;

•• Difficult conversations in the workplace (Employee’s course); and

•• Difficult conversations in the workplace (Manager’s course) They are video role plays between an employee and manager in a retail small business setting – demonstrating difficult conversations that can occur in the workplace. Each course will take learners up to one hour to complete, however the modules can be completed in multiple sittings as the myCPD system will bookmark where you are up to.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 33 : DECEMBER / JANUARY 2014

After completing these modules, you will be able to;

•• Understand some do’s and don’ts about having difficult conversations in the workplace; •• Important considerations to undertake when having a potentially difficult conversation; •• How to set up for a potentially difficult conversation with an employee (or manager) and relevant documentation that is recommended. The courses are available now at: www.mycpd.org.au in the ‘Featured Courses’ Section when first logging in.

If you have any queries please do not hesitate to contact the guild Pharmacy Academy on: 03 9810 9930 or email: guildpharmacyacademy@guild.org.au

GUILD INTERN TRAINING Thanks to Linda and Jenny from Werrington Pharmacy NSW for participating in the photography

Guild interns make the best interns because they have access to: • A program balanced with clinical and business knowledge • Comprehensive exam preparation • Visits from a clinical tutor providing on-site assistance and mentoring • 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

WHAT’s NEW & company news

It’s Time to Face the Facts; Use Your SPF 50+ Daily – Don’t Let the Sun Steal Your Beauty UV radiation is the biggest controllable cause of premature skin ageing1 and in a recent study led by Professor Adele Green of the Queensland Institute of Medical Research; it has finally been shown that regular sunscreen use can help prevent premature ageing2.

“REME-D is a therapeutic first-line support for migraine headache sufferers coupled with a holistic migraine management plan.”

When it comes to skin damage on the face, prevention is always better than cure, which is why Australian made sunscreen brand SunSense is educating Australians that their anti-ageing routine is about being proactive now by using sunscreen daily to help prevent the damage from occurring in the first place. Dr Kerryn Greive PhD, Scientific Affairs Manager at Ego Pharmaceuticals has been a strong advocator for every day sun protection for over 10 years and believes now is the perfect time to begin your daily sunscreen routine. “If you are inside for most of your day, that brief period when you are outside, which may be during your commute to work or a quick coffee break at your local cafe, is potentially enough daily exposure to the sun to build up over your lifetime and cause long term skin damage” said Dr Greive. “The protection sunscreen provides depends critically on its correct application, it is very important to remember to reapply” added Dr Greive.

BLACKMORES REME-D According to the World Health Organisation, migraines have been rated as one of the top three most prevalent conditions in the world. Episodes vary from one individual to another and can be highly disabling.1 Here in Australia, a National Health Survey in 2001 revealed around 6.2% of Australians over the age of 15 years selfreported migraine2 with a higher incidence among women: Women 8%, Men 4%. Blackmores has come together with leading Australian neurologist Dr Raymond Schwartz, to introduce REME-D; a therapeutic first-line support for migraine headache sufferers coupled with a holistic migraine management plan. Blackmores Reme-D for Migraine-Headache contains a specially chosen combination of feverfew & B vitamins (B2, B6, B9, B12) which may help reduce the frequency of migraine headaches and associated symptoms such as nausea and vomiting when taken regularly. Always read the label. Use only as directed. If symptoms persist see your healthcare professional. >> www.blackmores.com.au REFERENCES: 1. http://www.who.int/mediacentre/factsheets/fs277/en. 2. National Health Survey: Mental Health, Australia, 2001, http://www.abs. gov.au/ausstatsabs@.nsf/mf/4811.0. 3. http://headacheaustralia.org.au/migraine (viewed March 2013). 4. http://headacheaustralia.org.au/images/stories/PDFs/MSD_ Migraine_2011_Report.pdf. 5. Manack A et al. The Evolution of Chronic Migraine: Classification and Nomenclature. Headache. 2009;49:1206-1213.

Changes to Australian regulations3 late last year have seen the introduction of SPF 50+ sunscreens to the Australian market. SunSense was the first Australian sunscreen brand to replace the manufacturing of SPF 30/30+ with SPF 50/50+ sunscreens. Up to 80% of UV radiation can penetrate through light cloud cover4, so even when the sun is not shining on you directly, you are exposed. Using SunSense sunscreen in a daily routine over summer and throughout the year, particularly on areas most exposed to the sun like the face, neck, chest and hands will help prevent premature skin ageing. >> www.sunsense.com.au references 1 Garmyn M, Van den Oord J. Clinical and Histological Changes of Photoaging. In: Rigel DS, Weiss RA, Lim HW, Dover JS, editors. Photoaging. Canada: Marcel Dekker, Inc; 2004. Chapter 3; p. 33-54 2 Hughes MC, Williams GM, Baker P, Green AC. Sunscreen and Prevention of Skin Aging. Ann Intern Med. 2013; 158:781 -790 3 AS/NZS 2604:2012; Very High, SPF 50+, Broad spectrum. 4 World Health Organisation. Ultraviolet radiation: global solar UV index [online]. 2013 [cited 27 August 2013]. Available from URL: http://www.who.int/uv/resources/ archives/fs271/en/ 5 SPF 30+ is defined as SPF 31 as per AS/NZS 2604:1998. SPF 50+ is defined as 60.1 as per AS/NZS 2604:2012 6 Nielsen Value sales for November 2011 to October 2012

“SunSense is educating Australians that their anti-ageing routine is about being proactive now by using sunscreen daily to help prevent the damage from occurring in the first place.”

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BLACKMORES REME-D FOR MIGRAINE-HEADACHE

端 MAY ASSIST IN THE MANAGEMENT OF MIGRAINE HEADACHE 端 MAY HELP REDUCE THE FREQUENCY OF MIGRAINE HEADACHES WITH REGULAR USE 端 REGULAR USE MAY REDUCE SYMPTOMS ASSOCIATED WITH MIGRAINE

Learn more at blackmores.com.au Always read the label. Use only as directed. If symptoms persist see your healthcare professional.

WHAT’s NEW & company news

Blackmores Institute Symposium Community pharmacists should register now for the Blackmores Institute Symposium to secure the early bird offer of free cocktail networking function tickets. The event, being held in Sydney from 28th February – 1 March 2014 promises to be a game-changing occasion aimed at working with community pharmacy to grow the knowledge of the role that evidence-based, natural medicines can play in improving Australian health outcomes. Confirmed speakers to date include Associate Professor Lesley Braun, Associate Professor Parisa Aslani, Dr Brett Macfarlane, Dr Evelin Tiralongo, Dr Antigone Kouris and Liesl Blott. A number of other valuable speakers will be confirmed over the next few weeks. This educational and motivational event will prepare delegates to:

•• Explore new, integrative models of patient-centred

•• Discover how taking an active role in complementary medicines use can improve professional satisfaction

•• Meet patients’ needs for advice on incorporating herbs and natural supplements into everyday healthcare The broad range of educators, researchers and industry experts will present theoretical and practical topics around the issues around safety, regulations, evidence, managing interactions and more. As a special offering, delegates will receive an invaluable toolkit to help apply this new-found knowledge into everyday practice. Profits from the event will be donated to the Cure for Life Foundation. >> Register via www.blackmoresinstitute.org.au The early bird offer runs until 17th January, 2014

pharmacy practice

•• Enhance their role in helping your patients manage their own health and wellbeing

FINDING A NEW WAY TO WHEY: ISOWHEY® REVEALS NEW LOOK

AND NOW... MAKE “WHEY” FOR A NUTRITIOUS SWEET TREAT ISOWHEY®

IsoWhey®, the high-quality whey-protein based weight management range will unveil its new packaging and positioning in stores, from October 14.

IsoWhey, the high-quality whey protein based weight management range has unveiled its new packaging and positioning.

The new look reflects the longstanding core benefits of the IsoWhey® range, extending the brand beyond weight management solutions, to a comprehensive nutritional offering, for healthy living. Plus, with in-store merchandising support and a refreshed website featuring recipes, meal plans and exercise plans, IsoWhey® offers comprehensive support to your customers. Scientifically formulated and highly respected by practitioners, the IsoWhey® range continues to boast premium formulas, now with the added benefit of Seagreens®, a raw superfood containing antioxidants, polyphenols and polysaccharides. Utilising cold, enzymatic, ultra-filtration techniques, IsoWhey® contains ultra-purified whey protein isolate and high grade whey protein concentrate, providing over 15g of high-quality, biologically active protein per serve.

And now set to hit December 2013 you can satisfy your sweet cravings with IsoWhey Protein Pops, the deliciously convenient, high protein, low-carb snacks that make an ideal bite between meals. Whether it’s for the office, at home, after the gym or on the go, IsoWhey Protein Pops are great for refuelling your energy with added benefits of vitamins and minerals. IsoWhey Protein Pops not only offer a nutritional snack; they are also free from artificial colours, flavours, sweeteners and preservatives. Beat the 3pm sugar trap and feed your body a nutritious snack instead with IsoWhey Protein Pops. Healthy has never tasted so good! KEY FEATURES: High protein- more than 18g of protein per serve Low-carbohydrate – less than 1.9g per serve No artificial colours, flavours or sweeteners Naturally sweetened with stevia

The IsoWhey® range is one of the only powders which feature pure whey protein – high-quality protein which helps keep individuals satisfied between meals.

•• •• •• ••

“At IsoWhey®, we believe in a wholistic and natural approach to good health and our new look reflects this. IsoWhey® offers a wealth of nutritional benefits for better health in an easy to use formula” says Nicolie Jarvis, IsoWhey® Product Manager.

FLAVOURS: IsoWhey Protein Pops are available in two delicious flavours: Choc Coconut and Cookie Dough

“Our formula contains a balanced mix of prebiotic fibre, probiotics, vitamins, minerals and digestive enzymes, maximising the nutritional value”.

>> www.isowhey.com.au or call 1300 476 943

IsoWhey® is recommended for daily nutritional supplementation; for those who are time-poor, for seniors; for those who have limited cooking abilities and for those looking for long-lasting weight management solutions. >> www.isowhey.com.au or call 1300 476 943 GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 33 : DECEMBER / JANUARY 2014

Earn

CPD points

WHAT’s NEW & company news

Iberogast Silly Season Survival Tips In the lead up to Christmas, food coach Judy Davie has partnered with Iberogast® to compile ten tips to help Aussies manage their health throughout the festive season. 1. Drink plenty of water throughout the day and night Heat and alcohol combined is a recipe for dehydration and a horrible hangover to follow. For optimum rehydration, try adding a pinch of good quality sea salt and a dash of apple juice to your water. 2. Ditch digestive discomfort More often than not, our diets and eating routines change during the festive season. Taking clinically proven natural medicines such as Iberogast assists the relief of digestive discomfort like indigestion, heartburn or bloating* and helps you continue the festivities feeling better. 3. Don’t stress by making promises you can’t keep Instead of feeling stressed and guilty for breaking your promises, allow yourself to indulge a little–it is Christmas after all! 4. Fight the fatigue naturally When you are feeling fatigued after one too many Christmas parties, or experience that uncomfortable fullness after an overindulgent dinner, consider a natural medicine like Legalon®, which works to support your body’s natural detoxification processes, relieving fatigue due to an overloaded liver.

5. Whizz up a green smoothie to blast your body with nutrients 6. Remember to exercise In between meals, grab some family and friends and go for a gentle walk to aid digestion and stimulate metabolism. 7. Get a good night’s sleep 8. Combat festive angst Stress and anxiety is one of the greatest causes of poor digestion, and Christmas isn’t always known to be one of the most relaxing times of the year! Make sure you take time out to relax and rejuvenate for the year ahead. 9. Choose your poison carefully! Some alcoholic beverages are better than others so choose the purest, with less sugar, colours, preservatives and “hangover – causing” congeners. 10. Moderation, moderation, moderation Go ahead indulge in what you might not ordinarily eat but instead of three potatoes have one, avoid the turkey skin, have a tablespoon of gravy rather than a pool of it, and go easy on cream and cheese. If anything’s going to give you indigestion, high fat dairy will. >> www.iberogast.com.au

Have you recommended today?

Maintain digestive balance with Inner Health Plus

IHP2602 - 01/13

www.innerhealth.com.au Always read the label. Use only as directed.

PRODUCT IN ACTION

HYLO®-FRESH and HYLO-FORTE® Eye Drops HYLO®-FRESH and HYLO-FORTE® preservative-free eye drops have been developed by Ursapharm, a German company specialising in the field of dry eye treatment, and are distributed in Australia by AFT Pharmaceuticals.

Ursapharm focus on two key elements in their development of products for the treatment of dry eye - long-lasting moistening and best possible tolerability – and HYLO®-FRESH and HYLO-FORTE® eye drops represent a revolutionary advance in the treatment of dry eye through the combination of the patented COMOD® multi-dose application system and high quality sodium hyaluronate that provides intensive and long-lasting lubrication for dry eyes. HYLO®-FRESH (0.1% sodium hyaluronate) is for the treatment of dry eyes of moderate to medium severity, while HYLO-FORTE® (0.2% sodium hyaluronate) has a higher concentration of sodium hyaluronate and higher viscosity for the intensive treatment of severe and chronic dry eye or for postoperative treatment. The ingenious COMOD® multi-dose application system prevents contamination in the bottle and provides the precise delivery of multiple sterile doses of preservative-free medication, ensuring that HYLO®-FRESH and HYLO-FORTE® can be used for 6 months after opening.

“HYLO®-FRESH and HYLO-FORTE® eye drops provide the precise delivery of multiple doses of preservative-free eye drops in a bottle for an extended period (6 months) after opening.”

The major benefit of HYLO®-FRESH and HYLO-FORTE® eye drops is that they provide the precise delivery of multiple doses of preservative-free eye drops in a bottle for an extended period (6 months) after opening, as opposed to existing single dose preservative-free drops that need to be discarded after use. The use of high quality sodium hyaluronate in HYLO®-FRESH and HYLO-FORTE® also results in high viscosity drops that stay longer on the ocular surface for long-lasting moistening without vision

impairment. Because the drops are also phosphate-free they prevent corneadamaging precipitation and permanent deposits on contact lenses, which also means they are compatible for use with all types of contact lenses.

For more information visit: www.aftpharm.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 33 : DECEMBER / JANUARY 2014

PRODUCT IN ACTION

Gold Cross Oil of Cloves

Oil of Cloves, a product by Probiotec, is a natural antiseptic and pain-relieving remedy which is becoming increasingly popular in pharmacy.

“Oil of Cloves is proudly endorsed by Gold Cross and is the only Clove Oil product available in Australian pharmacies – making it a truly unique product in the marketplace.”

It is produced via steam distillation of clove buds and contains organoleptic properties which can best be described as spicy, sweet, fermented and woody. Oil of Cloves is best known as a solution for pain and is widely used in dental preparations to decrease discomfort associated with the recurrence of toothache, cavities, dental caries and tooth decay. Oil of Cloves also has domestic applications in eliminating household mould from areas such as wet carpets, curtains and refrigerator seals. General Manager of Marketing, Dusty Stringer claims Oil of Cloves is extremely easy to use, ‘Simply dilute ¼ of a teaspoon of Oil of Cloves for each litre of water used, spraying on the affected area. Leave for five minutes and then wipe clean’. Oil of Cloves has been publicy endorsed by cleaning expert Shannon Lush for the treatment of household mould. And the list of uses of this must-have household product does not stop there. Oil of Cloves contains antispasmodic properties when applied topically on the

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 33 : DECEMBER / JANUARY 2014

affected area. It also contains calmative qualities and is useful for expelling gas and stopping intestinal spasms. Clove Oil contains a mixture of chemical compounds, the main one being ‘Eugenol’. Eugenol generally makes up approximately 60-90% of each clove and contains both the antiseptic properties useful for cleaning and anti-inflammatory properties which act as the numbing agent for pain and give the oil its aroma. Oil of Cloves is proudly endorsed by Gold Cross and is the only Clove Oil product available in Australian pharmacies – making it a truly unique product in the marketplace. Dusty adds, ‘The fact that Oil of Cloves is an “all natural” essential oil means that it is preferred by many as opposed to other pain relieving products, we believe this is a great selling point for our product’.

For more information visit: www.trustgoldcross.com.au

PRODUCT SPOTLIGHT

BLACKMORES REME-D

Gold Cross Icthammol

Migraine can be debilitating and recurrent attacks can interfere with your daily life. Blackmores Reme-D for Migraine-Headache contains a specially chosen combination of feverfew & B vitamins (B2, B6, B9, B12) which may help reduce the frequency of migraine headaches and associated symptoms such as nausea and vomiting when taken regularly.

Gold Cross Icthammol ointment is used to treat foreign objects under the skin or infections. The ointment ‘draws’ out problems such as ingrown toe nails, splinters, glass shards or insect poisons. It can also be used to treat a variety of skin inflammations and can be used to heal cuts, sores and other surface abrasions.

Always read the label. Use only as directed. If symptoms persist see your healthcare professional.

Containing 250mg/g of Icthammol as the active ingredient, Gold Cross Icthammol ointment contains a waxy base that retains moisture and softens the skin, whilst promoting increased blood flow to create pus and assist with the ejection of foreign objects from the body.

>> www.blackmores.com.au REFERENCES: 1. http://www.who.int/mediacentre/factsheets/fs277/en. 2. National Health Survey: Mental Health, Australia, 2001, http://www.abs.gov.au/ ausstatsabs@.nsf/mf/4811.0. 3. http://headacheaustralia.org.au/migraine (viewed March 2013). 4. http://headacheaustralia.org.au/images/stories/PDFs/MSD_ Migraine_2011_Report.pdf. 5. Manack A et al. The Evolution of Chronic Migraine: Classification and Nomenclature. Headache. 2009;49:1206-1213.

>> www.trustgoldcross.com.au

Ethical Nutrients Mega Magnesium Ethical Nutrients Mega Magnesium is a high potency magnesium supplement available in a convenient tablet or delicious Raspberry flavoured powder. Each product contains the propriety, and highly absorbable form of magnesium, Meta Mag®. Mega Magnesium may be of benefit:

•• •• •• ••

RRP 60 Tabs $22.50 120 Tabs $39.95 250 g Powder $39.95

During times of stress. To relieve muscular aches, pains, cramps and spasms. In assisting cellular energy production. To relieve menstrual pain and cramping.

Restore your magnesium levels with Ethical Nutrients Mega Magnesium tablets or powder. Always read the label. Use only as directed. If symptoms persist consult your healthcare professional. >> www.ethicalnutrients.com.au

IsoWhey® IsoWhey® is a low-carbohydrate formula boasting 15g of high-quality whey protein per serve. Plus, IsoWhey® contains 23 vitamins and minerals, and pre- and probiotics for nutritional and digestive balance. IsoWhey® contains no artificial colours, flavours or preservatives. >> www.isowhey.com.au

ZO RUB – effective treatment for Chafing and Sweat Rash ZO RUB provides a barrier against friction to protect the skin and help prevent the redness and soreness caused by sweating and rubbing. It also contains a unique water-binding moisturiser to retain moisture in the skin, and as an effective antiperspirant it helps prevent sweat rash by keeping the skin dry. >> www.aftpharm.com

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 33 : DECEMBER / JANUARY 2014

60 SECONDS WITH / HEALTH CALENDAR

HEALTH CALENDAR 60 SECONDS WITH...

DECEMBER 2013 – JANUARY 2014 December 2013 World AIDS Day – Worldwide 01 December

World AIDS Day is one of the most globally recognised events of the year. On 1 December each year, World AIDS Day is celebrated across Australia to raise awareness in the community about the issues surrounding HIV/AIDS. HIV positive people need to be empowered in society. They have the right to participate in a community free from stigma and discrimination.

Victoria Schultz

Malouf Pharmacy Toowoomba

I decided to become a pharmacist because... I have been exposed to good

>> www.worldaidsday.org.au

health management, through pharmacy, all my life, as my mother is a pharmacist and so was her mother. Whilst working for them, I experienced the importance of a pharmacist, as a triage point, in the health of the community. This developed my desire for knowledge and a curiosity to solve a patient’s health problems.

2nd Annual Health Technology Technology Assessment Conference 2013 5 - 6 December 2013 | Sydney Harbour Marriott Hotel Stimulating innovation, understanding the benefits of health technologies and delivering a safe, effective and efficient health systems for all.

I have been working as a pharmacist for... 7 years – after graduating from JAMES COOK UNIVERSITY in Townsville

What I like best about my job is... Determining the best course of action for a patient’s health and encouraging them to be proactive about their life in regards to disease state management. I also enjoy discussing best practice with other health professionals.

My favourite hobby is... Can I say eating? And therefore hiking and running so that I can focus on my hobby. My favourite book is... Anything by the

>> www.healthcareconferences.com.au

January 2014 Cervical Health Awareness Month January 2014 Each year, approximately 12,000 women are diagnosed with cervical cancer in the United States. Yet cervical cancer is one of the most preventable cancers today. In most cases cervical cancer can be prevented through early detection and treatment of abnormal cell changes that occur in the cervix years before cervical cancer develops. >> www.nccc-online.org/awareness.html

author Karen Rose or any book where good wins over evil!

My best getaway ever was... climbing Mt Fuji whilst in Japan – although I don’t recommend it during typhoon season – poor visibility to put it mildly!

How I keep myself updated to the market news... Obviously I read ITK! 99% of my information comes from journals – I subscribe to Australian Pharmacist and Medical Observer which is great for all health professional information. Lectures are the best when available but I avoid conferences due to cost.

Over the next 3 years in pharmacy, I predict... It’s hard to say what I predict because no one can see the future but what I want is for the government and the community to acknowledge that community pharmacy provides an invaluable health service to the community.

Glaucoma Awareness Month January 2014 Glaucoma is a major cause of blindness throughout the world. In developed countries it is one of the major causes of untreatable blindness and visual disability. Our vision is for a world where no one is needlessly blind, and Indigenous Australians enjoy the same health and life expectancy as other Australian >> www.hollows.org.au

>> www.preventblindness.org

You Better Lookout 25 - 31 January 2014 Six days of relevant and crucial education and professional development sessions along with six social events of epic proportions. Take a tour of our website to see why YOU BETTER LOOKOUT and get to the 2014 NAPSA congress in Bendigo, Victoria. >> www.napsacongress.org

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 33 : DECEMBER / JANUARY 2014

CLASSIFIEDS

FOR SALE

WANTED – Shop fittings including gondolas, fridges, counters, dispensary equipment etc. Contact: Roma, Alchemy Pharmacy Brisbane Ph: 0419 837 838

1 X Ursofalk Suspension 250mg/5ml Exp: 08/2014 - $160 2 x Androcur 50mg Exp: 01/2014 - $100

WEBSTER UNIT DOSE 7 (WINDOW AT TOP) FOR SALE QTY – 75 White, 22 Green, 10 Purple, 120 Blue, 270 Pink, 93 Yellow, 105 Orange

1 x Zorac Cream 0.5mg/g 30g Exp: 04/2014 - $20

All to be sold at $1 each!!!! Pick up available. Or plus Postage.

1 x Zorac Cream 1.0mg/g 30g Exp: 04/2014 - $24

Contact: Rana, Outlook Drive Pharmacy, Dandenong North VIC Ph: 03 9795 1414, Email: outlookdrive@hotmail.com

1 x Reprieve 2mg Exp: 03/2014 - $80 Contact: Sonia, Amcal Oxenford Chempro Chemist Ph: (07) 55199200, Email: oxenford@chempro.com.au

1 x Votrient (Pazopanib) 400mg 60 Exp 05/2015 Cost less 10% (sell at $4137.45)

PKU Lophlex LQ 20 125ml sachets 30 in a box – 3 boxes at $450.00, usually $510 per box. Free postage included. 6 x Xylocaine 2% with adrenaline 1:80,000 10x5 ml amps EXP 11/2014 at $60.00 per box 2 x Actos 15mg Exp 01/2015 at $35.00 per box

Price incl. Registered Post within Australia. 2 x Qvar 50 inhaler EXP 05/2014 at $15.00 per box Contact: Dinesh, Bunyip Pharmacy, Ph: 03 5629 5407 Email: dsolanki@bunyip.aushealth.biz

Contact: Lori Rasmussen, Pease St Discount Drug Store Piccone’s Shopping Village Ph: (07) 40 532 883 F: (07) 40 320 446

1 x Azol 200mg 100, exp: 08/15 - $50 each 2 x Strattera 25mg, 28 & apos’s expiry 4/2014 - $65 each 1 x GenRx Cyproterone Acetate 50mg 20, exp: 04/14 - $25 each 1 x Strattera 25mg, 28 & apos’s expiry 4/2015 - $85 1 x GenRx Cyproterone Acetate 100mg 50, exp: 04/14 - $90 each 1x Stalevo 125/31.25/200 expiry 1/2015 - $150 1 x GenRx Baclofen 25mg 100, exp: 09/15 - $20 each 1 x Avanza Soltab 45mg 30 & apos’s expiry 1/2014 - $14 6 x APO-Mycophenolate 500mg 50, exp: 01/15 - $70 each Contact: Engy Ph: (07) 41927007, Email: toogoompharmacy@y7mail.com Contact: Tony, Camden Pharmacy Ph: 02 4655 8875, Email: camdenpharmacy@chemist.com 5 x Avodart expiry 04/2014 Wholesale price minus 40% @ $12 per box 2 X 3 Draw Flexishelf models valued at $1775 + GST

Contact: Sam Ph: (02) 9587-5814, Email: zainabspharmacy@hotmail.com

1 x 2 Draw Flexishelf valued at $1195 + GST Both are in excellent condition. I am willing to take any reasonable offer and buyer would need to be able to pick these up at their earliest convenience. Contact: Donna Mills, Direct Chemist Outlet Croydon Ph: 03 97237711

PLACE YOUR FREE CLASSIFIED ADVERT If you would like to place your free classified ad, forward any items for sale to Candice. Email: Candice.radford@goldx.com.au

Wanted: Surmontil Capsules 50mg 50 Contact: Susanna, Palmyra Chemmart Pharmacy Ph: (08) 9339 5522, Email: palmyradispensary@bigpond.com

BROUGH T T O YOU BY :

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 33 : DECEMBER / JANUARY 2014

Our tv advertising draws customers to your store.

Our training

enables you to give them the best advice.

Our cOmmitment

to you ensures they come back to you!

• maintain healthy digestive function • improve general wellbeing • maintain a healthy immune system

restOre yOur custOmers’ inner HealtH tHis cHristmas And See Them Return in the New Year it’s that merry time of year again where your customers may be overindulging in foods and alcohol that can disrupt their digestive balance, leading to symptoms of bloating, flatulence and poor digestion. Inner Health Plus contains the scientifically proven, therapeutic strains, Lactobacillus acidophilus (ncFm®) and Bifidobacterium lactis (bi-07), to assist in the maintenance of a normal healthy gastrointestinal system and digestive function. so this jolly season, help restore your customers’ digestive balance and improve their general wellbeing by recommending inner Health Plus. Our national tv campaign will continue throughout the season to drive customers to your store (and not a nearby supermarket).

www.ethicalnutrients.com.au best PrOducts best educatiOn best service industry Pulse independent research shows ethical nutrients, yet again,

as the leading supplier to Pharmacy providing unparalleled service excellence and product training for the 4th consecutive year!

ethical nutrients offers professional natural medicine training for all staff in your store in a variety of formats to suit the varied needs of your staff: • Online Learning Modules • In-Store Trainings • Training Evenings • itherapeutics.com.au

iHP2845 - 10/13

yOur natural business Partner