Pharmac APRIL 2020
Valuable education for pharmacy staff
MAGAZINE
ere Click heive to rec thly a mon of copy cy a Pharmin e... Magaz
Pneumonia in children SA Pharmacy law history
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Cannabis: what you need to know MISSED AN ISSUE OF PHARMACY MAGAZINE? DOWNLOAD PAST ISSUES ONLINE
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APRIL
2020
EDITOR’S NOTE
EVENTS IBS Awareness Month Autism Awareness Month National Minority Health Month
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Thank you
for your vital service
A
die-hard South African, I’ve always been
stretched healthcare system might just be able to
impressed by the people of our country
make it through this pandemic without complete
and the way we rally together when
collapse. Sadly, I worry it’s going to take a steep rise
times are hard. Our sense of humour,
in deaths before many South African’s begin to grasp
which has been so evident in the jokes, memes, and videos going around since the beginning of lockdown, is a truly unique flavour which warms my soul.
the gravity of the situation. you’re on the frontlines every day, facing the crisis, caring for patients, and putting the health of you
ruin it for everyone else. As I write this it is day 14
and your family in the hands of your fellow South
of the lockdown and the number of people
Africans. I can only hope that more people will begin
who continue to ignore the lockdown leave me
to understand the implications of their actions.
frustrated beyond measure. The complete lack of
to get worse before it gets better and the work
workers on the frontline and a other essential
you’re doing is vital. Your sacrifice and dedication
services personnel are making is infuriating. If I
are valued beyond measure. May you and
read one more post about some overly important
your families stay safe
and selfish individual bragging about how much
and come out stronger on
they enjoyed their morning jog… That people can
the other end of this.
have such utter disregard for the lives of those because the people flouting the rules for their
CROSSWORD CHALLENGE
daily jog aren’t the ones who are sharing a one
Congratulations to the
room shack with four other family members.
winner of Crossword #16
Yes, exercise and mental health are all important
Hanelie Visagie. For your
during the lockdown, but there are many things
chance to win a R500
you can do at home to stay fit.
Woolworths voucher don’t
If we can just flatten the curve for as long as possible, there’s a small chance our already
LIVE BY
1 Apr
Family Day
2 Apr
World Autism Awareness Day
7 Apr
World Health Day
13-19 Apr
Oral, Head, and Neck Cancer Awareness Week
17 Apr
World Haemophilia Day
20-26 Apr
African Awareness Week
22-29 Apr
World Primary Immunodeficiency Week
25 Apr
DNA Day
25 Apr
World Malaria Day
28 Apr
World Day for Safety and Health at Work
miss this month’s crossword puzzle on page 33.
PM
“Show respect even to people who don't deserve it; not as a reflection of their character, but as a reflection of yours.” – Dave Willis
FEEDBACK Send your letters and news or events to nicky.belseck@newmedia.co.za
2
International Caesarean Awareness Month
If you haven’t heard it yet, THANK YOU! It’s going
respect and appreciation for the sacrifice healthcare
around them makes my blood boil. Especially
International Parkinson’s Awareness Month
But I’m preaching to the choir. As pharmacists
That said, there are always some people who
WORDS TO
Testicular Cancer Awareness Month
| APRIL 2020 Pharmacy Magazine
NO-ONE SHOULD DIE BECAUSE THERE IS NO MATCH
HELP US SAVE LIVES! BECOME A BLOOD STEM CELL DONOR TODAY Every year adults and children are diagnosed with life-threatening blood diseases and their only hope of cure is a blood stem cell (bone marrow) transplant from a matching donor. It could be you they are waiting for.
share. give. register 0800 12 10 82 | www.sunflowerfund.org
Our time with ANTIBIOTICS is running out. Antibiotics are in danger of losing their effectiveness due to misuse and overuse, and in many cases they aren’t even needed.
Always seek the advice of a healthcare professional before taking antibiotics.
antibiotics / INNOVATION
URGENT NEED FOR NEW ANTIBIOTICS
WORLD HEALTH DAY
7 APRIL
Lack of new antibiotics threatens global efforts to contain drug-resistant infections
D
eclining private investment and lack of innovation in
that once we have these new treatments, they will be available
the development of new antibiotics are undermining
to all who need them.”
efforts to combat drug-resistant infections, said the World Health Organisation (WHO).
Two new reports reveal a weak pipeline for antibiotic agents.
The 60 products in development (50 antibiotics and 10 biologics)
On a more positive note, the pipeline for antibacterial agents to treat tuberculosis and Clostridium difficile (which causes diarrhoea) is more promising, with more than half of the treatments fulfilling all the innovation criteria defined by WHO.
bring little benefit over existing treatments and very few target the most critical resistant bacteria (gram-negative bacteria). While pre-clinical candidates (those in early-stage testing) are more innovative, it will take years before they reach patients. “Never has the threat of antimicrobial resistance been more immediate and the need for solutions more urgent,”
PRECLINICAL DEVELOPMENT REVIEW The pre-clinical pipeline shows more innovation and diversity, with 252 agents being developed to treat WHO priority pathogens. However, these products are in the very early stages of
said Dr Tedros Adhanom Ghebreyesus, Director-General of
development and still need to be proven effective and safe.
WHO. “Numerous initiatives are underway to reduce resistance,
The optimistic scenario, the report indicates, is for the first
but we also need countries and the pharmaceutical industry
2-5 products to become available in about 10 years.
to step up and contribute with sustainable funding and innovative new medicines.” The reports also found that research and development
WHO ON AMR New treatments alone will not be sufficient to combat the
for antibiotics is primarily driven by small- or medium-sized
threat of antimicrobial resistance. WHO works with countries
enterprises with large pharmaceutical companies continuing
and partners to improve infection prevention and control and
to exit the field.
to foster appropriate use of existing and future antibiotics.
CLINICAL DEVELOPMENT REVIEW
Drugs for Neglected Diseases Initiative (DNDi) have established
WHO in 2017 published the priority pathogens list, 12 classes of
the Global Antibiotic Research and Development Partnership
bacteria plus tuberculosis that are posing increasing risk to human
(GARDP), a non-profit research and development organisation
health because they are resistant to most existing treatments.
accelerating the development of new and improved antibiotics
The list was developed by a WHO-led group of independent
to tackle drug-resistant infections. GARDP’s strategy is to deliver
experts to encourage the medical research community to develop
five new treatments by 2025. GARDP is working with more than
innovative treatments for these resistant bacteria.
50 public and private sector partners in 20 countries to develop
In the area of research and development, WHO and the
Of the 50 antibiotics in the pipeline, 32 target WHO priority pathogens but the majority have only limited benefits when compared to existing antibiotics. Two of these are active against the multi-drug resistant gram-negative bacteria, which are spreading rapidly and require urgent solutions. Gram-negative bacteria, such as Klebsiella pneumoniae and Escherichia coli, can cause severe and often deadly infections that pose a particular threat for people with
and ensure sustainable access to treatments, promoting
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responsible use and affordability to all in need.
PM
It’s important to focus public and private investment on the development of treatments that are effective against the highly resistant bacteria because we are running out of options
{
weak or not yet fully developed immune systems, including newborns, ageing populations, people undergoing surgery, and cancer treatment. The report highlights a worrying gap in activity against the highly resistant NDM-1 (New Delhi metallo-beta-lactamase 1), with only three antibiotics in the pipeline. NDM-1 makes bacteria resistant to a broad range of antibiotics, including those from the carbapenem family, which today are the last line of defence against antibiotic-resistant bacterial infections. “It’s important to focus public and private investment on the development of treatments that are effective against the highly resistant bacteria because we are running out of options,” said Hanan Balkhy, WHO Assistant Director-General for Antimicrobial Resistance. “And we need to ensure Pharmacy Magazine APRIL 2020 |
5
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Breast Cancer DID YOU KNOW? Breast cancer is the most common cancer W A R N I N G
S I G N S
A puckering of the skin of the breast.
A lump in the breast or armpit.
A change in the skin around the nipple or nipple discharge.
Dimpling of the nipple or nipple retraction.
An unusual increase or shrinkage in the size of one breast or recent asymmetry of the breasts
One breast unusually lower than the other. Nipples at different levels.
An enlargement of the glands.
An unusual swelling in the armpit.
MYTH vs FACT I am too young to get breast cancer Being overweight/obese doesn’t matter
Many women who are under 40 are diagnosed with breast cancer Overweight women have a higher risk of being diagnosed with breast cancer, especially after menopause
Alcohol is not linked to breast cancer
Alcohol use increases the risk of breast cancer
Only women with a family history of breast cancer are at risk
All women are at risk, but family history increases the risk
I have never had children, so I can’t get breast cancer
Women who have never had children, or only had them after 30, have increased risk of breast cancer
Toll Free 0800 22 66 22 | www.cansa.org.za
EARLY DETECTION IS KEY Do monthly breast self-examinations Go for regular screening (clinical breast examinations) at CANSA Care Centres Symptom-free women aged 40 to 54 should go for a mammogram every year (women & years and older should change to every 2 years) CANSA has Mobile Health Clinics that do screening in communities Did you know? CANSA offers a variety of BREAST PROSTHESIS at our Care Centres, for those who had to undergo a mastectomy/lumpectomy
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dermatology / FRONT SHOP
The miracle world
of peptides
The world of skincare seems to get buzzier by the minute. From CBD to crystals, it’s hard to keep up and know what’s worth the hype
“
W
Antioxidants? Yes please. If you know anything about
e’re here to proclaim, once and for all, that peptides are 100% worth the
us, you know we love topical antioxidants. Thankfully,
hype,” said GR8SKN Skincare founder
peptides contain natural antioxidants that reduce
Dr Janine Ellenberger. “In fact, we think
disease-causing inflammation.
they’re worth their weight in gold. Here’s why.”
COLLAGEN 411
PM
AUTHOR: Dr Janine Ellenberger GR8SKN Skincare
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Skin abundant in collagen is plump, firm, and a sign of youth
“Collagen is naturally occurring in your skin. We love it because it’s essentially like scaffolding for your skin – it holds everything in place and prevents sagging, wrinkles, and dull skin. Skin abundant in collagen is plump, firm, and a sign of youth. “Unfortunately, collagen breaks down over time due to pollution, DNA damage from exposure to UV light, movement (like facial expressions), excessive sugar intake, and smoking. To make things worse, not only are you losing collagen over time, your body produces less collagen as you age.
ENTER: PEPTIDES That’s where peptides come in. Peptides are small chemical compounds composed of short-chain amino acids, which are the building blocks of protein and collagen. Simply put, peptides applied topically send a signal to our skin to produce more collagen. Here’s a deeper dive into the benefits of peptides: • Collagen, collagen, collagen. Peptides aid in the production of collagen to keep your skin plump, firm, and wrinkle-free. • Strengthened barrier. Strong, healthy skin starts with a strong barrier of fatty acids on the top layer of the skin. Peptides create proteins that strengthen these bonds. • Hydration station. A stronger skin barrier means greater natural moisture. Not only does a strong barrier keep bad bacteria out, it keeps good, natural moisture in, right where it belongs. • Complexion booster. More collagen in the skin means clearer and more even skin.
{
Collagen is essentially like scaffolding for your skin – it holds everything in place and prevents sagging, wrinkles, and dull skin
{ Pharmacy Magazine APRIL 2020 |
7
011 234 4870 | 0800 70 80 90 sms 31393 | www.sadag.org
allergies / EDUCATION
Autumn tips for hay fever Keep your patients sneeze and wheeze-free this autumn
J
ust when everyone’s gotten used to their
“Autumn can arrive with bad allergy symptoms,” said
summer routine the temperature dips slightly
allergist Dr Bradley Chipps, president of the American
and before we know it, it’s time to start thinking
College of Allergy, Asthma, and Immunology. “Many
*
about how to keep autumn allergies at bay. But
people don’t realise if they spend time preparing now,
the good news for patients is if they start planning now,
they won’t get hit as hard with sneezing, runny noses,
their allergy symptoms will likely be much less severe,
and itchy eyes when autumn allergies descend with full
and they’ll be able to enjoy the beauty the autumn
force. It’s a matter of planning ahead for what you know
season brings.
is coming based on your past experiences.”
{ FOUR PRACTICAL TIPS TO HELP PATIENTS KEEP AUTUMN ALLERGIES AT BAY {
The coming of autumn doesn’t
2
Autumn leaves may be
3
If a child suddenly seems to have
4
automatically mean cool weather.
gorgeous, but once they’ve
a constant runny nose, itchy eyes,
most prominent pollen, or another type,
With global warming, unseasonably
fallen, they begin to gather
a cough, and sneezing, they could
keeping pollen out of their life means
warm weather for longer periods of
mould, an allergen that thrives
be dealing with allergens in their
patients will experience fewer allergy
time is no longer a rare occurrence.
in autumn. In addition to
classroom. Children can be allergic
symptoms. Some simple “housekeeping”
Mild temperatures along with rain
leaves, mould can be found
to dust in classrooms, or there
tips can help. When they come in from
can promote plant and pollen
anywhere there is water –
might be pollen coming in through
outside, patients should safeguard
growth, while wind accompanying
including in the backyard, in
open windows. And don’t forget
against pollen coming in with them.
rainfall can stir pollen and mould into
a field of uncut grass, and in
about mould – often found in
Simple steps would be to leave their
the air, heightening symptoms for
clogged gutters. For patients
bathrooms and locker rooms – as
shoes at the door and throw clothes in
autumn allergy sufferers. Because
allergic to mould, the key to
well as dander from pets that other
the washing machine. Showering and
autumn allergies may start earlier
reducing it is moisture control.
children may bring in on clothing
washing hair in the evening before bed will
and last longer, it’s important for
Explain that they need to clean
and backpacks. If a child seems
ensure they’re not sleeping with pollen,
patients to begin taking their allergy
standing water anywhere they
to have symptoms that came on
getting it on their pillow and in their nose.
medications at least two weeks
find it. They can also help ward
around the time school started,
If possible, recommend patients keep
before their symptoms normally
off mould by cleaning gutters
encourage parents to make an
windows closed in both their home and
start. And they shouldn’t stop their
regularly and keeping home
appointment with an allergist. An
car and instead run the air-conditioner.
medications until pollen counts have
humidity below 60%.
allergist can set their child on the
They should also monitor pollen and
been down for about two weeks –
right track, for the long term, to
mould counts online to determine when
usually after the first frost.
handle their allergies or asthma.
it’s best to stay inside.
1
IT ISN’T COLD ENOUGH TO BE AUTUMN
BEAUTIFUL LEAVES + MOULD = MISERY
ALLERGIES AND SCHOOL
DODGING POLLEN MEANS DODGING SYMPTOMS
Whether it’s ragweed, which is autumn’s
PM
TO MONITOR SA'S POLLEN COUNTS VISIT WWW.POLLENCOUNT.CO.ZA
Pharmacy Magazine APRIL 2020 |
9
addiction / CUT OUT & KEEP SOURCE: The Nationally Coordinated Codeine Implementation Working Group
Talking to patients
about codeine
CUT& OUTEP KE
W
Because codeine can also cause euphoriant effects, which reinforce continued use, it poses a risk of developing tolerance and eventually dependence
hen a patient
STARTING THE CONVERSATION
complaining of pain specifically
requests codeine it’s advisable
• What have you tried for your pain in the past? • Over the counter (OTC) codeine-containing medicines have been used in the past for the self-treatment of chronic pain problems. However, they can have serious and potentially life-threatening
to ask a few questions, not
side effects and are not first-line in treating chronic pain, so we don’t always prescribe them.
just about the pain they want to treat, but also why they’d
• Sometimes long-term pain may indicate an underlying problem. Can you tell me more about your pain? How long have you had the pain for? Can you describe the pain you are experiencing (dull, sharp, tingling etc.)?
prefer codeine?
{
POSSIBLE RESPONSES WHEN CODEINE DEPENDENCY IS SUSPECTED
{
The global misuse of prescription or OTC pharmaceutical opioid analgesics, including those containing codeine, is an increasing public health issue
• How long have you used this medicine? Did you get it from the pharmacy, was it prescribed or did someone else give it to you? • I am concerned about your health. A request like this can sometimes be a sign of dependence on the medicine. How much are you taking? • Pain medicines with codeine only provide a short-term benefit. If your pain is worse when you don’t take them, it may be because you have become dependent on them. Using other medicines or non-drug methods have been shown to have better long-term benefits. • I am concerned that providing ongoing medicine is not good for your overall health. I suggest that we trial a graduated withdrawal program, or I can refer you to a specialist?
GENERAL
TIPS
• Asking open ended questions about pain will help with your assessment. • You will need to perform a comprehensive clinical assessment of the person’s pain rather than just treating the pain as a symptom. • Don’t assume that if someone asks you to assist them with pain that they are looking for pain tablets. Explore other options such as physiotherapy, massage, acupuncture, exercise,
✂
lifestyle changes, and active selfcare management.
Pharmacy Magazine APRIL 2020 |
11
DDB SA 45388
It’s not just blood. It’s saving a nation.
Donate blood. Your blood saves lives.
9
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vaccination / EDUCATION
Pneumococcal vaccination critical in HIV HIV positive or immune-compromised patients are at a high risk of contracting a potentially fatal pneumococcal disease
P
neumococcal disease (or pneumonia), is
Guidelines vary, but most
an infection caused by the Streptococcus
recommend conjugate vaccine to be
pneumoniae (pneumococcus) bacteria.
used in those who are HIV-infected. You could
In 2009, SA became the first African
follow with the polysaccharide vaccine about
country – and the first nation in the world with a high
8 weeks later. This would protect against a
HIV prevalence – to introduce the pneumococcal
broader range of serotypes.
vaccine into its routine immunisation programme.
The issue with vaccines for adults is that it isn’t covered by the state, as is the case in infants.
HOW DOES IT AFFECT HIV?
“In an ideal world, we would advocate the
According to Prof Sipho Dlamini, Associate Professor,
conjugate vaccine first followed by the polysaccharide
Division of Infectious Diseases & HIV Medicine –
vaccine. This is the approach that the US has taken.”
Groote Schuur Hospital, UCT, “In patients with HIV,
He emphasised that if we use the polysaccharide
the risk of pneumococcal disease is almost 100 times
vaccine only, most guidelines say this should only
greater compared to those who do not have HIV. Even
be used in HIV patients with a CD4 count of greater
on antiretroviral therapy (ART), that risk goes down to
than 200. The conjugate vaccine can be used
about 35-40-fold greater than in those without HIV.
irrespective of CD4 count.
ART doesn’t necessarily reduce the risk,” he said.
“It is important that HIV-positive patients have a discussion about getting vaccinated. Which one to use will be determined by local guidelines and
This is where vaccination comes in. The risk of
affordability,” he concluded.
pneumococcal disease in HIV is not only greater – the mortality and morbidity is high in this group of people. Globally, 1.6m people die of pneumococcal disease annually. This is a huge burden. In those not HIV infected, the greatest risk is in people younger than 2 and over 55. HIV mostly affects young adults. This population group (young adults with HIV) is now greatly at risk and vaccination is important for them. “People who are HIV infected should be vaccinated for pneumococcal disease to be protected from The vaccines available are PCV 13, a conjugate vaccine and the polysaccharide vaccine and
In patients with HIV, the risk of pneumococcal disease is almost 100 times greater compared to those who do not have HIV
{
suffering consequences of a severe disease.”
PM
{
WHAT CAN BE DONE?
PPV-23 the polysaccharide vaccine. The difference between the two is the serotypes covered. However, the conjugate vaccine is more immunogenic, and works better for weaker immune systems.
Pharmacy Magazine APRIL 2020 |
13
Y E A RS
T WENT Y
SADAG
MENTAL HEALTH FACT SHEET
LIFE-TIME PREVALENCE OF MENTAL DISORDERS IN SA Compared with 14 other countries in the WMH Survey, South Africa is the:
2nd highest for substance abuse disorders (13.3%) 6th highest for anxiety disorders (15.8%) 7th highest for mood disorders (9.8%) PATIENT ADHERENCE AT A GOVERNMENT HOSPITAL
MENTAL HEALTH IN SOUTH AFRICA • 3rd biggest contributor to the burden of disease • 7.7% reduction in mental hospital beds across all provinces • 11% of all non-natural death in SA is due to suicide • 16.5% of South Africans suffer from common mental health problems • 43.7% of people with HIV/AIDS have a mental health condition • 75% of clinic staff does not have a caring attitude • South Africa is in the bottom 4 countries providing mental health treatment
Only 15.4% of patients take their meds as suggested by their dr 1 in 3 patients do not attend their dr’s appointments • Most common reasons are +/- 6 mil South African suffers from PTSD • Forgetfulness 28.6% +/- 8000 South Africans commit suicide each year • Lack of Support 24.2% • Adverse reactions 13% 82.1% cannot afford private health care • Unavailability 11% > 1% of health budget devoted to mental health
SOCIAL BURDEN FOR MENTAL HEALTH PATIENTS
Can’t take care of dependants
Separated/ Divorced
Lost friends
Negative Family Relationships
17%
26%
47%
49%
SEEKING TREATMENT FOR MENTAL HEALTH
RESOURCES FOR MENTAL HEALTH Per 100,000 of the population there are: 9.72 Nurses 0.4 Social workers 0.27 Psychiatrists 0.32 Psychologists 2.8 beds for in-patients 1% beds for children
Research compiled by SADAG – References: DoH, 2012; WHO, 2012, SASH, 2009; MHaPP, 2007; Freeman, 2007; MRC, 2006; ALLERS, 2009; Janse van Rensburg, 2013
paediatrics / EDUCATION
Pneumonia
in children According to the World Health Organisation (WHO), pneumonia accounts for 15% of all deaths of children under 5 years old
P
neumonia is a form of acute lower respiratory
also spread via airborne droplets from a cough or sneeze.
tract infection that occurs when viruses, bacteria,
Early onset pneumonia can be acquired from the mother
or other micro-organisms cause inflammation of
during labour or delivery, with respiratory distress beginning
SIGNS AND SYMPTOMS
the lungs. When a patient has pneumonia, pus
at, or soon after birth. Because signs of pneumonia are
Children with
and fluid fill the alveoli in one or both lungs, which interferes
non-specific in neonates, any newborn infant with sudden
pneumonia may have
with oxygen absorption, making it difficult to breath.
onset respiratory distress or other signs of illness should be
a range of symptoms
assessed for pneumonia and sepsis.
depending on their
TYPES OF PNEUMONIA
age and the cause
WHY ARE CHILDREN VULNERABLE?
(bacterial or viral) of
The most common is streptococcus pneumoniae which
A healthy child has many natural defences that protect its
the infection.
occurs when the body is weakened in some way, such
lungs from the invading pathogens that cause pneumonia.
as illness, poor nutrition, or impaired immunity, and the
However, children and infants with compromised
bacteria can work their way into the lungs.
immune systems have weakened immune defences.
• Bacterial pneumonia is caused by various bacteria.
• Viral pneumonia is caused by different viruses including
Undernourished children, particularly those not exclusively
influenza (flu) and is responsible for about one-third of all
breastfed or with inadequate zinc intake are at a higher risk
pneumonia cases.
of developing pneumonia. Similarly, children and infants
• Mycoplasma pneumonia has somewhat different
suffering from other illnesses, such as AIDS or measles, are
symptoms and physical signs to other types of
more likely to develop pneumonia. Environmental factors,
pneumonia and is sometimes referred to as “walking
such as living in crowded homes and exposure to parental
pneumonia” since symptoms tend to be milder than
smoking or indoor air pollution, may also have a role to play
pneumonia caused by other germs. Caused by the
in increasing children’s susceptibility to pneumonia and its
bacterium mycoplasma pneumoniae, it generally causes
severe consequences.
DIAGNOSIS Pneumonia can be diagnosed in several different ways.
CAUSES
Healthcare providers can diagnose pneumonia by
Most cases of pneumonia follow a viral respiratory tract
the symptoms (in resource-poor settings), a physical
infection. Pneumonia is typically caused by a virus or
examination or by ordering diagnostics. Laboratory
bacteria. Infection can be passed between people from
tests can include chest X-rays and cell cultures to
direct contact (usually the hands) or inhaling droplets in the
look for pathogenic bacteria in the infected part of the
air from coughing or sneezing.
body. Usually, there should be a combination of clinical,
If a viral infection has weakened a child’s immune
• Rapid or difficulty breathing • Cough • Fever • Chills • Headache • Loss of appetite • Wheezing
a mild, widespread pneumonia that affects all age groups.
Common symptoms of pneumonia in children and infants include:
radiological, and laboratory findings to increase the
system, bacteria may begin to grow in the lungs, adding
likelihood of correct diagnosis. Healthcare providers can
a second infection to the original one. Certain children
diagnose many cases by using a stethoscope or observe a
whose immune defences or lungs are weakened by other
child’s respiratory rate and any breathing problems.
illnesses – such as cystic fibrosis, abnormalities in the
Children under five with severe cases of pneumonia may struggle to breathe, with their chests moving in or retracting during inhalation (known as ‘lower chest wall indrawing’). Infants may suffer convulsions, unconsciousness, hypothermia, lethargy,
immune system, or cancer – may be more likely to develop
COMPLICATIONS
pneumonia.
Most children affected by pneumonia recover without any
and feeding problems.
long-term difficulties.
TRANSMISSION
However, there are several potential complications
Pneumonia can be spread in several ways. The viruses
including:
and bacteria that are commonly found in a child’s nose or
• Septicaemia is the most common pneumonia
throat, can infect the lungs if they are inhaled. They may
complication and occurs when the bacteria causing
Continued on next page...
Pharmacy Magazine APRIL 2020 |
15
orders with SANBS for blood products based on their needs.
Units are transported to the nearest SANBS testing and processing lab.
Your blood saves lives.
Blood is transfused patient A unitto of blood is in need. Just one drawn from a blood donation has the potential volunteer donor. to save three lives.
A unit of blood is Blood is transfused to patient in need. Just one blood drawn from a volunteer donor. donation has the potential to save three lives.
Blood products are stored prior to transfusion. The shelf life of blood is limited.
Platelets expire in 5 days. Red blood cells expire in 42 days. Plasma has a 1 year shelf life from the day of collection.
Red blood cells expire in 42 days. Plasma has a 1 year shelf life from the day of collection.
In the processing laboratory, blood is spun down in a Blood is collected Blood is collected into a sterile bag into a sterile bag centrifuge and then separated and labelled. and labelled. into its different components.
Units are transported to the nearest SANBS testing and processing lab.
A unit of blood is drawn from a aves lives. volunteer donor.
Plasma In the processing laboratory, bloodniss spun in a Contai proteidown ns and centrifuge and then separated into its different components. clotting factors used to treat patients with massive bleeding or clotting factor deficiencies.
ls Plasma moglobin, a protein that Contains proteins and n throughout the body. clotting factors used to patients with anaemia or treat patients with massive e to trauma or surgery. bleeding or clotting factor deficiencies.
5
5 5
Blood is collected into a sterile bag and labelled.
Blood is tested to ensure that it is safe for transfusi on. Platelets expire in 5 days.
Blood products are stored prior to transfusion. The shelf life of blood is limited.
Local hospitals place orders with SANBS for blood products based on their needs. Units are transported
Local hospitals place orders with SANBS for blood products based on their needs.
to the nearest SANBS testing and processing lab.
Blood is transfused to patient in need. Just one blood Your blood saves donation lives. has the potential to save three lives.
Your blo
Blood is tested to Blood is tested to ensure that it is safe ensure that it is safe for transfusion. for transfusion. In the processing laboratory, blood is spun down in a centrifuge and then separated into its different components.
Red blood cells Platelets Blood products Contain haemoglobin, a protein that Crucial inarehelstored ping blood on.eThe carries oxygen throughout the body. prior to transfusi clots. Pati nts wishelthflow lifeplofablteloeodt leivel s lims ioften ted. suffer Used to treat patients with anaemia or blood loss due to trauma or surgery. from bruising and bleeding.
Platelets expire in 5 days. Red blood cells expire in Platelets Red blood cells Plasma 42Platelets days. Plasma has a Crucial Contain haemoglobin, in helping a protein that blood Crucial in helping blood Contains proteins and clots. carries oxygen Patients throughout the with body. low clotting factors used to clots. Patients with low 1 year shelf life from platelet Used to patients treat levels patients with anaemia often suffer platelet levels often suffer treat withormassive from bloodbruising loss due to or trauma and or surgery.bleeding. from bruising and bleeding. bleeding clotting factor the day of collection. deficiencies.
R C c U b
paediatrics / EDUCATION pneumonia spreads into the bloodstream. The spread
Key prevention measures include:
of bacteria can lead to septic shock or metastatic
• Immunisations help reduce childhood deaths from
secondary infections like meningitis, especially in infants.
TREATMENT
pneumonia in two ways. First, vaccinations help prevent
Treating pneumonia
children from developing infections that directly cause
depends on its likely
can lead to increased capillary permeability and
pneumonia such as haemophilus influenzae type b (Hib).
cause and how ill the
accumulation of fluid in the pleural space. Pleural
Second, immunisations may prevent infections that
child is. The usual
effusion should be considered if a child does not respond
can lead to pneumonia as a complication (e.g. measles
approach is to give
to 48-hour treatment with intravenous antibiotics.
and pertussis).
antibiotics effective
• Pleural effusion injury to the lung due to an infection
• Lung abscesses are thick walled cavities containing
• Adequate nutrition: Undernourished children are
against bacterial and
purulent material that are the result of acute
at a substantially higher risk of suffering childhood
mycoplasma pneumonia.
destruction of the lung following inflammation,
death or disability. Malnutrition weakens a child’s
There is no clearly
necrosis, and cavitation. They are rare and mostly
overall immune system, as adequate amounts of
effective treatment
seen in children with respiratory co-morbidities or
protein and energy are needed for proper immune
for viral pneumonia,
neurodevelopment abnormalities.
system functioning. Undernourished children also
which usually resolves
• Atelectasis is caused due to obstruction of air passages
have weakened respiratory muscles, which inhibits
on its own.
by presence of foreign bodies, mucus plugs, or tumours
them from adequately clearing secretions found in
within the airways/in the wall of the airways.
their respiratory tract
Other treatment may include:
• Exclusive breastfeeding: It is widely recognised
PREVENTION
that children who are exclusively breastfed develop
Pneumonia kills more children than any other illness. Any
fewer infections and have less severe illness than
efforts to improve overall child survival must make the
those who are not.
reduction of pneumonia’s death toll a priority. Preventing children from developing pneumonia in the first place is
micronutrients, particularly zinc, face additional risks
essential to reducing child deaths.
of developing and dying from pneumonia.
{
Children under five with severe cases of pneumonia may struggle to breathe, with their chests moving in or retracting during inhalation
• Increase fluid intake • Enough rest
• Zinc: Children who lack sufficient amounts of specific
PM
• Appropriate diet
{
• Cool mist humidifier in the child’s room • Nebulizer treatments • Acetaminophen (for fever and discomfort) • Medication for cough
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cannabis / CPD SOURCE: SAHPRA
CANNABIS: WHAT YOU NEED TO KNOW
The South African Health Products Regulatory Authority (SAHPRA) has answered frequently asked questions about cannabis and related substances WHAT IS CANNABIS?
than 0.1% THC; or when present in processed
and Dravet syndromes. Sativex spray,
Cannabis refers to the plants in the genus
products from cannabis seed containing not more
containing CBD and THC, registered in
Cannabis, which includes various species or
than 0.001% THC; or when separately specified
the UK and Canada, is indicated for treating
sub-species. Cannabis species in the genus
in Schedule 6 for therapeutic use. Synthetic
spasticity symptoms in multiple sclerosis
include C.sativa, C.indica, and C.ruderalis.
cannabinoid substances are also listed separately
patients. Marinol capsules, containing
in Schedule 7. THC (also known as the synthetic
dronabinol (synthetic THC), are registered in
variant, dronabinol) is listed in Schedule 6, when
the USA and the UK, and indicated for use in
intended for therapeutic purposes.
chemotherapy-induced nausea and vomiting,
WHAT ARE TETRAHYDROCANNABINOL AND CANNABIDIOL?
CBD is listed as a Schedule 4 substance.
Between 60 and 100 chemicals called
and to treat anorexia associated with weight
cannabinoids and some 300 non-cannabinoid
Certain CBD preparations have been excluded
loss in patients with AIDS. Marinol was
chemicals are produced by the cannabis
from the operation of the Schedules by the
previously registered in SA but is no longer
plant. Delta-9 tetrahydrocannabinol (THC)
Minister of Health for a time-limited period,
marketed in this country.
and cannabidiol (CBD) are two of the many
as per an exclusion notice (R.756) published in
cannabinoids present in the cannabis plant, in
Government Gazette No.42477 on
varying concentrations. THC is psychoactive in
23 May 2019. This does not infer that CBD is
HOW IS CANNABIS USED FOR MEDICINAL PURPOSES?
nature and is the cannabinoid most sought after
excluded from other requirements of the Act.
Cannabis for medicinal use refers to the crude,
by recreational users for the “euphoric” high. CBD,
Schedule 7 substances are deemed to have
standardised, and quality-assured cannabis
on the other hand, is not psychoactive in nature.
no legitimate medicinal use and can only be
plant material that is cultivated, harvested,
accessed by means of a permit issued by the
processed, and packaged to be used in the
WHAT IS THE DIFFERENCE BETWEEN MARIJUANA AND HEMP?
Director-General of the National Department
manufacture of pharmaceutical preparations
of Health (NDoH). Medicines and substances
which are required to meet the requisite
These are colloquial terms often used to
categorised as Schedule 4 or Schedule 6
quality, safety, and efficacy standards.
describe different species, sub-species, or strains
are only available on the prescription of an
Cannabis-containing medicines cover a range
of the same Cannabis plant. The cannabis
authorised prescriber and can only be obtained
of quality-assured cannabis preparations
plant can be cultivated to contain varying
from a pharmacy or the holder of a dispensing
intended for therapeutic use, including as oils or
concentrations of cannabinoids, such THC and
licence issued in terms of the Medicines Act.
tinctures or other pharmaceutical dosage forms
CBD, dependant on the intended use. The high
However, refer to Question 20 in relation to
such as tablets and suppositories. The dried
THC-containing cannabis plant, generally utilised
personal use of cannabis by an adult in private.
flowering buds of the female plant may also be
for recreational purposes, is commonly referred
SAHPRA is responsible for the registration and
presented as “flos”, which can also be presented
to as marijuana, weed, ganja, or insangu. The
regulation of cannabis-containing medicines in
in granular form. Pharmaceutical preparations
low-THC-containing cannabis plant, cultivated
SA. Amendment of the entries for cannabis and
of cannabis contain specific active components
for the production of fibre (included in such
related substances in the Schedules is currently
(cannabinoids) in known amounts. The dose and
products as bricks, ceiling boards, and textiles) or
undergoing consideration.
strength of the preparation can be controlled and standardised, making it safer for patients to
seeds and the products produced from the seed
ARE THERE ANY REGISTERED CANNABIS-CONTAINING MEDICINES IN SA?
(such as cosmetics, oils, paint), is commonly referred to as hemp.
WHAT IS THE CURRENT STATUS OF CANNABIS IN TERMS OF THE MEDICINES ACT?
To date, there are no registered
Cannabis (the whole plant, parts, or products 7 substances in terms of the Medicines and
WHAT CANNABIS-CONTAINING REGISTERED MEDICINES ARE AVAILABLE GLOBALLY?
Related Substances Act, 1965 (Act 101 of 1965)
Epidiolex oral solution, registered
(the Medicines Act), except when present in
by the FDA and EMA, contains
processed hemp fibre and products thereof,
CBD and is indicated for treating
in a form not suitable for ingestion, smoking,
seizures in very rare, but severe forms of
or inhaling purposes, and containing not more
epilepsy in children – Lennox Gastaut
use.
PM
cannabis-containing medicines in SA.
thereof) and THC are currently listed as Schedule
This is a condensed version of the full CPD-accredited article which first appeared in the Medical Chronicle in February 2020. CPD points cannot be guaranteed as they are awarded at the South African Pharmacy Council’s discretion. FOR THE FULL ARTICLE AND TO COMPLETE THE CPD QUESTIONS VISIT WWW.MEDICALACADEMIC.CO.ZA INSTRUCTIONS: 1. Go to www.medicalacademic.co.za 2. Click the tab labelled ‘CPD Login’ on the far-right tab near the top of the page to access this and other CPD accredited articles. Pharmacy Magazine APRIL 2020 |
19
PHARMACY LAW / SA’s history
History of the regulation of the pharmacy profession in SA Pharmacy Magazine will be featuring a series of extracts from Pharmacy Law in South Africa (A Practitioner’s Handbook over the coming months. Pharmacy Law in South Africa (A Practitioner’s Handbook), which is intended to be used by both pharmacy students and pharmacists in all areas of practice, was borne of deep frustration and long experience. The authors have seen how access to the text of the various Acts, regulations, rules, and guidelines that govern professional practice is insufficient. Written by Andrew Gray (BPharm MSc (Pharm) FPS FFIP), Lorraine Osman (DipPharm FPS), and Yousuf Vawda (BA BProc LLM LLD), the handbook meets a need in the pharmacological field for a title that educates on the legal and ethical requirements of pharmacist.
O
rganised pharmacy in SA can be traced back to the nineteenth century when by
Legislation leading to the establishment of the South
1807, there were nine licensed apothecaries
African Pharmacy Board in 1928 was influenced mainly
(as they were then called) in the Cape
by the passage of the Public Health Act which led to
Colony, of English, Dutch, German, and French origin.
the creation of the Department of Public Health in 1919.
Due to the dominance of the medical profession at the
This law provided a sharper focus on public health and
time, pharmacists found their livelihood and position
symbolised increased government involvement in the
being threatened by the then Medical Committee which
regulation of the health professions. Previously, health
determined who entered their profession; by doctors
matters had been controlled by the Department of
who dispensed their own medicines; and by shopkeepers
Internal Affairs. Almost similar to the provision in the
who sold patent medicines and traded in poisons – a
current Pharmacy Act as amended in 1997, domination
monopoly sought by pharmacists. Pharmacists sought
of the Pharmacy Board membership by any one
some protection from this competition on the basis
province was minimised by the provision of the Act
that the pharmacist, unlike the shopkeeper, was bound
that, of the six members to be elected by pharmacists,
by a strict code of conduct relating to the sale and
not more than two would be from any one province
storage of poisons and was liable for any indiscretion
(the difference today, of course, is the provision for one
made by an apprentice or assistant in his employ. The
member of the Pharmacy Council to be nominated by
quest for independence from the medical profession
the Member of the Executive Council of the province,
and protection from competition from the doctors
although it does not stipulate that such a nominee
and shopkeepers tended, to a considerable extent, to
should necessarily be employed in the public sector).
overshadow the public interest, and were the real driving forces that led to pharmacists, initially in the Cape
The objects of the current South African Pharmacy
Colony, but eventually in the rest of SA, fighting for the
Council, as stipulated in the Pharmacy Act, are:
establishment of a pharmacy regulatory body.
• to assist in the promotion of the health of the
The Cape Pharmacy Board was established in 1892 and was characterised by principles which included the requirement that the majority of members be pharmacists; that the majority of members be elected, and not nominated; restrictions on the sale of
population of the Republic; • to control and promote, and to establish and maintain adequate standards in respect of pharmaceutical education in the Republic; • to control the practice of the pharmacy profession
scheduled poisons by shopkeepers; and the imposition
and to investigate in accordance with the provisions
of the full chemist and druggist’s annual licence fee
of this Act complaints relating to the affairs of
of £5 for doctors who wished to dispense medicines. Pharmacy boards were eventually created in each of the provinces, leading to the establishment of the
20
South African Pharmacy Board in 1928.
| APRIL 2020 Pharmacy Magazine
pharmacists; and • to advise the Minister on any matter relating to pharmacy.
SA's history / PHARMACY LAW Thus, in addition to the primary concern of protecting
healthcare facilities and the Pharmacy Council could
the public, by prescribing standards for pharmaceutical
not, for example, conduct inspection in the public
education and for the practice of pharmacy the Act now
sector and take punitive action for any transgressions
locates the role of the Pharmacy Council and, indeed,
of the Pharmacy Act. Section 52A of the Amendment
of the pharmacy profession, in the broader area of healthcare provision by specifying involvement in the
Act thus read: ‘The Act is binding on the State’); • the ownership of pharmacies (in terms of the 1996
promotion of the health of the population and placing the
NDP, non-pharmacists would be allowed to own
Minister of Health at the apex of matters related to the
pharmacies, provided the pharmacy continued to be
practice of pharmacy.
under the supervision of a pharmacist. The objective
In 1995, as a result of the new political dispensation
of this policy direction was to ensure the provision of
which abolished apartheid, established a unitary South
pharmaceutical services to underserved areas of the
African state under a new (then interim) Constitution, and which incorporated the formerly self-governing territories
country, particularly the rural areas); and • the investigative and disciplinary powers of the
of Venda, Bophuthatswana, Ciskei, and Transkei, the
council (the aim was to enable council’s inspectors
Pharmacy Amendment Act was passed. In the main, the
to conduct search and seize inspections, strengthen
1995 Amendment Act provided for the establishment,
its disciplinary power and allow it to impose penalties
constitution, and objects of the Interim Pharmacy
where this had previously not been provided for).
*
Pharmacy boards were eventually created in each of the provinces, leading to the establishment of the South African Pharmacy Board in 1928
Council of South Africa, the abolition of the South African Pharmacy Council (which had by then ceased to be known
The constitution of the Pharmacy Council was also
as the South African Pharmacy Board), and the repeal of
expanded to make provision for the Minister to appoint
certain laws in respect of the pharmaceutical profession
nine pharmacists, one from each province, nominated by
which remained in force in the various territories (of the
the Members of the Executive Council (MEC) for Health
above mentioned formerly self-governing territories
of that province. Although not specifically stipulated,
Ciskei, and Transkei had their own medical councils,
these nominees are generally from the public sector.
which were also being abolished) of the national territory
This was particularly important considering that, in
of the Republic by virtue of section 229 of the Interim
terms of the country’s Constitution, the provinces
Constitution. The Interim Pharmacy Council was expected
were responsible for the provision of services, and
to make recommendations to the Minister on the
representation of the council would allow them to keep
constitution of a new council within a period not exceeding
abreast of the legal requirements for the provision of
24 months calculated as from the date of commencement
pharmaceutical services, as well as allow them to make
of the Pharmacy Amendment Act.
input into pharmacy regulation.
PM
In parallel with the existence of the Interim Pharmacy Council, the National Department of Health (NDoH), on the instruction of the new Minister, embarked on the development of the country’s first National
Organised pharmacy in SA can be traced back to the nineteenth century when by 1807 there were nine licensed apothecaries (as they were then called) in the Cape Colony
Drug Policy (NDP). The NDP was adopted by Cabinet as official government policy in 1996 and eventually included as an addendum to the 1997 White Paper for the Transformation of the Health System in SA. During this period, major amendments to the country’s laws regulating the handling and use of medicines and the performance of pharmacy services, namely the Medicines and Regulate Substances Control Act and the Pharmacy Act respectively, were drafted and passed by Parliament. The Pharmacy Amendment Act No 88 if 1997, provided, inter alia, for: • the abolition of the Interim Pharmacy Council of South Africa; • the establishment of the South African Pharmacy Council and for its objects and general powers; • extension of the control of the council to the public sector (until then the country’s health-related legislation was not applicable to public sector
Pharmacy Law in South Africa (A Practitioner’s Handbook) is available in print format, eBook format, and online format. To purchase, or for more information visit LexisNexis online bookstore www.lexisnexis.co.za
Pharmacy Magazine APRIL 2020 |
21
Misuse of ANTIBIOTICS puts us all at risk. Taking antibiotics when you don’t need them speeds up antibiotic resistance. Antibiotic resistant infections are more complex and harder to treat. They can affect anyone, of any age, in any country. Always seek the advice of a healthcare professional before taking antibiotics.
CROSSWORD #18 1 2 3 4 12
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TO ENTER Use the letters in the highlighted blocks to find the final answer for this month’s crossword puzzle. Email the answer with your name, surname, and cellphone number to PharmacyMagazine@newmedia.co.za. Competition closes 20 May 2020. Winners will be contacted directly. Visit www.medicalacademic.co.za for full terms and conditions.
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4. As you age, your body produces less _ _ _ _ _ _ _ _, _
1. Amendment of the entries for cannabis and related substances
leading to dry skin and the formation of wrinkles (PAGE 12)
in the _ _ _ _ _ _ _ is currently undergoing consideration. (PAGE 29)
7. Gelusil Plus relieves _ _ _ _ _ _ _ in pregnancy. (PAGE 27)
2. What kind of cream is Covarex? (PAGE 28)
12. What is autumn’s most prominent pollen? (PAGE 15)
3. A.Vogel Eczema Drops are a _ _ _ _ _ _ _ _ _ _ medicine which assists
13. If a patient has rheumatoid arthritis, osteoarthritis,
in the treatment of eczema (PAGE 12)
or another type of _ _ _ _ _ _ _ _ joint condition, waiting
5. What kind of pain relief does Andolex-C Spray provide in
to see their doctor may result in permanent joint
just 5 minutes? (PAGE 5)
damage and disability. (PAGE 22-23)
6. Peptides contain natural _ _ _ _ _ _ _ _ that reduce
14. Never has the threat of _ _ _ _ _ _ _ _ resistance
disease-causing inflammation. (PAGE 9)
been more immediate and the need for solutions more
8. _ _ _ _ _ _ _ _ _ _ _ reduces the symptoms of sneezing, runny nose,
urgent. (PAGE 7)
watery eyes, and other allergy symptoms. (PAGE 14)
15. What is the most common pneumonia
9. OTC codeine-containing medicines have been used in the past
complication? (PAGE 25)
for the self-treatment of _ _ _ _ _ _ _ pain problems (PAGE 19)
16. Legislation leading to the establishment of the
10. Organised pharmacy in SA can be traced back to the
South African Pharmacy Board in 1928 was influenced
_ _ _ _ _ _ _ _ _ century. (PAGE 30-31)
mainly by the passage of the Public _ _ _ _ _ _ _ _ Act.
11. SA was the first African country to introduce the _ _ _ _ _ _ _
(PAGE 30-31)
vaccine into its routine immunisation programme (PAGE 21)
Pharmacy Magazine APRIL 2020 |
23
CROSSWORD
ANSWERS: CROSSWORD #17
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MAGAZINE
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| APRIL 2020 Pharmacy Magazine
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