Pharmac
Valuable education for pharmacy staff
JUNE 2020
MAGAZINE
Allergies
over winter Monthl crosswo y rd
WIN!
Boost your immune system
5
*
Flu vaccine myths debunked
STRUGGLING TO KEEP YOUR PATIENTS ALLERGIES AWAY? CHOOSE ALLECET! Rapidly absorbed from the gut1
Peak plasma concentration is reached within one hour2
Onset of activity from 20 minutes1
S2 Allecet Syrup. Reg. No.: 37/5.7.1/0153. S2 Allecet Tablets Reg. No.: 37/5.7.1/0034. For further prescribing information refer to the package insert as approved by the medicines regulatory authority. References: 1. Derakhshandeh, K. & Mohebbi, M. Oral bioavailability and pharmacokinetic study of cetrizine HCl in Iranian healthy volunteers. Res. Pharm. Sci. 4, 113–121 (2009). 2. Zhang, L., et al. The clinical use of cetirizine in the treatment of allergic rhinitis. Pharmacology 92, 14–25 (2013). CIPLA MEDPRO (PTY) LTD. Co. Reg. No. 1995/004182/07. Building 9, Parc du Cap, Mispel Street, Bellville, 7530, RSA. Website: www.cipla.co.za Customer Care: 080 222 6662.
Why take baby steps? #Balancedbelly #Infant
Support baby’s overall development with a unique three strain combination probiotic. ProbiFlora Infant Drops take care of the entire gastrointestinal tract from oral health, small intestine to the colon.
Infant Drops Multistrain Probiotic3
Probiotic Product A Single Strain Formulation4
Drops per dose
4
5
Strains
3
1
Bifidobacterium lactis - 400 million CFU
Lactobacillus reuteri - 100 million CFU
CFU
Lactobacillus rhamnosus - 300 million CFU
Health benefits of probiotics are associated to adequate amounts1 and strain specific properties.2 In general the effective probiotic dosage seems to be in the range of 107 to 109 CFU/ mg per day.1
Lactobacillus salivarius - 300 million CFU
Cost5
R149,95
R192,95
CFU = colony-forming units
References: 1. Bertazzoni, E., Donelli, G., et al. Probiotics and clinical effects: is the number what counts? Journal of Chemotherapy 2013;25(4):193-212. 2. Fijan, S. Microorganisms with Claimed Probiotic Properties: An Overview of Recent Literature. Int. J. Environ. Res. Public Health 2014;11:4745-4767. 3. Probiflora Probiotics Infant Drops 3 strain – Regular (Drops) package insert. 4. Reference available on request. 5. Price Document, Data on File. Probiflora Probiotic Infant Drops 3 strain-Regular drops. Each dose per 4 drops (0,167 ml) contains Bifidobacterium lactis 400 million CFU; Lactobacillus rhamnosus 300 Million CFU; Lactobacillus salivarius 300 million CFU. Health supplement. This unregistered medicine has not been evaluated by the South African Health Products Regulatory Authority for quality, safety or intended use. Adcock Ingram Limited (Pty) Ltd. Reg. No. 1949/034385/06. Private Bag X69, Bryanston, 2021, South Africa. Tel. +27 11 635 0000 www.adcock.com 2019112510176679
Valuable education for pharmacy staff
HEALTH AND WELLNESS While men and women may be similar, we both have unique needs when it comes to skincare, grooming, and health
JUNE 2020
8
CONTENTS EDITOR’S NOTE
4
ICPA vs Clicks: important victory for community pharmacies
FRONT SHOP How long does it take for products to work?
13
19
Boost the immune system Stress, bad health habits, and poor nutrition compromise the immune system’s ability to keep cold and flu at bay Allergies over winter The bulk of allergens which have higher levels during winter are indoor allergens, including house dust mite, moulds, cockroaches, and pet dander
CUT OUT & KEEP: 5 FLU VACCINE MYTHS DEBUNKED
22
Know your products Nasal congestion occurs when nasal and adjacent tissues and blood vessels become swollen with excess fluid, causing a “stuffy” plugged feeling
*
7
17
EDUCATION
25
EDUCATION
5 common winter illnesses in children
PHARMACY LAW
31
As many of the common winter illnesses affecting children can be treated at a pharmacy, it is essential for pharmacy personnel to have basic knowledge of them
Scope of practice
CROSSWORD 33 Crossword #20 34 Crossword #19 Answers
www.medicalacademic.co.za
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Pharmacy Magazine JUNE 2020 |
3
JUNE
2020
EDITOR’S NOTE
ICPA vs Clicks:
EVENTS Men’s Health Month
important victory for community pharmacies
National Youth Month World Blood Donor Month
W
hile COVID-19 is still dominating
the matter to the Director General of the DoH for
Western Cape High Court is a
consideration of a sanction against Clicks for
triumph for community
the contravention of the Act and Regulations,
Four years after the Independent Community
Go Turquoise for the Elderly Campaign
1 June
International Children’s Day
1-7 June
World Heart Rhythm Week
7 June
International Cancer Survivors Day
8 June
World Brain Tumour Day
14 June
World Blood Donor Day
16 June
Youth Day
18 June
Autistic Pride Day
22-28 June
SANCA Drug Awareness Week
25 June
World Vitiligo Day
26 June
International Day Against Drug Abuse and Illicit Trafficking
While the Western Cape High Court has referred
headlines, a recent ruling by the
pharmacies across SA.
15 May15 June
the Clicks Group has indicated that it will be appealing the decision.
Pharmacy Association (ICPA) first lodged a complaint with the Department of Health (DoH)
IN THIS MONTH’S ISSUE
against various subsidiaries of Clicks and its holding
With winter now firmly upon us we look at 5 Common
company, the Western Cape High Court last week
winter illnesses in children (page 25), Allergies over
ruled in favour of the ICPA.
winter (page 19), 5 Flu vaccine myths debunked
The judgment against Clicks essentially
(page 17), and Boost the immune system (page 13).
rules that groups with interests in both dispensing
In the pharmacy law feature we look at pharmacy
and manufacturing pharmacies are in contravention
scope of practice (page 31) and our front shop
of the Pharmacy Act. The Clicks Group owns
feature explores how long it takes for products to
Clicks retail pharmacies as well as Unicorn
work (page 7).
Pharmaceuticals through one of its subsidiaries. both retail and manufacturing, a pharmacy would
CROSSWORD CHALLENGE
gain financially if the product were promoted by
Congratulations to the
pharmacists in the chain’s network over other
winner of Crossword #18
products. This conflict could result in the
Karen Lonsdale. For your
consumer not receiving the best quality product
chance to win a R500
at the best available prices. Furthermore,
Woolworths voucher
products which are not strictly needed might be
don’t miss this month’s
recommended and sold, which is not in the best
crossword puzzle on
interest of the consumer.
page 33.
The judgment noted that by having an interest in
WORDS TO
LIVE BY
PM
“Being underestimated is one of the biggest competitive advantages you can have. Embrace it.” – Author unknown
FEEDBACK Send your letters and news or events to nicky.belseck@newmedia.co.za
4
| JUNE 2020 Pharmacy Magazine
28 June - 4 July
World Allergy Week
DRY, IRRITATED & TIRED EYES?
With the NEW blink® eye care range 20501
freshness is just a blink away.
Applicant: Genop Healthcare (Pty) Ltd. PO BOX 3911, Halfway House, 1685, South Africa. Tel 0861 436 674. Co. Reg. No. 1984/011575/07. www.genop.co.za. 03/2020/PROMO/39. Marketed by Adcock Ingram Healthcare (Pty) Ltd. Reg. No. 2007/019928/07. Private Bag X69, Bryanston, 2021, South Africa. Tel +27 (00) 11 635 0000. www.adcock.com. Customer Care: 0860 ADCOCK/232625.© Johnson & Johnson Vision Care, Inc. 2020. Reg. No. G1180601630009. PP2020MLT4304.
dermatology / FRONT SHOP
HOW LONG DOES IT TAKE FOR PRODUCTS TO WORK? Patience is a virtue. We’ve heard that a thousand times, but in order to see results from a new skincare product, just how patient do we have to be?
AUTHOR: Dr Janine Ellenberger GR8SKN Skincare
{ {
Clients can help shorten their skin cycle with gentle exfoliation and vitamin A
T
o see results from most
However, improvements related to skin
products, we need to wait
texture, pigmentation, wrinkles, scarring,
roughly 3-4 skin cycles. The
acne, and sebum production all happen
length of a skin cycle varies
at the deepest, basal layer of the skin.
depending on the person: a skin cycle
Thus, improvements are usually not seen
might be about 28 days for young, healthy
until 3-4 skin cycles (4-5 months).
skin, but could be 50+ days for more mature skin. Sun exposure, pollution, and
TIPS FOR RESULTS
aging all slow down skin cycles.
• Do not give up: This goes without
Want to speed up the skin cycle?
saying, but routine and consistency are
Clients can help shorten their skin cycle
instrumental in making big changes
with gentle exfoliation (using alpha hydroxy
in skin. If clients try something for two
acids/fruit acids) and Vitamin A.
weeks and give up because they haven’t seen any changes yet, they’re not giving
THE SCIENCE BEHIND IT 3-4 skin cycles may seem arbitrary, but it’s not. When trying out a new product,
the basal skin cells enough time to show what they can do. • Take pictures: It can be very difficult
that product starts making changes in the
to see subtle changes in skin over
deepest, basal layer of the epidermis. That
long periods of time. Taking pictures
layer slowly rises to the top layer of the
along the way can help clients see the
epidermis, one layer at a time. So, clients
improvements they seek.
S0
need to invest now to reap the benefits later. Making improvements in skin takes time,
DIFFERENT TYPES OF RESULTS
dedication, and consistency. Just like
Those seeking skincare solutions for
exercising, one workout will not give you
conditions related to the surface of the skin
the results you’re looking for. It’s important
(like clogged pores) will see faster results,
to make fitness (and good skincare) a priority
typically around six weeks or one skin cycle.
in life for good.
PM
Pharmacy Magazine JUNE 2020 |
7
MEBET085 BETADINE SHAMPOO Medical Chronicle 56x265 2020/05/22 mm ®.indd 17:40 1
HEALTH & WELLNESS / men’s health
*
Men’s focus
While men and women may be similar, we both have unique needs when it comes to skincare, grooming, and health. In recognition of Men’s Health Month, we highlight 8 products specially engineered with men in mind.
{
Prep® Derma Protective Cream relieves the harshness of shaving and is scientifically
MALE FERTILITY Fertipil Plus for Men*
formulated to offer medicated protection for skin during shaving.
It’s no secret that exercise is good for the body, but did you know it can make skin glow too?
Fertipil Plus for Men has been
{
scientifically demonstrated to
LIP PROTECTION Labello® Active for Men www.labello.co.za
Labello® Active for Men is specially crafted to give lips long-lasting,
www.fertipil.co.za
www.aspenpharma.com
SMOOTH SHAVE Prep® Derma Protective Cream
effective moisturising care and
enhance male fertility and improve overall reproductive wellness as part of a healthy diet and lifestyle. Advertisement supplement
protection without leaving any shine and colour on lips. Developed for men it is fragrance free.
CALM & SOOTHE Nivea Men Sensitive Cooling After Shave Lotion
comfortable cooling
SKIN DEEP Vaseline® MEN Even Tone Repairing Moisture Body Lotion
sensation. The alcohol-free
A breakthrough
formula with chamomile
in moisturising
instantly soothes and calms irritation without burning while offering
and seaweed extracts does not burn and soothes and calms the skin. For a lasting cool and calming sensation on sensitive skin.
www.vaseline.co.za
www.nivea.co.za
a long-lasting mild and
technology Vaseline® MEN Even Tone Lotion is fast absorbing, nongreasy, and helps to restore even skin tone.
HEAD FIRST Hawkins & Brimble Elemi & Ginseng Matt Clay
Old Spice® Wolfthorn
Ideal for creating texture and
to keep you dry and
movement, this versatile product can be used on both dry and damp hair. Tsubaki Oil from the Tsubaki plant in Japan, and coconut oil to help improve hair condition without leaving it greasy.
*This unregistered supplement has not been evaluated by SAHPRA for its quality, safety, or intended use.
8
| JUNE 2020 Pharmacy Magazine
ANTIPERSPIRANT Old Spice® Wolfthorn Deodorant Stick Deodorant Stick helps www.oldspice.com
Cooling After Shave Lotion
www.hawkinsandbrimble.co.uk
Nivea Men Sensitive
odour free for up to 24 hours. Leaves you smelling great and feeling confident all day long.
men’s health / HEALTH & WELLNESS
MEN’S HEALTH
MONTH
HAIR GROOMING BaByliss for Men Nose & Ear Hair Trimmer BaByliss for Men Nose & Ear www.babyliss.com
Hair Trimmer has a tapered edge and circular cutting system to safely and quickly trim unwanted hair from the nose, ears, and other
Not only is it important to know what chemicals harm the skin & body, but it is equally important to know what ingredients nourish and feed the skin, promoting a healthy, happy barrier
hard-to-reach places.
Pharmacy Magazine JUNE 2020 |
9
AND FOR > 5 BR 0 D E
1
S AR YE
PHOLCODINE
SC
RI
BE
RA
PRE
N D 2- 5
TRU ST
DRY COUGH
H DD RY C O UG
B
Suppresses a dry cough for up to 10 hours#2 No known codeine-like side-effects at recommended doses*6,7
FROM THE iNOVA FAMILY TO YOUR FAMILY *Constipation, euphoria, addiction/habit forming6,7 Pholtex Forte References: 1. Data on file. 2. Pholtex Forte approved package insert, February 1999. 3. Pholtex Junior approved package insert, February 2004. 4. Impact Rx script data –September 2019. 5. Pholtex Plus approved package insert, July 2017. 6. Core pholcodine product information, Dec 2005 [Online]. Australian Government Department of Health, Therapeutic Goods Administration. [cited 27 September 2019]; Available from URL: https://search.tga.gov.au/s/search.html?collection=tga-websites-web&query=pholcodine. 7. Gibbon CJ (ed). South African Medicines Formulary, 5th ed. Cape Town, South African Medical Association, 2000. P 367, 464. #
Scheduling status: S2 Proprietary name (and dosage form): PHOLTEX FORTE liquid. Composition: Each 5 mL liquid contains Pholcodine 15 mg. Registration number: 32/10.1/0116. Scheduling status: S2 Proprietary name (and dosage form): PHOLTEX JUNIOR syrup. Composition: Each 5 mL liquid contains Pholcodine 5 mg. Registration number: 29/10.1/0013. Name and business address of applicant: iNova Pharmaceuticals (Pty) Ltd. Co. Reg. No. 1952/001640/07. 15e Riley Road, Bedfordview. Tel: 011 087 0000. www.inovapharma.co.za. For full prescribing information, refer to the package insert as approved by the SAHPRA (South African Health Products Regulatory Authority). Further information is available on request from iNova Pharmaceuticals. IN3497/19
supplements / EDUCATION
*
Boost the
immune
system Despite millions of Rands invested into medical research, a cure for the common cold or the flu has yet to be discovered
W
hile a wide range of medicines are available
our busy lifestyles, this isn’t always possible. “While we know what we should be
to reduce the symptoms
doing to keep healthy, it’s not easy to
of the common cold
balance our health and the demands of
and the flu, antibiotics are useless against the bugs responsible for these illnesses.
day-to-day living.” Dr Terblanche said prevention is better
The immune system is the body’s only
than a cure. “Ideally, to improve your
line of defence. But stress, bad health
immune system and prevent getting sick,
habits, and poor nutrition compromise
it’s important to get good nutrition by eating
the immune system’s ability to keep the
enough fruit, vegetables, and whole grains.
cold and flu at bay.
It is equally important to reduce your stress
This is according to Dr Anél Terblanche, Medical Officer at Samwumed Medical
by getting enough sleep and exercise.” She suggests considering adding
Scheme, who said that while general
vitamin C and zinc supplementation to
healthy living is the best way to give your
boost the immune system when a balanced
immune system the upper hand, thanks to
lifestyle and diet aren’t enough.
{
Stress, bad health habits, and poor nutrition compromise the immune system’s ability to keep the cold and flu at bay
S0
{ Continued on next page...
Pharmacy Magazine JUNE 2020 |
13
METEE032 TEEJEL Pharmacy Magazine 56x265 mm_®.indd 2020/05/23 1 14:14
supplements / EDUCATION VITAMIN C A well know immune booster, this powerful antioxidant helps to maintain collagen function and heighten the body’s ability to repair wounds. Along with its immune supportive function that helps the body fight against bacteria, viruses, and other sources of infection, vitamin C also assists with iron uptake in the body. Iron is an important component of haemoglobin, the substance in red blood cells that carries oxygen from your lungs to transport it throughout your body. Haemoglobin represents about two thirds of the body’s iron. If you don’t have enough iron, your body can’t make enough healthy oxygen-carrying red blood cells.
VITAMIN D Usually associated with building strong bones, a growing body of research suggests that vitamin D is vital for the proper functioning of the immune system. A fat-soluble vitamin, vitamin D is created when the skin is exposed to solar ultraviolet rays. Doctors suggest we need to be exposed to approximately 15 minutes of sunlight per day to create enough vitamin D. It is important to know that supplementation of vitamin D should only be prescribed and controlled by a doctor, and only in patients who have proven low levels of Vitamin D.
ZINC Present in every tissue, organ, fluid, and secretion of the body, zinc is essential for proper immune function. The World Health Organisation believes zinc deficiency is the leading cause of digestive tract infections among children. Critical for immune system function low zinc levels is associated with increased susceptibility to pneumonia and other infections in the elderly. Unlike certain vitamins, zinc is not stored for long periods of time in the body. This means that we need to get a constant supply of quality zinc either in our diet or by supplements. Meat and chicken are excellent sources of zinc, as are nuts and lentils. In a Western diet, food products such as breakfast cereal are fortified with zinc and these products provide an increasingly important source of zinc.
TAKING CONTROL For most people and most colds, the usual
• A cough associated with the common cold
course and duration of illness is up to one
may be caused by nasal obstruction or
and a half weeks. People who only have
postnasal drip. To relieve these symptoms,
mild symptoms generally do not require any
it is recommended that a cough suppression
symptomatic treatment.
with dextromethorphan is used.
Those suffering various symptoms
Although zinc sulphate lozenges and syrup
associated with the common cold should
may decrease cold symptom severity and
treat them accordingly:
duration, Dr Terblanche advises against
• Analgesics may be used to relieve associated
using these because of uncertain benefits
symptoms (e.g. headache, ear pain, muscle
and known toxicities, including irreversible
and joint pains, malaise, and sneezing).
anosmia (loss of the sense of smell) for
• Symptomatic treatments for nasal
S0
S0
S0
some of these products. She adds that
symptoms that have moderate evidence
people are encouraged to take hygienic
of efficacy include combination product
measures such as handwashing, which can
containing an antihistamine and a
prevent the spread of respiratory viruses,
decongestant.
especially from younger children.
PM
Pharmacy Magazine JUNE 2020 |
15
MEBET064 BETADINE WOUND CARE Pharmacy Magazine 2020/05/23 56x26513:46 mm ®.indd 1
RELIEVES
ANY COUGH*
1-3
DRY2
WET
1-3
TICKLY CHESTY2 MUCUS 4
Contains Natural Ingredients1-3 ALCOHOL FREE**
LACTOSE FREE
GLUTEN FREE
* Children’s Cough Syrup - Cough associated with colds ** Syrups only References: 1. Pholtex Bronchostop® Cough Syrup professional information, September 2019. 2. Pholtex Bronchostop® Children’s Cough Syrup instructions for Use, February 2019. 3. Pholtex Bronchostop® Cough Pastilles professional information, September 2019. 4. Data on file. Scheduling Status: S0 Proprietary name (and dosage form): Pholtex Bronchostop® Cough Syrup. Composition: Each 5 ml syrup contains: 39 mg Thyme herb extract and 277 mg Marshmallow root dry extract. Pharmacological Classification: Complementary Medicine: Discipline Specific Traditional Claims D33.6 Western Herbal Medicine. Scheduling Status: S0 Proprietary name (and dosage form): Pholtex Bronchostop® Cough Pastilles. Composition: Each pastille contains: 51.1 mg Thyme herb extract and 4.5 mg Marshmallow root dry extract. Pharmacological Classification: Complementary Medicine: Discipline Specific Traditional Claims D33.6 Western Herbal Medicine. Proprietary name (and dosage form): Pholtex Bronchostop® Children’s Cough Syrup. Composition: Each 5 ml syrup contains: 48 mg Marshmallow root dry extract and 250 mg Honey. These unregistered medicines have not been evaluated by the SAHPRA for its quality, safety or intended use. The claims made in this material is for medical information and educational purposes only. For full prescribing information, refer to the individual professional information or instructions for use. Further information is available on request from iNova Pharmaceuticals. Name and business address of applicant: iNova Pharmaceuticals (Pty) Limited. Co. Reg. No. 1952/001640/07, 15e Riley Road, Bedfordview. Tel. No. 011 087 0000. www.inovapharma.co.za. IN3535/19.
5
CUT& OUTEP KE
vaccination / CUT OUT & KEEP
Flu vaccine
myths debunked
Although the flu affects so many people each year, myths and misconceptions continue to circulate
W
orldwide, flu epidemics result
misconceptions about the flu vaccination will
in 3-5 million cases of severe
help increase the number of patients receiving
illness and about 290 000-650 00
the flu shot, thereby decreasing the
respiratory deaths. Clarifying any
high morbidity and mortality rate due to flu.
MYTH: THE FLU VACCINE GIVES YOU THE FLU
MYTH: PREGNANT WOMEN SHOULD NOT GET THE FLU VACCINE
A patient cannot get the flu
Some patients think pregnant
from receiving a flu shot as the vaccine
women shouldn’t get the flu shot because
contains inactive flu viruses. It is common
they believe it could be harmful to the foetus
for some patients to experience side
thus leading to developmental issues like low
effects that are not related to the flu such
birth weight or miscarriage. The Centres for
as mild tenderness, redness, or swelling
Disease Control and Prevention recommend
in the area where they received the shot,
pregnant women should get vaccinated as it
headache, or a low-grade fever.
protects both mother and baby from the flu as expecting mothers are at a higher risk of serious complications from the flu.
MYTH: PEOPLE DON’T NEED TO GET THE FLU VACCINE EVERY YEAR
MYTH: HEALTHY
every year. A patient needs a vaccination
PEOPLE DON’T NEED TO GET THE FLU SHOT
that matches the new strain of the viruses
Anyone can get sick from the
each year. In order for a patient to protect
flu, healthy individuals included.
themselves as well as others from the flu,
A contagious condition, influenza can
they need to get the flu shot at the beginning
lead to serious complications like
of the flu season to allow the body’s
pneumonia. Even if a patient only
immune system the time it needs to build up
gets a mild case of the flu,
protective antibodies against the virus.
they can still pass it on
The viruses that can cause flu change
to more vulnerable groups such as new-born babies, adults over the
MYTH: THE FLU VACCINE
age of 65, and those
IS INEFFECTIVE
with weakened
Although getting the vaccine prevents most
immune systems.
patients from becoming ill with the flu, some patients will still become infected. This may occur because a patient becomes exposed to the virus before getting a vaccination, before the vaccination has taken effect, or because the vaccine doesn’t match the circulating virus closely enough. The flu shot only protects against illnesses caused by the flu virus strains that match the vaccine strains. Other viral and bacterial infections cause similar symptoms and are often mistaken for flu. When there is a good match between vaccine and circulating influenza strains, the vaccine prevents infection in around three out of four healthy adults
✂
under 65 years of age (73%).
PM
Pharmacy Magazine JUNE 2020 |
17
FAST Relief
1
3
LONG Lasting
2
2
MOISTURIZING Effect
*
1
Nasal decongestant
LAUNCHING SOON <6
years
6+
years
Relief for up to
12 HOURS Your pocket-sized, nasal decongestant spray. S1 OXYMIST Nasal Spray. Reg. No. 47/16.1/0792. S1 OXYMIST Nasal Spray. Reg. No. 47/16.1/0793. 1. Fuad, M. et al. Oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis. J Allergy Clin Immunol 127, 927-934 (2011). 2. Druce, H. M. et al. Topical nasal decongestant oxymetazoline (0.05%) provides relief of nasal symptoms for 12 hours. Rhinology 56, 1â&#x20AC;&#x201C;8 (2018). For full prescribing information, refer to the Professional Information approved by the medicines regulator authority. CIPLA MEDPRO (PTY) LTD. Reg. No. 1995/004182/07. Building 9, Parc du Cap, Mispel Street, Bellville, 7530, RSA. Website: www.cipla.co.za. Customer Care: 080 222 6662 [13262]
*
winter ailments / EDUCATION AUTHOR: Professor Claudia Gray
WORLD ALLERGY
WEEK
28 JUNE - 4 JULY
Allergies over winter As autumn comes to an end, allergies caused by grass and tree pollens are easing off, but with a new season comes a new set of prevailing allergens
Winter-related allergies can be mediated in three ways:
an increased exposure to such allergens during winter
• Exposure to those allergens which are more prolific
months is a reduction in indoor ventilation and an
during the winter months leading to typical allergic
associated increase in indoor humidity levels, and a
rhinitis or asthma.
greater amount of time spent indoors in contact with
• Worsening of allergies and asthma secondary to winter viruses. • Worsening of symptoms because of the cold air itself.
such allergens. Those with an allergy to pet dander can have symptoms all year round, but winter may be associated with more flare ups than usual. Reduced ventilation in
ALLERGENS WHICH ARE MORE PROLIFIC DURING THE WINTER MONTHS
the home (fewer open windows and doors), as well as
The bulk of allergens which have higher levels during
contribute.
increased time spent by pets indoors during winter, may
winter are indoor allergens, including house dust mite, moulds, cockroaches, and pet dander. The reason for
Patients with a pet dander allergy should take the following steps during winter: • Vacuum regularly using a vacuum cleaner with a HEPA filter (high efficiency particulate air filter).
*
Cold and flu viruses, which are prolific during winter, can mimic allergic symptoms and simultaneously exacerbate rhinitis and chest symptoms
• Discourage dogs from sleeping in bedrooms and on couches. • Dogs should be groomed and washed regularly, but not inside the house. Continued on next page...
{
Frequent use of nasal saline rinses and diligent use of allergic rhinitis and asthma control treatment can lessen the impact of viral illnesses
{ Pharmacy Magazine JUNE 2020 |
19
Cetirizine dihydrochloride 10 mg / tablet Cetirizine dihydrochloride 1 mg / mL
STRUGGLING TO KEEP YOUR PATIENTS ALLERGIES AWAY?
CHOOSE ALLECET!
Syrup: 60 mℓ / 150 mℓ
Tablets: 10’s / 30’s
From 2 years +
From 6 years +
Rapidly absorbed from the gut1
Peak plasma concentration is reached within one hour2
Onset of activity from 20 minutes1
S2 Allecet Syrup. Reg. No.: 37/5.7.1/0153. S2 Allecet Tablets Reg. No.: 37/5.7.1/0034. For further prescribing information refer to the package insert as approved by the medicines regulatory authority. References: 1. Derakhshandeh, K. & Mohebbi, M. Oral bioavailability and pharmacokinetic study of cetrizine HCl in Iranian healthy volunteers. Res. Pharm. Sci. 4, 113–121 (2009). 2. Zhang, L., et al. The clinical use of cetirizine in the treatment of allergic rhinitis. Pharmacology 92, 14–25 (2013). CIPLA MEDPRO (PTY) LTD. Co. Reg. No. 1995/004182/07. Building 9, Parc du Cap, Mispel Street, Bellville, 7530, RSA. Website: www.cipla.co.za Customer Care: 080 222 6662.
winter ailments / EDUCATION
exposure levels do tend to peak over winter with
WORSENING OF ALLERGIES DUE TO WINTER VIRUSES
reduced household ventilation and increased time
Cold and flu viruses, which are
spent indoors. Fluffy blankets, down duvets, and
prolific during winter, can mimic
thick coats which have been taken out of storage
allergic symptoms and simultaneously
cupboards all trap house dust mite, increasing
exacerbate rhinitis and chest symptoms. Pre-existing
exposure even more during winter.
allergies can, in turn, also lead to prolongation
House dust mites are perennial allergens, but
of cold and flu symptoms. Frequent use of nasal During winter, those suffering from a house dust
saline rinses and diligent use of allergic rhinitis
mite allergy should take the following steps to
and asthma control treatment such as intranasal/
reduce allergen exposure:
inhaled corticosteroids can lessen the impact of
• Vacuum regularly using a vacuum cleaner with a
viral illnesses. Brief use of nasal vasoconstrictors,
HEPA filter. • Reduce fluffy toys and blankets. Wash bedding
which exert a decongestant action on mucous membranes of the nasopharyngeal cavity can
and blankets at 60 degrees or higher, if possible.
provide relief of nasal congestion due to the common
Air thick blankets and duvets outside on a sunny
cold, sinusitis, allergic rhinitis, and hay-fever.
day. Fluffy toys and blankets can also be placed in the freezer overnight then washed at normal temperature to reduce dust mite carriage. • Wet-mop floors instead of sweeping, especially in bedrooms. • Consider use of house dust mite impermeable
WORSENING OF ALLERGIC SYMPTOMS BECAUSE OF THE COLD AIR ITSELF Cold-induced airway irritation or damage can cause rhinorrhoea or bronchospasm. This is worsened by rapid decreases in temperature and is particularly
mattress covers, pillow covers, and duvet
manifest during exercise in cold weather, when
encasings.
the normal compensatory nasal humidification is bypassed during exercise-induced hyperventilation.
Mould thrives in warm, damp regions and is prolific in coastal areas, both inside the house and outside
OTHER FACTORS
in the garden. Like dust mite it is a perennial allergen,
Further factors such as an increase in use of
but with reduced household ventilation during winter,
indoor fires, higher pollution production, increased
excess mould can grow in bathrooms, kitchens, and
use of air-drying indoor heaters can all worsen
cupboards during winter months.
respiratory allergies.
Some tips for reducing mould allergen levels in
CONCLUSIONS
the house during winter include:
Winter carries several risk factors for an
• Ventilate the house daily, even if the air is a little
exacerbation in respiratory allergies. Patients and
cold. • Limit indoor plants and firewood as they can encourage mould proliferation. • As much as possible avoid hanging wet washing inside the house.
*
healthcare providers should ensure that allergic rhinitis and asthma medication plans are up to date and being adhered to, and that indoor allergen exposure is reduced as much as possible during winter. Additional measures such as frequent use of saline sprays may be helpful in counteracting the
Cockroaches
drying effects of indoor heaters, and in reducing the
Cockroach droppings can cause allergic symptoms
impact of upper respiratory viruses.
PM
Those with an allergy to pet dander can have symptoms all year round, but winter may be associated with more flare ups than usual
and levels may increase during winter. Inhalation of cockroach droppings can worsen allergic rhinitis and asthma. Cockroach levels can be reduced by keeping food well contained and diligently cleaning up crumbs. Fixing leaky pipes and sealing cracks in the home can also help.
For information on AFSA's UCT-accredited “Understanding Allergies” online courses visit https://allergyfoundation.co.za/learning/
Pharmacy Magazine JUNE 2020 |
21
*
KNOW YOUR PRODUCTS / winter ailments
Combat congestion
Nasal congestion occurs when nasal and adjacent tissues and blood vessels become swollen with excess fluid, causing a â&#x20AC;&#x153;stuffyâ&#x20AC;? plugged feeling. Minor illnesses, for instance, a cold, the flu, and sinus infections, are the most common causes of nasal congestion. Fortunately, illness-related congestion usually improves within a week
22
| JUNE 2020 Pharmacy Magazine
Nasal congestion rarely causes major health problems and is most often caused by the common cold or a sinus infection. Symptoms usually improve right away with proper treatment
winter ailments / KNOW YOUR PRODUCTS Nasal congestion can be more threatening in infants than in older children and adults. Symptoms can interfere with infant feedings and can even lead to fatal breathing problems SCHEDULE 2 PRODUCT:
Coryx Paediatric Syrup**
S2 SCHEDULE 2 PRODUCT:
Opadry Yellow, Sodium
Ibumax Cold and Flu**
Lauryl Sulphate. Contains lactose.
INDICATION:
INDICATION: Coryx Paediatric Syrup is indicated for the relief of
S2
symptoms associated with colds and influenza, such as nasal congestion. INGREDIENTS:
Ibumax Cold and Flu tablets are
DOSAGE:
indicated for the relief of cold
ADULTS & CHILDREN
and flu symptoms, including
OVER 12 YEARS:
nasal congestion, headache,
Always take the lowest
fever, and sore throat.
possible dose for the shortest possible duration of treatment.
Each 5ml contains: Triprolidine Hydrochloride 1.25mg, Pseudoephedrine
½ medicine measure (2.5ml)
Hydrochloride 25mg,
3 times a day.
Vitamin C 75mg.
CHILDREN 6 MONTHS -
Preservatives: Sodium
2 YEARS*: Not recommended.
INGREDIENTS:
Take 1-2 tablets every
Each film-coated tablet
4-6 hours. Do not take more
contains: 200mg Ibuprofen
than 6 tablets in any 24-hour
and 30mg Pseudoephedrine
period. Always take Ibumax
DOSAGE:
Hydrochloride.
Cold and Flu with food or milk.
ADULTS & CHILDREN OVER
Inactive ingredients: Colloidal
Advise patients to consult their
12 YEARS: 2 medicine
Silicon Dioxide, Croscarmellose
doctor if symptoms persist
measures (10ml) 3 times a day.
Sodium, Lactose Monohydrate,
beyond 3 days.
CHILDREN 6-12 YEARS:
Magnesium Stearate, Microcrystalline Cellulose,
www.cipla.co.za 080 222 6662 Advertisement supplement
Benzoate 0.2% m/v, Potassium Sorbate 0.2% m/v.
*A doctor’s advice should be obtained before administering CORYX PAEDIATRICSYRUP to children aged less than 2 years. Do not exceed the stated dose and if symptoms persist consult a doctor.
1 medicine measure (5ml)
www.cipla.co.za
3 times a day.
080 222 6662
CHILDREN 2-5 YEARS:
Advertisement supplement
If congestion lasts longer than a week, it’s often a symptom of an underlying health issue such as allergies, hay fever, nasal polyps, or chronic sinusitis SCHEDULE 0 PRODUCT:
Other ingredients:
Sinulex Forte Capsules***
Microcrystalline Cellulose, Magnesium Stearate, Pirosil.
S0
INDICATION: Sinulex’s comprehensive formula
DOSAGE:
supports the body’s ability to
ACUTE DOSAGE
naturally deal with allergens,
ADULTS AND CHILDREN
colds, flu, and sinusitis for healthier
ABOVE 12:
airways and a clear head. The
Take 1 capsules 3 times daily
active ingredients may help to
CHILDREN 6 - 12 YEARS:
reduce inflammation and fight the
Take 1 capsule 2 times daily
pathogens that can cause respiratory
It is recommended to take
infections and congestion.
this dosage for at least 5 consecutive days.
INGREDIENTS:
CHRONIC DOSAGE
Each capsule contains:
ADULTS AND CHILDREN
Pelargonium Sidoides
ABOVE 12 YEARS:
Extract PE60 100mg,
Take 1 capsule 2 times daily.
Horseradish Extract 200mg,
CHILDREN 6 - 12 YEARS:
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L-Ascorbic Acid (Vitamin C) 300mg.
Take 1 capsule daily. Or as
086 111 8272
prescribed by your healthcare professional.
Advertisement supplement
**For full prescribing information refer to the package insert approved by the medicine’s regulatory authority. ***This unregistered medicine has not been evaluated by SAHPRA for its quality, safety, or intended use. Pharmacy PharmacyMagazine Magazine JUNE MAY 2020 |
23
THROAT
&
MOUTH
n oz
je
t
3-IN-1 SORE THROAT & MOUTH SOLUTION.
zle
MEET NIXIE
Learn more about Cold & Flu symptoms
SCAN HERE
S1 Proprietary name and dosage form: Oranix Oral Rinse/Spray Composition: Each 15 ml contains: Benzydamine HCI 22.5 mg, Chlorhexidine gluconate 18 mg, Alcohol 9 % v/v. Pharmacological classification: A. 16.4 Nasopharyngeal and bucco-pharyngeal antiseptics. Indications: For the relief of minor infections and painful inflammatory conditions of the mouth and throat. Registration number: 34/16.4/0391. For full prescribing information refer to the Professional Information approved by the medicines regulatory authority. iNova Pharmaceuticals (Pty) Ltd 15E Riley Road, Bedfordview 2007. Marketed by: CIPLA MEDPRO (PTY) LTD. Website: www.cipla.co.za Customer Care: 080 222 6662. [512762005a]
www.ciplaallergy.co.za
5 A
winter ailments / EDUCATION
Common winter illnesses in children
With the arrival of colder weather, you’ll increasingly be facing complaints of common winter illnesses from parents and guardians
s many of the common winter illnesses affecting children can be treated at a
THE COMMON COLD
pharmacy, it is useful for pharmacy
A viral infection, the common cold
personnel to have basic knowledge of them.
is the leading cause for children to visit the doctor and stay home from school. Although rhinoviruses are primarily responsible, there are over 200 cold causing viruses. Young children are more susceptible to contracting a cold, with some experiencing as many as 8-10 each year. Colds tend to be more common during autumn and winter when children are indoors and closer to each other. Cold viruses are found in the nose
RESPIRATORY SYNCYTIAL VIRUS Respiratory syncytial virus (RSV) is a common viral infection that affects the linings of the airways which includes the nose, throat, windpipe, bronchi, and bronchioles. The most common cause of respiratory infections in infants and children under 2 years of age, almost all children have had a RSV infection by the time they are 2-3 years old. Highly contagious, RSV spreads through direct
Other symptoms include:
and throat. Because children touch
• Sneezing
their noses, eyes, and mouths so often
• Low-grade fever
and then touch each other while
• Loss of appetite
playing, cold germs spread easily.
• Sore throat, and possibly difficulty
Parents, siblings, and caregivers can get viruses on their hands and then
swallowing • Cough
spread them between children by touch. Cold viruses may also be spread
There is no cure for the common cold and
through the air when a child with a cold
because it is caused by a virus, antibiotics
coughs or sneezes.
will have no effect in treating it. The
A child suffering from a cold will
most parents can do is ensure their child
have a runny nose with clear mucus,
is comfortable, gets plenty of rest, and
and then later thicker, coloured mucus.
drinks a lot of fluids.
contact with the nose and mouth secretions. The virus can live on surfaces, toys, hands, etc.
NOROVIRUS
and infected children spread the virus before
Norovirus is probably the most common
symptoms appear. Droplets from a cough or sneeze
virus that few people have ever heard of.
may also spread the infection. RSV infections
Also known as the winter vomiting bug,
occur throughout the year, but there are typically
norovirus is part of a group of common
widespread outbreaks during the winter months.
viruses that cause gastroenteritis.
Symptoms of RSV are like the common cold.
Highly contagious, noroviruses can
Most children will have mild cold symptoms like
spread quickly in places where children
a clear runny nose, fever, and cough. Some
are in close contact like schools and
children may get an ear infection and a mild
day care centres. A patient can catch
fever. More serious symptoms include wheezing
a norovirus by touching a surface or
and difficulty breathing.
object that has been contaminated and
There is no effective treatment or vaccine for
then putting their hand in their mouth.
RSV infection. Cold like symptoms in infant
Consuming contaminated foods or
low-grade fever, body aches, and
patients should be treated with a gentle
beverages, and sharing cups and utensils
fatigue. Patients usually get sick
suctioning of the nose. Hot-air vaporisers should
are how the virus is spread.
12-48 hours after being exposed to the
be avoided because they carry the risk of
Symptoms of norovirus are much
virus. Treatment of norovirus primarily
scald burns, and cool- mist vaporisers may get
like other causes of gastroenteritis,
involves giving the body time to fight the
contaminated with moulds.
including vomiting and watery diarrhoea
virus on its own, drinking enough liquids,
that cause dehydration. Other symptoms
and getting plenty of rest.
Its important children get plenty of rest and drink enough liquids to avoid dehydration.
include nausea, stomach cramps,
Continued on next page...
Pharmacy Magazine JUNE 2020 |
25
CORI’S SUPER POWERS
Recommend SA’s NO. 1 Paediatric
COLD & FLU reliever1
Relieves cold & flu symtoms Unblocks noses Helps fight allergies Supports the immune system
RECOMMEND THE POWERFUL RELIEF OF CORYX PAEDIATRIC SYRUP FOR THE SYMPTOMS OF COLD & FLU. AVAILABLE WITHOUT A PRESCRIPTION.
Learn more about Cold & Flu symptoms
SCAN HERE
S2 Reg. No. 31/5.8/0056. NS1 Reg. No. 04/17.5.8/1652 (Namibia). Coryx paediatric syrup. Each 5 mℓ contains: triprolidine hydrochloride 1,25 mg, pseudoepherine hydrochloride 25 mg, vitamin c 75 mg. For full prescribing information, refer to the Professional Information approved by the medicines regulatory authority. Reference: 1. As per IMS data published April 2020. CIPLA MEDPRO (PTY) LTD Reg. No. 1995/004182/07. Building 9, Parc du Cap, Mispel Street, Bellville, 7530, RSA. Website: www.cipla.co.za Customer Care: 080 222 6662 [512762005c]
www.ciplaallergy.co.za
winter ailments / EDUCATION
STREP THROAT A common childhood illness, strep throat is caused by the bacteria streptococcus. Rare in children younger than 2 years, it is more common in 4-8-year-olds. The most common cause of strep throat is Group A streptococcus (GAS). Also known as streptococcal pharyngitis, strep throat is usually spread through direct person-to-person transmission. Typically, transmission occurs through saliva or nasal secretions from an infected patient. Patients with a strep throat are more
• Swollen tender glands in the neck
likely to transmit the bacteria. Although
• Headache, irritability, or fussiness
rare, spread of GAS infections may also
• Poor appetite
occur via food.
• Pain in the abdomen • A red rash on the body that feels like
A child with strep throat may have
sandpaper. It may appear 12-48 hours
these symptoms:
after the first symptoms. This is known
• Sore throat
as scarlet fever.
• Bright red swollen tonsils, sometimes with patches or streaks of pus • “Strawberry” look to the tongue or tiny red spots on the back roof of the mouth • Fever
{
Strep throat is usually treated with antibiotics, along with lots of rest and plenty fluids, the patients should be back to regular activities within a few days.
Most children recover from the flu within a week, but they may still feel very tired for as long as 3-4 weeks
{
FLU Influenza (flu) is a highly contagious viral infection that affects the air passages of the lungs. It is one of the most severe and common viral winter illnesses. Because the flu is caused by different flu viruses each season, patients are exposed to new types of viruses every year. The flu is a respiratory disease but the whole body seems to suffer when the patient is a child. According to the University of Rochester Medical Centre, symptoms include:
vomiting, and diarrhoea. Because antibiotics aren’t effective
• High fever
against viral infections, treatment should
• Body aches, which may be severe
be focused on easing the patient’s
• Headaches
symptoms until the illness passes. Along
• Sore throat
with getting lots of bed rest and drinking
• Fatigue
plenty fluids, you may recommend the
• Runny or congested nose
patient receives a flu shot.
• Cough that gets worse
S0
Most children recover from the flu within a week. But they may still feel very tired for
And in some instances, nausea,
as long as 3-4 weeks.
PM
Pharmacy Magazine JUNE 2020 |
27
MEBET070 BETADINE MOUTHWASH & GARGLE Pharmacy 2020/05/23 Magazine 13:3156x265 mm
SA's history / PHARMACY LAW
Scope of practice
A
scope of practice outlines the functions, activities, and responsibilities for which
Pharmacy Magazine will be featuring a series of extracts from Pharmacy Law in South Africa (A Practitioner’s Handbook) over the coming months.
pharmacy personnel have been educated and are authorised to perform. It is
important that all registered persons should perform only those functions defined within their scope of practice. Working outside the appropriate scope of practice could present a risk to patients. The acts specially pertaining to the profession of a pharmacist include activities for which only pharmacists are fully trained.31 They form the basis of the pharmacist’s scope of practice. Aspects of these acts may be delegated to pharmacist interns, pharmacy
Intended to be used by both pharmacy students and pharmacists in all areas of practice,
students, and pharmacy support personnel, but full responsibility cannot be delegated and ultimately, the pharmacist must take responsibility for work performed by subordinate pharmacy personnel. of practice, which is based on those functions and
ACTS SPECIALLY PERTAINING TO THE PROFESSION OF A PHARMACIST
activities that may be performed by that category of
The following are the prescribed acts specially
person. It is important for the pharmacist to know the
pertaining to the profession of a pharmacist:
scopes of practice of all registered pharmacy personnel.
• providing pharmaceutical care by taking
Each category of registered person has its own scope
Pharmacy Law in
32
Although each person can be held responsible for his
responsibility for the patient’s medicine-related
own actions, the pharmacist is ultimately responsible
needs and being accountable for meeting these
for ensuring that each person works only within his
needs, which shall include but not be limited to the
scope of practice.
following functions: evaluating a patient’s medicine-related needs
Pharmacist interns are permitted to perform the
o
by determining the indication, safety, and
scope of practice of a pharmacist, but it must be under
effectiveness of the therapy;
the supervision of their registered tutor. They may not
dispensing of any medicine or scheduled substance
work independently until they have completed the
o
on the prescription of a person authorised to
requirements for a pharmacist intern and have been
prescribe medicine;
registered as a pharmacist. Similarly, for purposes
furnishing of information and advice to any person
of training only, pharmacy students are permitted to
o
with regard to the use of medicine;
perform the scope of practice of a pharmacist, but
determining patient compliance with the therapy
under supervision of a pharmacist. If, while they are
o
and following up to ensure that the patient’s
still students, they work in a pharmacy in their spare
medicine-related needs are being met; and
time, they may work withing the scope of practice of a
providing pharmacist-initiated therapy;
pharmacist’s assistant basic or post-basic, depending on their year of study.
o
• the compounding, manipulation, preparation, or packaging of any medicine or scheduled substance,
Learner pharmacist’s assistants, basic, and post-
or the supervision thereof;
basic, may work according to the scope of practice of each category. They may not be supervised by
• the manufacturing of any medicine or scheduled substance or the supervision thereof;
a pharmacist’s assistant but must work under the supervision of a pharmacist.
• the purchasing, acquiring, importing, keeping, possessing, using, releasing, storage, packaging,
Working outside the appropriate scope of practice could present a risk to patients
repackaging, supplying, or selling of any medicine or scheduled substance or the supervision thereof; and • the application for the registration of a medicine in accordance with the Medicines Act.
PM
South Africa (A Practitioner’s Handbook), 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. 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
31 Regulations relating to the practice of pharmacy. GNR. 1158 of 2000. 32 As described in reg 3 of the Regulations relating to the practice of pharmacy. GNR. 1158 of 2000.
Pharmacy Magazine JUNE 2020 |
31
CROSSWORD #20 1 3
2 5
4 6
5 10
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8 2
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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 July 2020. Winners will be contacted directly. Visit www.medicalacademic.co.za for full terms and conditions.
2
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15. Stress, bad health habits, and poor nutrition _ _ _ _ _ _ _ the
2. Although each person can be held responsible for his own
immune system’s ability to keep cold and flu at bay. (PAGE 13-15)
actions, the _ _ _ _ _ _ _ is ultimately responsible for ensuring that each person works only within his scope of practice. (PAGE 31)
DOWN
5. Ibumax Cold and Flu tablets are indicated for the relief of cold
1. Prep Derma Protective Cream relieves the _ _ _ _ _ _ _ _ of shaving.
and flu symptoms, including nasal congestion, _ _ _ _ _ _ _ , fever,
(PAGE 8-9)
and sore throat. (PAGE 22-23)
3. Consider adding vitamin C and zinc _ _ _ _ _ _ _ _ to boost the
9. House dust mites are _ _ _ _ _ _ _ allergens, but exposure levels
immune system when a balanced lifestyle and diet aren’t
tend to peak over winter with reduced household ventilation
enough. (PAGE 13-15)
and increased time spent indoors. (PAGE 19-21)
4. _ _ _ _ _ _ Forte provides relief for persistent dry cough. (PAGE 12)
10. A contagious condition, influenza can lead to serious
6. A patient cannot get the flu from receiving a flu shot as the
complications like _ _ _ _ _ _ _. _ (PAGE 17)
vaccine contains _ _ _ _ _ _ _ flu viruses. (PAGE 17)
11. Clients can shorten their skin cycle with gentle _ _ _ _ _ _ _
7. Broncho Stop Cough Syrup is alcohol, gluten, and _ _ _ _ _ _ _ free.
and Vitamin A. (PAGE 7)
(PAGE 16)
13. Symptoms of norovirus are much like other causes
8. Although _ _ _ _ _ _ _ are primarily responsible, there are over 200
of _ _ _ _ _ _ _. _ (PAGE 25-27)
cold causing viruses. (PAGE 25-27)
14. Nasal congestion can be more _ _ _ _ _ _ _ in infants than in older
12. Nomopain is indicated for specific relief from pain associated
children and adults. (PAGE 22-23)
with _ _ _ _ _ _ _. _ (PAGE 32)
Pharmacy Magazine JUNE 2020 |
33
ANSWERS: CROSSWORD #19
CROSSWORD CROS SWOR WINN D #18 ER
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MAGAZINE
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| JUNE 2020 Pharmacy Magazine
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