SA Pharmaceutical Journal - Volume 77, Issue 1, 2010
Volume 77, Issue 1, 2010
Source: SA Pharmaceutical Journal 77, pp 6 –7 (2010)More Less
Author Angelene Van der WesthuizenSource: SA Pharmaceutical Journal 77, pp 8 –17 (2010)More Less
Dyslipidaemia is a disorder of lipoprotein metabolism that alters the concentration or composition of lipoproteins. Atherosclerosis and pancreatitis are the two major complications of dyslipidaemia. The most common dyslipidaemia is hypercholesterolaemia, which is one of the major risk factors for coronary heart disease (CHD) and cerebrovascular morbidity and mortality. Severe hypertriglyceridaemia can cause acute pancreatitis. Initial therapy for any lipoprotein disorder is lifestyle changes which include smoking cessation, a diet low in saturated fats, weight loss if indicated and regular aerobic exercise. Correction of any precipitating factors such as uncontrolled diabetes, alcohol abuse or medications should be undertaken. If lifestyle changes are not effective, then drug therapy should be considered. The choice of drug therapy is dependent on the type of lipoprotein disorder. The most effective cholesterol lowering drugs are the statins (HMG CoA reductase inhibitors). They work by inhibiting the rate-limiting step in cholesterol synthesis. They are the most potent form of monotherapy as well as being the most cost effective. Patients not responding to statin monotherapy can be treated with combination therapy, which may include bile acid resins, fibrates, nicotinic acid or ezetimibe. Dietary supplements such as plant sterols and fish oils can also assist in lowering cholesterol levels. Lipid lowering is beneficial in patients with dyslipidaemias for both primary and secondary prevention of CHD.
Author Lee BakerSource: SA Pharmaceutical Journal 77, pp 18 –49 (2010)More Less
The expanded programme of immunisation (EPI) was introduced by the WHO in 1974 with the aim of vaccinating all children below the age of one year against six killer diseases. Since then, new vaccines against other severe vaccine-preventable diseases have been developed. South Africa is in the fortunate position to be able to include many of these new options into the National EPI and adjust the EPI schedule according to the disease epidemiology of the country. The rationale behind some of these additions and changes to the national EPI is discussed.
Author Elmarie Van der WesthuizenSource: SA Pharmaceutical Journal 77, pp 22 –28 (2010)More Less
Oral contraceptives (OCs) are classified according to the dosage of ethinyloestradiol (EE), the type of progestogen and whether the dosages of EE and progestogen stay the same during the cycle or change in a phasic manner. Ultimately, there is no statistically significant difference in efficacy between high-dose and low-dose OCs. There is also no difference in efficacy between monophasic and multiphasic products, which, other than lower hormone content, have no benefit over monophasic products.
Several medications, such as rifampicin, some of the anticonvulsants and certain HIV medications, may reduce the efficacy of OCs and higher dose OC preparations are recommended in patients taking these concomitant drugs.
The effectiveness of OCs with typical use is largely dependent on compliance, which is influenced by bleeding patterns and side-effects. In this regard, the composition of the OC may play a significant role.The dosage of EE and type of progestogen may relate to specific noncontraceptive benefits, such as improvement in dysfunctional uterine bleeding, dysmenorrhoea, premenstrual tension, endometriosis, iron deficiency anaemia, hyperandrogenism and acne. The 3rd generation progestogens and antiandrogens are generally regarded as more ''skin friendly''.
The cardiovascular safety of OCs has long been controversial and although complications such as myocardial infarction and stroke have been reduced over the years with lower EE dosages, the risk of venous thromboembolism (VTE) has not decreased consistently. In fact, some of the low-dose products containing 3rd generation progestogens and antiandrogens may be associated with a higher risk of VTE.
Breast cancer is another controversial issue associated with OC use. Epidemiological studies do not report an increased risk, whereas other meta-analyses do. The risk may be amplified by genetic susceptibility, although data on the subject are not consistent.
An increased risk of hepatic adenoma and cervical cancer has also been noted with OC use, but the latter seems to be dependent on persistent human papilloma virus infection. On the other hand, ovarian and endometrial cancer is reduced by the use of OCs, although genetic susceptibility may also modify the risk.
As indicated by several studies on risk factors related to the safety of contraceptives, the choice of contraceptive is more complicated in patients with certain medical conditions, seeing that physiologic changes and side-effects associated with the method may increase the risk of morbidity / mortality in these women. All women requesting contraceptives should have a risk-benefit assessment before starting on any contraceptive to ensure the safety of the method. This is also true for OCs and in this regard the latest World Health Organization safety categories may be consulted.
Author Fae FarrerSource: SA Pharmaceutical Journal 77, pp 29 –3 (2010)More Less
Several new products were introduced to the South African market in the past year. They include ophthalmic preparations, cardiac medications, contraceptive agents, a product for allergic rhinitis, new products for kidney disease, malaria prophylaxis for children, and a few vaccines.
Some of the products are new combinations of familiar active ingredients, or are introduced in new forms e.g. new delivery systems.
This brief review looks at some of the new pharmaceutical products launched in 2009.
Revision of the national guideline for first-line comprehensive management and control of sexually transmitted infections : what's new and why? : guidelinesAuthor David A. LewisSource: SA Pharmaceutical Journal 77, pp 34 –40 (2010)More Less
A revised national guideline for the management and control of sexually transmitted infections (STIs) has recently been published by the national Department of Health according to the Essential Drugs List. Since 2004, there has been a marked rise in resistance to ciprofloxacin among Neisseria gonorrhoeae isolates in several South African cities, requiring a change from quinolones to cephalosporins to treat presumptive gonorrhoea. In keeping with WHO recommendations, acyclovir has been added as part of first-line therapy for the management of genital ulceration. The national guideline has been revised accordingly in order to improve management of several key STI syndromes.
Eflornithine derivatives for enhanced oral bioavailability in the treatment of human African trypanosomiasis : cum laudeAuthor Cloete TheunisSource: SA Pharmaceutical Journal 77, pp 41 –43 (2010)More Less
Human African trypanosomiasis (HAT), or sleeping sickness, is caused by the parasite protozoa Trypanosoma brucei gambiense and T.b. rhodesiense and is transmitted to humans by the tsetse fly (Glossina) which can only be found in sub-Sahara Africa between latitudes 14°N and 29°S (WHO,1998).
Author Andy GraySource: SA Pharmaceutical Journal 77, pp 44 –47 (2010)More Less
The familiar medicines management cycle can conveniently be divided between the logistic functions (procurement and distribution) and those that are more clinical in nature (selection and use). While the logistic functions have traditionally fallen within the scope of practice of pharmacy, the clinical functions have always demanded a multi-disciplinary team approach.
Source: SA Pharmaceutical Journal 77, pp 52 –53 (2010)More Less
2010 has finally arrived. South Africans have been waiting for it in eager anticipation since the announcement that South Africa was to host the 2010 Fifa World Cup. For the past few years, the country has been in a frenzy to ensure that the infrastructure is conducive to such a momentous occasion. And now it is upon us. Are we ready for it? This article carries extracts from the Department of Health's 2010 website, http://www.doh.gov.za/sa2010/index.htm.
Source: SA Pharmaceutical Journal 77, pp 57 –58 (2010)More Less
Diabetes distance learning module
It's a good topic but it should be emphasised that patients taking chronic medication must continue to do so and that this disease is not curable but manageable. Patients who use supplementary immune boosters have to be warned that these are not a replacement for their chronic medicines. - JNM