SA Pharmaceutical Journal - Volume 77, Issue 4, May 2010

Recently, a number of members have questioned the prescribing of some dentists. In one case a patient approached the pharmacist to supply antibiotics and even tranquilisers. Having been told that such medicines could not be supplied without a legal prescription, the patient subsequently produced prescriptions written by a dentist. In this case the patient had obviously called on his friend, the dentist, to provide the prescriptions. In another case, a dentist prescribed DHEA for the husband of his receptionist!

Should I or shouldn't I?

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I'm not great on decision making at the moment, so I've been arguing with myself. Do I start my letter to you this month by complaining about pharmacists, and then move on to more positive subjects? Or do I cheer myself up by talking about good things first, and then complain about pharmacists? Or do I just moan and groan? Or do I just focus on the upbeat stuff?

Learning from our travels

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Heeding the Health Minister's call

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The PSSA happenings

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Congratulations and Condolences

Presentation of scroll to Claude Ernest Ambler

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News from the Cape Midlands

The PSSA / Alpha Pharm Distance Learning Programme continues to offer pharmacists useful, practical, up-to-date information that enables them to provide optimal pharmaceutical care to their patients.

Depression is a common chronic and recurrent illness that is the cause of significant morbidity that often requires long-term treatment. Depression is among the most common health disorders in women. The prevalence of depression is approximately twice as great in women as in men and it is more common in the childbearing years. Despite its common occurrence it is frequently undiagnosed and left untreated during pregnancy usually due to concerns about the safety of treating women during pregnancy. Depression itself can have a negative impact on the course of the pregnancy as well as the foetus. All antidepressants cross the placenta and expose the foetus to the effects of these medications. The decision on whether to treat a pregnant woman with depression with pharmacotherapy depends on the severity of the disease, the number and frequency of episodes and the history of response to medication. Whether or not the patient may breastfeed also needs to be taken into consideration when deciding on which antidepressant to prescribe. Psychotherapy may obviate the need for pharmacotherapy in mild to moderate depression and may also be beneficial in patients taking antidepressants. All pregnant patients with depression need to be assessed and treated on an individual basis. Pharmacists can provide patients with general counselling regarding depression and antidepressants and support by identifying any pharmaceutical issues such as interactions, persistent side effects, and adherence. Pharmacists may also identify potential suicide risk which may become apparent when talking with a patient which would require urgent referral.

Coughing is a normal reflex reaction due to stimulation of the cough receptors in the brain. Generally, elderly patients have an increased incidence of illnesses and take more medications compared to younger patients. This potentially increases risks of drug interactions and side effects. Because coughing can be a symptom of another underlying disease, a careful evaluation of signs, symptoms and other factors must be undertaken when an elderly patient presents with a cough.

Sodium bicarbonate, sodium citrate and potassium citrate cause alkalinisation of the urine. They may be given to relieve urinary discomfort in mild urinary tract infections and to prevent the development of uric acid renal calculi in the initial stages of uricosuric therapy for hyperuricaemia. Sodium bicarbonate is also used parenterally to correct metabolic acidosis and orally as an antacid. This article provides a brief review of the therapeutic role of alkalinising agents for alkalinisation of the urine and for the neutralisation of acid secretions in the gastrointestinal tract.

Post-nasal drip (PND) can be a bothersome symptom and one of the main reasons for patients visiting a general practitioner (GP), pulmonologist or ear, nose and throat (ENT) surgeon. It can be either a symptom, sometimes not appreciated by the examining practitioner, or an important clinical sign suggesting rhinosinusitis. This article aims to explain the aetiological factors and initial work-up of the patient with a PND and rhinosinusitis and suggest a treatment paradigm for practitioners.

Smoking is a global epidemic. Every eight seconds a person dies of tobacco-related disease, and almost as quickly another smoker is recruited. Encouragingly, South Africa is at the forefront of legislation to control tobacco use and in this article we review the recent changes in our Tobacco Control Products Act. In addition to legislation, we as pharmacists need to educate people about the dangers of smoking and need to offer help to those who want to quit. We can provide encouragement; give practical tips and make recommendations regarding nicotine replacement therapy.

Rotavirus gastroenteritis is a common cause of severe infection throughout the world, even in countries with good hygiene and sanitation measures. Rotavirus infection is characterised by sudden onset of watery diarrhoea, fever and vomiting. Although the infection is usually mild and self-limiting, it can lead to severe dehydration with electrolyte imbalances followed by death. Prevention of rotavirus infections can best be achieved through vaccination. The rotavirus vaccine has been shown to be a safe and effective vaccine. The World Health Organization recommends that rotavirus vaccination be incorporated into all national immunisation schedules.

The speciality of Emergency Medicine is new in South Africa. Registration with the Health Professions Council of South Africa was approved in March 2003. In contrast, the USA was the first country to register emergency medicine as a speciality in 1979.

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The traditional "casualty" model for managing acutely ill patients in South Africa has generally been geared to each speciality, "donating" junior doctors to the "front shop" of the hospital. The sorting or triage of patients has been, at best, rudimentary, with eyeball triage being the standard in many facilities. Furthermore, Emergency Medicine Departments are seldom structured and many hospitals run separate emergency areas such as medical, surgical and paediatric.

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The Anglo-American model that channels all emergencies through a specialised unit has been adopted in South Africa as the proposed system for Emergency Medicine. However, each country using this system has different variations of the model. For example, the United Kingdom has implemented a 4-hour waiting time target for all patients who attend the Emergency Medicine Departments. This means that 98% of all patients should spend no longer than 4 hours in an Emergency Medicine Department. They also have distinct areas for treating patients. These are See and Treat, Minor Injuries, Major Medical and Resuscitation. Some have 24-hour stay observation wards for monitoring conditions such as head injuries and overdoses. The final South African Model has yet to be established and is currently in evolution.

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The Goal of Emergency Medicine Departments is to offer a rapid and high standard of care to all patients who require acute treatment. Many acutely ill patients initially present in a pharmacy, because the pharmacist is easily accessible and can offer early treatment or advice in many instances. The pharmacist is thus faced with a range of patients who require medical attention, from minor complaints to potentially life-threatening emergencies such as a sudden acute myocardial infarction and even cardiac arrest.

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Although this article does not intend to cover emergency medicine or principles of first aid in any detail, it does create an awareness for the pharmacist that there are new developments in emergency medicine in South Africa. Pharmacists, especially those in rural areas, may benefit from learning Basic Life Support Skills and are encouraged to undertake training in this field.

Recently asked questions : drug info

Xarelto^® - a new oral anticoagulant

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Rivaroxaban (Xarelto^®) is a new oral anticoagulant that was recently registered in South Africa. It is the first of two new orally administered anticoagulants poised to change anticoagulation practices by offering improvements over the current standard of care, such as fixed oral dosing and no need for routine monitoring.

The theme for the conference was chosen as a tribute to the fact that the FIFA Soccer World Cup will be taking place on African soil for the first time. It is also an opportunity to concentrate on world class pharmaceutical services, and assess South African hospital pharmacy practice in light of world standards.

There are just a few days to go before the 2010 FIFA soccer world cup is to be held right here in Mzansi.

Garmin maps have been upgraded to include all community pharmacies. The maps were revised following a CPS request to include pharmacies to allow tourists who are travelling with a Garmin to locate the nearest pharmacy if required during the FIFA Soccer World Cup. While it is anticipated that this will be very useful to visitors to the country, local consumers may also benefit from this information should they require a community pharmacy while they are on holiday.

Competition is probably as old as mankind. And there is nothing wrong with it. Economists and capitalists will tell you how the world has benefited from it. Nature will show you how the survival of the fittest has led to the survival of species. So the conclusion has to be that it is good and it is utilitarian and we accept it like that.

Nurturing Excellence Academic Excellence Awards 2009

I was recently invited to the oath-taking ceremony of the 2009 pharmacy graduates of the University of the Western Cape. Various student awards were also handed out during the proceedings and I was proud to hand over the Academy Undergraduate Academic Excellence Award to the top student in each class of 2009.