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Sign Up It's Free! A DH spokesperson confirmed: It will appear in television, print and outdoor media, and leaflets distributed to pharmacies and CP practices.

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I also was at the first of the meetings we are having with the diagnostic and medical appliance representatives and as we look at the development of technologies there, we can see enormous potential. The challenge is going to be how we make sure the white paper, the discussions and Ara's Next Steps get that. There is a huge prize there. One of the key roles identified by government for pharmacies is in expanding their services in sexual health. If I could use Tower Hamlets as an example, the PCT there has a series of services, sexual health being one, along with cessation of smoking, and possibly hypertension - they have got contracts with their local pharmacies.

We can point to Tower Hamlets and show that with proper discussions between the PCT and pharmacies, you can see the potential in sexual health, ill-health prevention and health inequalities. Does the latest cut in category M generics profits spell the end for pharmacies trading solely on dispensing?

The contract came in during The pharmacies thought, as we did, that it was a very good contract. What it allowed was for us to survey the margins. The contract builds in a margin anyway, which was to the benefit of the pharmacist. When the DH looked at the actual prices paid and added on top what we allowed pharmacists to keep, as an incentive to get a good price, there was still a greater amount and the contract did agree if that happened, there would be a payment back.

I think - I am sure they won't see it this way - but they should be reassured that the contract is sound and the mechanisms in place for both sides are working. I think it's absolutely consistent with the terms of the contract for community pharmacists. Do you use your own local pharmacy? Yes, I have an independent close to where I live in Bristol. My son's 30 now but when he was small you could just pop in and say, 'Do you have something for a cold?

I think the main thing is I have absolute confidence in them. If they say, 'No, you need to see your CP', I will do, but I have this thing that why should I go and see the CP if there are others who are qualified enough to advise me? I have always been a fan of pharmacies. They have a lot to offer. Would it include checks for chlamydia, for instance, which has been suggested by ministers? We are looking at the type of setting, and there is already pressure on CPs. The potential of using clinical skills outside to provide services means we need to ensure that pharmacists are within the discussions.

There are a lot of good examples around the country with PCTs where they are beginning to develop that process. Dawn's local pharmacist has her say Elizabeth Holmes is pharmacy manager of Pharmacy Plus in Bristol. On what she would like the pharmacy minister to do: The industry has to support more pharmacists in post at any one place.

That's the only way that I could do my job to the level I'm expected. I'm besieged by letters requiring me to do this, that and the other - it's more and more bureaucracy. What that pharmacist has done is understand what the local community needs. That's got to be the way of the future. It's a two-way street - it's about the pharmacist understanding the needs of the community and the PCTs recognising the clinical skills there, and the government recognising it's got the right framework to release that potential.

Manufacturing over 20 billion tablets and capsules per year in 3. Now with the support of employees worldwide we have crossed the Atlantic to find a new home here. If service and value are important to you - lets talk business. We very much look forward to working with you. Chairman Nigel Clarke said: Our job is to find what members of the profession think is valuable.

Co-op acquisition The Co-operative Group is negotiating to buy 51 of PCT Healthcare's 90 pharmacy branches in the north of England and is expected to make a further announcement shortly. PCT Healthcare was unavailable for comment. More than minor success Nearly 39, people in the Forth Valley have signed up to the minor ailments service, part of the Scottish contract that allows pharmacists to provide free treatment for minor illnesses to patients exempt from prescription charges.

Off the register D Pharmacist was 'serious potential risk to patients' A pharmacist who repeatedly turned up for work smelling of alcohol and sometimes "unshaven, and slurring his speech" has been struck off by the Royal Pharmaceutical Society.

A disciplinary hearing last month was told that Andrew Graham Shepherd, of Broceulan, Talybont, Dyfed, who worked at the Gareth James Pharmacy, Aberystwyth, also vomited on two occasions in the dispensary and had previously been stopped for drink-driving.

The disciplinary hearing was told that he had been found to be four times over the limit and disqualified from driving for three years by Ceredigion Magistrates Court on April 24, However, he had not told the Society about his conviction. Mr Shepherd, who did not attend the hearing, told the Society in a letter he had received treatment for alcoholism and was emigrating to China to take up a teaching post.

Striking him off, disciplinary panel chairman John Burrow said: UKL Day Lewis staff: The imminent government white paper on pharmacy services could hand primary care trusts greater control over pharmacy services, Sandra Gidley MP told delegates at last weekend's Day Lewis conference in Brighton. The move could be bad news due to PCTs' lack of understanding of what pharmacy had to offer, she warned. The Lib Dem MP also called for the sector to review the image it presented to the public.

Pharmacy now needed to decide if its future revenue should come from general retailing or from clinical services, she argued. Ms Gidley called on pharmacists to court MPs to show how the profession could help deliver healthcare targets.

Pharmacists were one of the "most highly rated" professions in the country, beating even doctors, Ms Gidley said, "but we don't always project what we do to the best of our ability". Prescribers are recommended to consult the Summary ot Product Characteristics before prescribing, particularly in relation to side-effects, precautions and contra-indicatjons Legal category: Kymatika is different sir' miss out!

Kymatika has the 'fingerprints' of a wide range of foods on its database. I'm scared, that's why. I'm not scared of the challenge of new roles, but worried that I won't be able to fully delegate the responsibility for my old ones. The reason most pharmacists don't, or won't, leave the dispensary is because they are responsible for everything that happens there. However good my support staff are they are human beings, and as things stand it's not fair to make them completely responsible for a mistake made in my absence.

Nor do I want to be responsible for a mistake made by someone else. However rigorous I make the SOPs, human error will always creep in. Who will get sued for a dispensing error made while I'm the responsible pharmacist but off the premises? If dispensing technicians assumed that responsibility nobody would want the job.

And I don't expect the Society to come to my defence if anything goes wrong. In fact, I'd expect them to do everything in their power to get me off the Register. I cannot imagine how issues such as dealing with controlled drugs and sales of pseudoephedrine can be dealt with in my absence. My patients would have to come back later because I won't be able to afford one of these video links that enables me to remotely see what's happening in the pharmacy.

If all pharmacists can't be RPs we will end up with a two-tier profession and a workforce crisis. If all newly qualified pharmacists can't work alone there won't be enough pharmacists to keep all the network going. The RP initiative should be a step forward, but if we're not careful it could take us in the wrong direction. Whatever legislative changes are enacted I won't be leaving the premises without a cast iron guarantee that following SOPs will make me and my staff immune from legal action and the wrath of the Statutory Committee.

The green, green grass of home The grass is always greener on the other side. The other side of the Atlantic, that is. But I wonder which is the best place to be a pharmacist. Personally I like the idea of charging patients directly for their drugs and helping them manage them to find cost-effective solutions.

But I'd still prefer to come home for my own treatment, superbugs or not. Your views Kent Woods Beware the growing trade in fake medicines Following the biggest ever investigation undertaken by the MHRA, four of the defendants in a global 'fake drugs' conspiracy trial were sentenced to a total of 14 and a half years at Kingston Crown Court, in September. A fifth defendant a pharmacist received a community service sentence but the jury failed to reach a decision regarding the remaining four defendants, so a retrial has been set for The convicted defendants were found guilty of trading in fake medicines - purporting to be Propecia, Cialis and Viagra - across the world.

In the main, they were selling these on the internet or forwarding them on for sale in the USA but, on one occasion, they managed to break into our legitimate supply chain, causing us to issue a product recall. The scale of the gang's operation was truly global. In sentencing, Judge Price said: These sentences are designed to deter others from becoming involved in the lucrative business.

The scale of enterprise was truly global and conducted with a total and cynical disregard for consumers. The quality of the packaging of these counterfeits is excellent, often making them difficult to detect at a glance. We are determined to continue with robust enforcement action in this area. Should pharmacists have any suspicions about medicines or suppliers then we would urge them to contact us: Dysphagia, or swallowing difficulty, is a much more widespread problem than you might think.

Such non-compliance has serious consequences in that it can lead to poor outcomes, hospitalisation or even patient death. Strachan I, Greener M. Medication-related swallowing difficulties may be more common than we realise Pharmacy In Practice December S. That's why it makes sense to give people who can't swallow solid medicines a more appropriate formulation such as a liquid - and the sooner this is done the greater the difference it can make in terms of improved compliance and patient welfare.

Rosemont specialise in liquid medicines offering solutions across a wide range of therapeutic areas. RasGiTiDnt t we realise. Rosemont House, Yorkdale Industrial Park. For more clinical news see: The Department of Health announced last week that girls aged 12 and 13 will receive the HPV vaccine, starting next autumn.

A year later, girls aged up to 18 years will begin to be immunised as part of a catch-up programme. Parents will be able to decide whether or not their daughter receives the injection.

All the home countries are to participate in the campaign, which aims to cut cervical cancer rates by up to 70 per cent. The cervical screening programme will continue, not only because it will be many years before the effects of routine immunisation become evident, but also because the vaccine does not protect against all the causes of cervical cancer.

The makers of the two cervical cancer vaccines, GSK Cervarix and Sanofi Pasteur MSD Cardasil both welcomed the move, though the government has yet to decide which of the vaccines it will use. However, the DH hinted that price would influence its choice, saying it aimed to "negotiate a reduction in vaccine price during the procurement process". The fpa Family Planning Association supported the introduction of an HPV vaccine, but appeared to favour Cardasil for its action against genital warts.

Cardasil provides protection against HPV types 6, 11, 16 and 18, and is licensed for the prevention of genital warts, whereas Cervarix - for HPV types 16 and 18 only - is not. The fpa also pushed for the programme to be extended, pointing out: Publishing in the Journal of the National Cancer Institute ; Some 4, patients receiving various types of surgical and radiation therapy were included in the analysis, which was designed to investigate whether ADT contributed to the metabolic syndrome, and therefore increased cardiovascular risk.

Over three years of follow up, subjects in the study treated with ADT were 2. Neuron mismatch may cause fibromyalgia pain The unexplained pain experienced by patients with fibromyalgia may be due to a mismatch between the sensory and motor nerve systems, say University of Bath researchers. Writing in the journal Rheumatology, they described a study in which patients were asked to look at a reflection of one arm while moving the other in a different direction hidden behind a mirror.

Of the 29 subjects who took part in the experiment, 26 reported the classic symptoms of a fibromyalgia flare-up in the hidden limb - a transient increase in pain, and senses of temperature change and heaviness. Fibromyalgia is one of the commonest conditions seen by rheumatologists, but some clinicians do not recognise it as a diagnosis, and instead consider that it reflects a state of anxiety or attention- eeking.

Researcher Dr Candy McCabe said that there was a growing body of evidence that a sensory-motor conflict is at the heart of the condition. Alongside the other anti-TNF agents etanercept Enbrel and infliximab Remicade , adalimumab may now be considered for RA patients who have already tried methotrexate and another disease modifying anti-rheumatic drug DMARD , and who have "active" RA as assessed by a rheumatologist on two separate occasions.

Patients should usually receive concomitant methotrexate, unless it is not tolerated. Nice recommends continuing the therapy only if the disease has improved sufficiently after six months, and the patient should have check-ups every six months to ensure they are still responding to treatment. If the first choice of drug is not tolerated, a second may be started if deemed appropriate.

The National Rheumatoid Arthritis Society praised the extended guidelines, commenting: The Nurofen Community Care Pharmacy Assistant Award recognises pharmacy staff who go out of their way to help their customers, over and above their day job. It could be anything from offering a cup of tea to a regular elderly customer to learning the basics of a foreign language to better communicate with people of the local community.

However big or small you think it is, they are helping to remove life's little pains and we want to know about it! We'll use all the expertise we've built up from working with thousands of pharmacists around the country to make sure you get the right advice, help and support.

So when you want a wholesaler you can rely on, give us a call. Although most can be related to personal cigarette smoking, over 4, people who have never smoked die of lung cancer every year. The overall survival rates from lung cancer are poor, with fewer than 10 per cent of patients surviving five years after diagnosis and nearly 80 per cent dying within a year.

The main problem is that lung cancer is often not diagnosed until it has reached an advanced stage. This article points to ways in which pharmacists might make a real impact on survival rates. Risk groups The median age at diagnosis is just over 70 years. Lung cancer is relatively uncommon under What are the most common symptoms? How is lung cancer treated? Plan This month's Lung Cancer Awareness campaign aims to encourage earlier diagnosis. By reading this article you can be alert to symptoms and will learn about the latest treatments.

The author also gives some indication of prognosis for a cancer with a low survival rate. This article can help in the following CPD competencies: Between 80 and 90 per cent of cases occur in smokers or ex-smokers, although the risk fails significantly after quitting at almost any age.

Around one in six lifelong smokers will die of lung cancer. The co-existence of chronic obstructive pulmonary disease COPD has been shown to multiply the risk up to four-fold. A number of other factors increase risk, such as exposure to asbestos and environmental radon particularly in some areas of the South West. Patients with a family history of lung cancer are also at slightly higher risk. Symptoms and signs The symptoms are relatively non-specific and commonly occur in the general population, especially older smokers.

Many patients already have co-morbidities such as COPD and ischaemic heart disease, which have symptoms overlapping those of lung cancer. The general public has a low awareness of the symptoms, but healthcare professionals need to be alert to possible lung cancer, especially where the symptoms are unexplained and persistent over three weeks , and occur in the high risk groups outlined above.

Cough, dyspnoea, haemoptysis, chest pain, fatigue and weight loss are perhaps the most common. Often it is the change in a pre-existing symptom particularly cough as much as new symptoms that should raise the alarm. Haemoptysis occurs in fewer than 50 per cent of cases and is less specific than often thought. Only about one in 20 patients with haemoptysis in the community will have a diagnosis of lung cancer.

More common signs include clubbing of the fingers, palpable lymph nodes in the supraclavicular fossae and chest signs such as pleural effusion, consolidation and wheeze.

Less common signs include hoarseness and swelling of the face and neck from superior vena caval obstruction. Types of lung cancer Most lung cancers arise in the mucosa lining the airways. There are two broad groups: SCLC is strongly associated with smoking.

It now accounts for around 10 per cent of all lung cancer cases in the UK. It has the fastest doubling time of all the sub- types and tends to spread to regional lymph and other organs early in its course. Some 75 per cent of patients have metastatic disease by the time they are diagnosed.

NSCLC is a phrase used to cover most of the other forms of lung cancer, with only some rare sub-types excluded. The most common are: Haemoptysis and finger clubbing are more common in these types. Although still much more prevalent in smokers, the link to smoking is not so strong and it is the most common type to occur in never- smokers.

It is also more common in women. It tends to arise in the lung periphery, often as a nodule that may be detected incidentally when chest x-rays or CT scans are carried out for other purposes. Many adenocarcinomas are relatively slow growing. However, even in patients with NSCLC some two-thirds have metastatic disease at the time of diagnosis and no more than 20 per cent are potentially operable.

Diagnosis and staging Initially, the most important investigation is a chest x-ray Figure 1, p This is abnormal in around 95 per cent of patients with lung cancer symptoms. It is important to remember that a normal chest x-ray does not rule out the diagnosis, so if the GP remains concerned, the patient should be referred to a rapid access lung clinic run by the lung cancer multidisciplinary teams available in most major hospitals. Patients are seen within two weeks and thereafter the pathway of care is usually well streamlined.

Further tests used in this setting include a CT scan of the abdomen and thorax, bronchoscopy, needle biopsy of the lung, biopsy of supraclavicular lymph nodes, CT or MRI brain scan, PET scan and isotope scan.

The main processes in the rapid access clinics are: Staging is central to defining optimum treatment. Details oftheTNM tumour, node, metastasis classification, used for most patients, are not relevant here but patients are broadly divided into three main groups, those with: Metastases most commonly occur to the liver, brain, bones, other lung and adrenal glands.

Treatment and prognosis Small cell carcinoma Only a small number of patients with SCLC have tumours at an early enough stage for surgery to be feasible, but those who are operated on often have a good prognosis. In most cases, though, SCLC is best thought of as a systemic disease and the first line of therapy is chemotherapy.

The most frequently used combination of agents is cisplatin and etoposide given by iv infusion as a day case. Between three and six courses are usually administered at three- weekly intervals depending on the patient's fitness and response. In patients with less extensive disease and relatively good prognostic markers, chemotherapy is combined with radiotherapy to the primary site.

Most patients with SCLC obtain good symptomatic relief with chemotherapy and around 85 per cent have a significant objective response. There is an overall improvement in median survival of between nine and 15 months, depending on stage, but most patients eventually relapse and fewer than 5 per cent will be alive five years after diagnosis. Surgical resection is the best option and in the minority with the earliest stage disease stage IA , the five- year survival rate is around 75 per cent.

This falls to around 30 per cent with stage MIA disease, though this can be improved by adjuvant ie post-surgical chemotherapy. Radical radiotherapy offers an alternative, although the proportion of long-term survivors is smaller. Combination chemo- radiotherapy is now the treatment of choice in relatively fit patients. Treatment is not aimed at long-term survival, but modest medium-term survival gains and symptom palliation.

Combination chemotherapy is the first-line treatment in fitter patients. The most common regimes used in the UK are gemcitabine plus carboplatin or cisplatin and vinorelbine plus cisplatin, but mitomycin, vincristine plus cisplatin is still used in some centres.

The most common schedule is three cycles at three-weekly intervals. The objective response rate to these regimes is around 50 per cent and up to two-thirds of patients obtain symptomatic relief. The median survival is improved by only around 10 weeks, but the proportion of patients who survive to a year is doubled.

In the UK docetaxol is mostly used in this setting. The two currently under most scrutiny are inhibitors of epithelial growth factor receptor EGFR eg erlotinib and vascular endothelial growth factor VECF eg bevacizumab. Erlotinib is the only agent so far licensed in the UK, although Nice has yet to decide whether it will be recommended on a cost- effective basis for NHS funding in England.

These new compounds are showing great promise in certain patients and have a much less troublesome toxicity profile. Many can be taken orally. Palliative care Palliative and supportive care are essential from the time of diagnosis. Specific palliative measures include radiotherapy to relieve local symptoms and other techniques such as stenting and laser therapy to open up obstructing airways. Most palliative care is, though, supportive in the true sense of the word and includes pharmacological measures to relieve pain, dyspnoea, anorexia, fatigue and depression.

Lung cancer specialist nurses are a vital part of the lung cancer team, supporting patients and their families as they progress along the care pathway. What can the pharmacist contribute? A key problem with lung cancer is that it has often progressed beyond curative treatment by the time the patient reaches specialist care. But we know that the earlier we 'catch' patients the better the chances of 'cure'. Although the symptom profile is relatively non-specific there is good evidence that many patients have symptoms long before diagnosis.

We need to find ways of raising public awareness of the early symptoms and get across the 'earlier the better' message. Patients with respiratory symptoms often go to their pharmacists for advice, whether it be for a cough and breathlessness, or to ask about the need for antibiotics. If pharmacists were universally aware of the features of the high risk groups and warning symptoms, they would be in a key position to encourage patients to see their doctor urgently and request a chest x-ray.

Survival rates for lung cancer in the UK are well below those seen in many other western countries and there is a four-fold variation in five-year survival across the UK. It is likely that a significant proportion of these differences result from late presentation of patients to medical care in some areas. Pharmacists could make a real difference to improving outcomes simply by learning the basic characteristics of lung cancer and remaining constantly vigilant. If there are, think about how you can recognise potential patients.

If so, how did you react? Think about how the patient would like you to respond. Now plan some responses so that you are well prepared in future. Resources and a free helpline are available for patients with all types of cancer on www.

Information about Macmillan nurses is available on www. Read pages four to five of the Nice guideline on lung cancer found at www. Do you know more about how you might help patients who have been diagnosed? What else might you do to develop your knowledge of this area? If you wish to register for Pharmacy Update, please contact Pauline Sanderson on They're ones that Mr Spencer wants me to do to provide evidence of my competence in prescription endorsing as part of my training," Julia replies.

I reckon I know my endorsing. I'll watch and see how you get on. This first one is for two x 28 escitalopram 20mg tablets," says Julia.

What's the next one? I can't see it in the BNF, so I'll have to look a bit further. Give me a couple of minutes. We had to call the skin hospital for the formula, because the dermatologist had just written 'Tar Pomade g.

Use as before for scalp psoriasis' in the letter to the patient's CP, and he'd copied it verbatim onto the prescription. Once we had the formula we sent away to get it made. Gla, G1e,C1c, CI f. The review of 23 trials found that aspirin reduced the risk of non-fatal Ml by 28 per cent overall, but did not reduce the risk of fatal Ml. However, almost all of the difference could be explained by considering the gender mix of the trials.

The Care Quality Commission will be able to carry out infection control inspections, close down hospital wards if necessary, and issue early warning notices when problems arise. The if body - announced by the Department of Health last week - will work across health and social care in both the NHS and independent sector. DH alcohol leaflets Two leaflets warning about the perils of excess alcohol consumption have been published by the Department of Health. As well as outlining the detrimental effects of alcohol, the booklets list advice and contacts for those wanting to cut down or needing support.

The authors commented that the reason women show less benefit from aspirin was a mystery, but pointed out that research had revealed significant differences between the coronary vessels of men and women. For more information, see www. Now that's smart Symbia ation overleaf for alternative dosing regimens for regular prophylactic use e. Each inhalation containing metered doses equivalent to mcg budesonide Turbohaler and 6mcg formoterol Turbohaler.

Treatment of asthma where the use of a combination inhaled corticosteroid and long acting beta 2 - agonist is appropriate. COPD Symbicort only: Asthma Symbicort maintenance therapy - regular maintenance treatment with a separate rescue medication: Some patients may require up to a maximum of 4 inhalations twice daily.

Dose should be individualised. When symptoms are controlled, titrate to the lowest effective dose, which could include a once daily dosage Children under 6 years: Not recommended Asthma Symbicort maintenance and reliever therapy - regular maintenance treatment and as needed in response to symptoms: Should especially be considered for i patients with inadequate asthma control and in frequent need of reliever medication ii patients with asthma exacerbations in the past requiring medical intervention Adults including elderly: Patients should take 1 additional inhalation as needed in response to symptoms.

If symptoms persist after a few minutes, an additional inhalation should be taken. Not more than 6 inhalations should be taken on any single occasion. A total daily dose of more than 8 inhalations is not normally needed; however, up to 12 inhalations a day could be used for a limited period Patients using more than 8 inhalations daily should be strongly recommended to seek medical advice and should be reassessed, their maintenance therapy should be reconsidered Patients should be advised to always have Symbicort for reliever use Children and adolescents under 18 years of age: Hypersensitivity allergy to budesonide, formoterol or inhaled lactose Warnings and Precautions: If treatment is ineffective, or there is a worsening of the underlying condition, therapy should be reassessed Sudden and progressive deterioration in control requires urgent medical assessment.

Patients should have their appropriate rescue medication available at all times, i. Therapy should not be initiated during an exacerbation. Serious asthma-related adverse events and exacerbations may occur and patients should continue treatment but seek medical advice if asthma symptoms remain uncontrolled or worsen after initiation with Symbicort. As with any inhaled corticosteroid, systemic effects may occur, particularly at high doses prescribed for long periods.

These may include adrenal suppression, growth retardation in children and adolescents. Potential effects on bone should be considered especially in patients on high doses for prolonged periods that have co-existing risk factors for osteoporosis.

Caution when transferring patients who have required high dose emergency corticosteroid therapy in the past or prolonged treatment with high doses of inhaled corticosteroid or oral corticosteroids or in a situation likely to produce stress e.

Observe caution in patients with thyrotoxicosis, phaeochromocytoma, diabetes mellitus, untreated hypokalemia, or severe cardiovascular disorders. As with other beta,-agonists. Particular caution recommended in unstable or acute severe asthma as this effect may be potentiated by xanthine-derivatives, steroids, diuretics and hypoxia. Monitor serum potassium levels Hypokalemia may increase the disposition towards arrhythmias in patients taking digitalis glycosides.

In diabetic patients, consider additional blood glucose monitoring. Concomitant treatment with itraconazole, ritonavir or other CYP3A4 inhibitors should be avoided unless the benefits outweigh the systemic side effect risks. Symbicort maintenance and reliever therapy is not recommended in patients using potent CYP3A4 inhibitors. Not to be given with beta adrenergic blockers including eye drops unless there are compelling reasons.

Concomitant administration with quinidine, disopyramide, procainamide, phenothiazines, antihistamines terfenadine , MAOIs and TCAs can prolong the QTc-mterval and increase the risk of ventricular arrhythmias. L-Dopa, L-thyroxine, oxytocin and alcohol can impair cardiac tolerance. Concomitant administration with MAOIs, including agents with similar properties such as furazolidone and procarbazine, may precipitate hypertension.

Risk of arrhythmias in patients receiving anaesthesia with halogenated hydrocarbons Pregnancy and Lactation: Should only be used when the benefits outweigh the potential risks.

Side-effects include headache, palpitations, tremor, Candida infections in the oropharynx, coughing, mild irritation in the throat, hoarseness, tachycardia, muscle cramps, agitation, restlessness, nervousness, nausea, dizziness, sleep disturbances and bruises.

Rarely, hypokalemia, cardiac disorders including atrial fibrillation, supraventricular tachycardia and extrasystoles, bronchospasm and immune system disorders including exanthema, urticaria, pruritus, dermatitis and angioedema.

Very rarely, psychiatric disorders including depression and behavioural disturbances mainly in children , angina pectoris, hyperglycaemia. As with other inhalation therapy, paradoxical bronchospasm may occur in very rare cases. Adrenal suppression, growth retardation in children and adolescents, decrease in bone mineral density, cataract and glaucoma may occur as systemic effects of high doses of inhaled corticosteroids over prolonged periods of time Package Quantities: In addition, information about adverse event reporting can be found at www.

Pulm Pharmacol Ther ; 14 1: The inhaler size was a good enough reason for most people not to want to use it. With most people on multi-dose regimes, which often necessitate injecting in public, there was little chance that Exubera could be inhaled as discreetly as injecting insulin.

Furthermore, patients know the long-term safety of Exubera had not been established in terms of lung function or tumour development. Diabetes itself has its own risks, so why take additional ones?

In embarking on this very expensive exercise, it appears that Pfizer did not address what patients most dislike about their condition. It is not the injections that are the most troublesome part but the daily grind of managing diabetes - frequent blood glucose testing, avoidance of hypoglycaemia, the planning required for everyday activities such as exercise and diet, and the ongoing underlying fear of the long-term complications.

There is a message here for pharmaceutical companies and maybe for others too, which is that it is important to establish patients' priorities, rather than make assumptions. Let us hope that future developments in insulin delivery are more successful and more in line with patients' needs.

There still are no insulins or regimes that sufficiently mimic the natural production of insulin to provide good glycaemic control easily, so patients hope for a non-invasive delivery system with predictable absorption.

For many patients, the development of the oral insulin capsule has much appeal but this may not be problem-free as it is not the normal place for insulin to be delivered. The ideal for most people? According to our research, it is the continuous pump that delivers insulin in response to automatic blood HJPBWJ glucose measurements. Clinical Matters Amonafide granted orphan status The experimental acute myeloid leukaemia treatment amonafide Xanafide, Xanthus Pharmaceuticals has been granted orphan drug status by the European Commission.

The drug is currently in phase III trials, www. Email us at haveyoursay cmpmedica. Then simply tear off your entry and pop it in the post. Clinical News 3 November Diabetes services failing patients Many patients with diabetes are not achieving the target glycated haemoglobin HbA lc levels, the National Diabetes Audit has warned.

Analysis of over , records from patients with diabetes in primary and secondary care in found that just six in 10 achieved the recommended HbA 1c measurement of 7. Data from specialist paediatric centres revealed that nearly a third of children and adolescents had HbA lc levels of over 9. Furthermore, almost 9 per cent experienced at least one episode of ketoacidosis in the audit year.

Carried out for the Healthcare Commission, the report calls for commissioned services that improve outcomes for all people with diabetes. In particular, young people with very high HbA- C levels should be offered additional support to improve glycaemia control and minimise the risk of complications, it said.

The audit did contain some good news, stating that nearly three-quarters of people with diabetes achieved the Nice cholesterol guideline of lower than 5mmol per litre. The report also highlighted the "pleasing downward trend in the prevalence of stroke and myocardial infarction" in the three years since the audit began. However, the Agency has recommended changes to the indications and the additional information sections of the drugs' SPCs.

The additional information will warn that there is no evidence of benefit when the haemoglobin is raised beyond the level needed to control anaemia symptoms, and that significant levels of excess mortality have been observed in patients with anaemia associated with cancer taking epoetins compared with those who did not. The public health guidance is based on strategies and approaches that have been proved effective at bringing about health benefits for the population as a whole.

Nice hopes it will equip health professionals with the necessary skills to arm patients with the knowledge required to adopt healthy attitudes and behaviours. The document also highlights the need to take into account local factors when planning intervention programmes, and assess potential barriers to change with advice on how to overcome them. The guidance also stresses the importance of evaluating any initiatives adopted. We're working with the local health board in a bid to increase understanding of health and health- related issues in the most socially deprived areas of North Ayrshire.

Owing to funding restrictions, only patients living in certain postcodes are eligible for an MOT, which allows us to more effectively target services at those based in the most deprived areas. Each MOT takes about 40 minutes and comprises free blood pressure, diabetes and cholesterol tests, a BMI assessment, plus a calculation of their risk of cardiovascular disease within the next 10 years. In addition to the tests, patients complete a health check questionnaire, which asks about any family history of cardiovascular disease, smoking and drinking habits, exercise taken, general mood, age and regular medication taken.

We would refer patients with a cardiovascular risk of more than 20 per cent to their CP. We can refer patients to WeightWatchers free if their BMI is higher than 30 and they need support with their diet. Under the white coat If I was in charge of pharmacy for a day, I'd get more pharmacies involved in similar services. A recent extension to this is a weight management programme in the pharmacy in which we weigh the patient weekly for three months and give advice on healthy living.

After this, if the patient is losing weight but still has a BMI of more than This would be dispensed weekly for three months and then monthly for up to a year. We've also given free suntan lotion and pedometers to our customers in the designated areas, and offer exercise vouchers that entitle them to discounted access to their local leisure centre for activities such as swimming and aerobics.

It's been satisfying when we have highlighted a potential health problem for a patient and referred them to their GP for further help and evaluation.

However, it's frustrating when a customer feels they would benefit from an MOT, but they're not eligible because they don't live in the right postcode area.

Manning the operation has required some thought and effort from the whole pharmacy team. I feel I am now starting to extend my role within the community. However, I couldn't have done this without the massive amount of support and continuing enthusiasm I receive from all my staff - from the great Saturday Out of hours When I'm not at work, my hobbies are going to the gym, shopping shoes, shoes, shoes and I'm a dedicated watcher of all things Big Brother.

Having the right attitude and taking time to train staff to assist really helps you pull together as a team. Patients are pleased that we are providing the service as well as signposting them to other healthcare professionals. They come to us either because we've flagged up that they could be eligible, or because they have seen the leaflet. Our local GPs have also been supportive and are grateful to us for highlighting a problem, or even just providing an up-to-date reading for their own records.

Since the product launched more than 50 years ago, the size of the population has changed considerably and this has prompted the sizing review, says manufacturer Molnlycke. The changes, also including the introduction of the company's new logo and a change in the 'flesh' descriptor to 'beige', will be phased in as new product is supplied to wholesalers.

Tubigrip provides tissue support in the treatment of strains, sprains, soft tissue injuries, joint effusions, general oedema, post-burn scarring and ribcage injuries. The product is also suitable for pressure dressings and arm fixation. Said to address conditions experienced by dry eye sufferers such as grittiness, itching and burning, the range comprises three variants. Clinitas Hydrate is a liquid gel drop that boosts the aqueous layer. The preservative-free Clinitas Soothe is supplied in single-use units for convenience.

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A novel bronchodilator xanthine apparently without adenosine receptor antagonism and tremorogenic effect. The Quintiles Prize Lecture TY - JOUR. T1 - Bronchodilator activity of a nonxanthine phosphodiesterase inhibitor; 2,4-diaminocyanobromopyridine (compound 1) AU - Smith,P. F. Study online flashcards and notes for Ch37 Bronchodilators and other Resp Drugs including when taking Xanthine received a Nobel Prize?

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