Recent advertising by Johnson & Johnson Pacific has been found in breach of the ASMI Code of Practice.

There is no clinical evidence to show that ZYRTEC® is twice as effective as CLARATYNE® for treating allergic rhinitis.

Accordingly the advertised claim was misleading and not based on substantiated facts.

Johnson & Johnson Pacific has been ordered by the ASMI Complaints Panel to publish this retraction.

ZYRTEC® is a registered Trade Mark of UCB Farchim SA 3537/12

Take a look at the April Classifieds here.

For Sale:

• 1x Gabapentin GenRx 800mg Exp:  01/13  $100
• 3x Tarceva 25mg  Exp:  10/12   $500 each
• 2x Stalevo 75/18.75/200 Exp: 11/12  $200 each
• 3x Solian 200mg  Exp: 09/13   $ 80 each
• 1 x Solian 100mg  Exp: 09/12   $ 15

Contact: Blanche, Whitebridge Pharmacy, Whitebridge, NSW, Ph: (02) 49433798, Email: whitebmanager@optusnet.com.au

_____________________________________________________________

For Sale:

• 5 x  HUMULIN 30/70 100 U/mL 10mL vials, Exp 07/12

Contact Donna, Beaudesert Discount Drug Store, Beaudesert, QLD, Ph: 07 5541 2672, email: beaudesertchemist@nunet.com.au

______________________________________________________________________________________________________

For Sale:

• 1 x Arava 10mg 30 tabs, Exp 03/2013 $58.40
• 2 x Risperdal Consta Injections 25mg/2mL (Cold chain fridge line, free delivery in local area 10km radius) Exp 05/2013, $106.35 each
• 1 x Salofalk Granules 500mg Sach 100 Exp 03/2013
• 1 x Zeldox 40mg 60 caps, Exp 01/2015 $116.55

Contact: Gill, Terry White Market Square, Rouse Hill Town Centre, Sydney, Ph: 02 8882 9033, email rousehill2@terrywhitechemists.com.au

Free postage for all items

All prices quoted are at a 20% discount

_____________________________________________________________

For Sale:

• 4 x Mabthera 100mg/10mL, Exp 03/13, Cost: 973.59 each, 10% Discounted price: $876

Drug Safe Wanted:

• We would like to buy a large drug safe, 6-7 shelves, At least 1500 high by 1000 wide.

Please contact Timothy Shelton, Terry White Chemists, Bairnsdale, VIC, Ph: 0409 311 248 /03 5152 3107, email: timshel@bigpond.net.au
___________________________________________________________________________________
For Sale:

• 1 x Eligard, 6 month Expiry 06/12 cost price $ 2,047.56

Contact: Narelle, Chemist Outlet Mayfield, Mayfield, NSW, Ph: 02 4968 2983, email:mayfield.disp@nielsbowen.com

____________________________________________________________________________

For Sale:

• 1 x Exelon Patch 5 24hr/4.6mg 30 Exp. 6/12  $130
• 4 x Creon 40000 Caps 100 Exp. 2/14  $80 ea
• 1 x Phosphate Sandoz Tab 100 Exp. 9/13  $60
• 1 x Salofalk Tabs 500mg 100 Exp. 1/13  $118
• 1 x Seroquel XR 200mg Tabs 60 Exp. 12/13  $145
• 2 x Strattera 40mg 28 Caps Exp. 9/13  $85 ea

Postage Free over $50.00

For any enquiries, please contact: Kerri Elliott, Southside Pharmacy, South Lismore, NSW, Ph: 02 6621 4500, email: sspharmacy@westnet.com.au

_____________________________________________________________________________________________

For Sale:

• 1 x Symbol Pharmascan unit, programmed with Mountain Top. Fully functional.  $500-

Contact Kerry, Sunrise Beach Pharmacy, Sunrise Beach, QLD, Ph: 07 5447 2469 / 0409 269 964, email: sunrisepharmacy@bigpond.com

______________________________________________________________________________________________

For Sale 50% Discount:

Minirim Ampoule (4cmg, 10x1ml), Cost per box $116.78, 50% discount

• 2 boxes – Exp: 04/13
• 2 boxes –  Exp: 11/13
• 3 boxes - Exp: 01/14

Please contact: Vinh Nguyen, Kim Vinh Pharmacy, Bankstown, NSW, Ph: (02) 9707 2385 ,Email: kimvinhchemist@yahoo.com.au

_______________________________________________________________________________

For Sale:

• 2 x Abilify 15mg, Exp 06/12 $112 ea
• 1 x Androfeme 1% cream, Exp 12/12 $23
• 2 x Hydrea 500mg, Exp 09/12,12/12 $38 ea
• 1 x Mesasal 250mg tab Exp 06/12 $47
• 1 x Pulmicort 1mg/2mL resp Exp 08/12 $23
• 1 x Zyprexa 2.5mg Exp 08/12 $33

We will pay for postage

Contact: Michelle, Corrigin Pharmacy, Corrigin, WA, Ph: 08 9063 2094,  Email: cpharmacy@westnet.com.au

__________________________________________________________________________________________

For Sale:

• 1 x Androcur 50mg 50, Exp: 01/2014, $75
• 1 x Clexane 100mg/1mL 10, Exp: 07/2014, $75
• 3 x Kepcet 500mg 60, Exp: 11/2012, $60
• 2 x Oratane 20mg 60, Exp: 11/2012, $80
• 1 x Risperdal Quicklet 2mg, Exp:04/2013, $33.50
• 1 x Salofalk 500mg 100, Exp: 04/2013, $120

Contact: Robert, Windaroo Pharmacy, Windaroo, QLD, Ph:38040900, Email:windaroo.village@nunet.com.au

_______________________________________________________________________________

For Sale:

All COST PRICE less 20% (includes free postage over $50) Credit Card payment only please.

• 4 x Temodal 100mg, 5 capsules CP=$732.47 Exp: 11/12
• 2 x Strattera 25mg, 28 capsules CP=$93.48 Exp: 9/12
• 1 x Neotigason 10mg, 100 capsules CP=$350.38 Exp: 1/14
• 5 x Kytril 2mg, 1 tablet CP=$22.71 Exp: 2/15
• 5 x Zithromax IV 500mg, 1 vial CP=$25.54 Exp: 5/12
• 2 x Deseril 1mg, 50 tablets CP=$16.18 Exp: 10/12
• 1 x Buspar 10mg, 50 tablets CP=$45.56 Exp: 10/12

Please contact Kathy, Gerald Burns Pharmacy, Bicton, WA, Ph: 08 9339 3696, email: geraldburns.pharmacy@frednet.com.au

___________________________________________________________________________________________

For Sale:

• 4x Trileptal 150 mg 100 Tablets, 1 x box Exp: 08/12 and 3 x boxes Exp: 01/13,  Price: $30/box

Contact: Harley Lambert-Pharmacist, Care Pharmacy, Broadmeadows, VIC, Ph: 03 9302 2640, email:  broadmeadows@carepharmacy.com.au

______________________________________________________________________________

For Sale:

• 1 x Avonex with Diluents, Exp 07/12

Contact: Sue, Bowen’s Pharmacy, Wyoming Shopping Village, Wyoming, NSW, Ph: (02) 4328 4081, email: wyoming.disp@nielsbowen.com

_________________________________________________________________________________

For Sale:

• 8 x Aranesp 60ug ang 0.3ml syr x 4, Exp 06/12, $600 ea
• 1 x Aranesp 40ug ang 0.4mls syr x 4, Exp 4/12,   $400 ea
• 2 x Cellcept caps 500mg 50, Exp 2/13, $150 ea
• 2 x Cellcept caps 250mg 100, Exp 4/13, $150 ea
• 2 x Humira inj/syr 40mg/0.8ml x 2, Exp 8/12&10/12, $1,300 ea
• 1 x Humira inj/syr 40mg 0.8ml x 6pk, Exp 10/12, $4200 ea

Contact: Graham, Hardings Pharmacy, Annerley, Ph: 07 3892 1494, email: annerley@hardingspharmacy.com.au

_________________________________________________________________________________________

For Sale:

• 1x Zyban 150mg Qty 90.Exp 07/12. Price:$65
• 1x Toprol XL 23.75mg  Exp 09/12 Price :$8
• 2x Edronax 4mg  Exp 08/12 Price: $18 each
• 1x Clopixol Depot 200mg/ml Qty 5. Exp 10/12 Price $12
• 4x Tramal SR 200mg Exp 07/07/12 Price $8 each
• 2x  Trisequence Exp 07/12 Price $10 each

Contact: Hitesh Kumar, Sunnybank Hills Pharmacy, Sunnybank Hills, QLD, Ph: (07) 3273 7244, email: hiteshpoonam@hotmail.com

___________________________________________________________________________________________

For Sale:

• 1 x Actonel 30mg 28, Exp 08/14, $227 neg.

Contact:  Jessica, Chemist Outlet, East Gosford, NSW, Ph: 02 4325 2839, email: eastgosford.disp@nielsbowen.com

___________________________________________________________________________________

For Sale:

• 1x Tetrabenazine 25mg tablets (OA), Exp 6/15, $275

Contact: David , Ross Trewin Soul Pattinson Chemist, Mt Druitt, NSW, Ph:  (02) 9832-0700, email: admin@litafan.com.au_

__________________________________________________________________________________

For Sale – Never been Dispensed:

• 1 x VFEND (voriconazole) 200mg (56 tabs), Exp:08/13 $2,000

Contact: Miriam, Bowen Plaza Pharmacy, Bowen, QLD, Ph:0747861143. Email: bowenplazapharmacy@hotmail.com

________________________________________________________________________

For Sale:

• 1 x Avandamet 4mg/1000mg x56, list price is $88.16, Exp. 11/12 @$ 63
• 1 x Avandamet 4mg/1000mg x56, list price is $88.16, Exp. 01/13 @ $59

Contact:  Tony, Woolloomooloo Pharmacy, Woolloomooloo, NSW, Ph: 02 9357 2710, email: info@wpharmacy.com.au

_____________________________________________________________________For Sale:

All stock 25% off listed price:

• 1 x Neotigason 25mg 100caps, Exp 8/12
• 1 x Largactil 100mg 100 tabs, Exp 6/12
• 1 x Oxytrol 3.9mg patch, Exp 5/12
• 1 x Pexsig 100mg 100 tabs,  Wxp 5/12
• 1 x Timoptol Xe 0.25% eyedrop,  Exp 6/12
• 6 x Topamax 200mg 60 tabs, Exp 5/12

Contact:  Hien/ Greg, Pharm-assist pharmacy, Werrribee, VIC, Ph: 03 9741 2864, email:  hien.phan@hotmail.com

_______________________________________________________________

For Sale:

• Copaxone 20mg/ml (prefilled syringe) [1] x 28 Exp:05/2012 ($879.95)

20% off cost price on the following items:

• 1 x Aranesp 20mcg/0.5 ml [4], Exp: 06/2012
• 1 x Famvir 125mg [40], Exp: 02/2013

• 2 x Buscopan 10mg [100],Exp: 04/2013
• 1 x Hytrin 2mg [28], Exp: 03/2014
• 1 x Actonel 5mg [28], Exp: 10/2012
• 1 x Nolvadex-D 20mg [30], Exp: 03/2013
• 1 xPepcidine 40mg [30],Exp: 02/2013

_______________________________________________________________________________________

For Sale:

1 x Clarins Display Case (4 bay).  Only 2 years old.  Includes full lighting and in great condition.

Price: $4,000.00 plus dismantling, pick up/delivery costs and assembly.

Contact: Jenny Heathershaw, Heathershaw’s Central Park Pharmacy, Glen Iris, VIC, Ph: 9509 7912/0439 823 9012

For Sale – Save $ 1,380!

• 2 x Nexavar 200mg,  Exp:08/13 $5,000, save $1,380!

Contact: Anthony, Hamilton Pharmacy, NSW, Ph (02) 49613179, Email:  piggott@post.com

_________________________________________________________________________________________

For Sale:

• 2x Risperdal tablets 4mg Exp 31/5/2012 — $161.15
• 1x Aranesp 20mcgx4 (box marked) Exp 30/6/2012 — $335.31
• 1x Xenical 84mg Exp 30/6/2012 — $121.58
• 2x Neoral 50mg Exp 31/8/2012 — $176.51

Contact: Michael Andersen, Harrison’s Pharmacy, Noosa NSW, Phone: (07) 5455 8900, email: noosa@harrisons.com.au

___________________________________________________________________________

For Sale:

• 1 x Clarins Display Case (4 bay).  Only 2 years old.  Includes full lighting and in great condition. Price: $4,000.00 plus dismantling, pick up/delivery costs and assembly.

Contact: Jenny Heathershaw, Heathershaw’s Central Park Pharmacy, Glen Iris, VIC, Ph: 9509 7912/0439 823 9012

_______________________________________________________________________________________

For Sale:

For Sale:

For Sale:

• 1 x Arava 10mg 30 tabs, Exp 03/2013 $58.40
• 2 x Risperdal Consta Injections 25mg/2mL (Cold chain fridge line, free delivery in local area 10km radius) Exp 05/2013, $106.35 each
• 1 x Salofalk Granules 500mg Sach 100 Exp 03/2013
• 1 x Zeldox 40mg 60 caps, Exp 01/2015 $116.55

Contact: Gill, Terry White Market Square, Rouse Hill Town Centre, Sydney, Ph: 02 8882 9033, email rousehill2@terrywhitechemists.com.au

Free postage for all items

All prices quoted are at a 20% discount

_____________________________________________________________

• 4* Mabthera 100mg/10mL, Exp 03/13, Cost: 973.59 each, 10% Discounted price: $876

Contact:  Joseph or Paige,  Chemist Outlet Hamilton, NSW, Ph: 4961 5987, email: hamilton.disp@nielsbowen.com

For Sale:

From a Fuji Kiosk:

• 1x Sony Digital Photo Printer
• 1 box Sony 2UPC-R156H
• Self laminating colour printing pack

Total price $250.00

Contact: Kent, Alderson’s Pharmacist Advice, Rockdale, NSW, Ph: 02 95672632, Email: aldersons@nexon.com.au

_______________________________________________________________________________________________________

Pharmacist Required Maternity Position

The pharmacy is located 3 hours from Melbourne.  Friendly and efficient pharmacist required from 1st of February to 31st of December 2012 (dates negotiable).

Please email mulwala@nunet.com.au with your resume including your Australian Pharmacist Registration number.  _________________________________________________________________________________________________

• 10 x Stemetil 25mg supp ( exp 07/2012 ) cost minus 50% $5.00 each

Contact: Simone, TerryWhite Chemist Rockingham, WA, Ph: 08 9527 3202, email: SMansell@twcrockingham.com.au

__________________________________________________________________________________________________

For Sale:

Great deals on Dispensary stock.  Free postage if you spend over $25.  All items sold GST free

50% off wholesale list price:

• Circadin 2mg 21 tabs, Exp 01/15
• 2 x imovane 30 tabs, Exp 01/14
• 3 x Omacor capsules Exp 12/12
• 3 x Strattera 40mg, Exp 01/13
• Locilan, Exp 02/15 $5

Special deal:

• 1 box of Rebif 44 (interferon beta-1a) 4×1.5ml cartridges, Exp 07/12,@ $699 (over $300 off wholesale price).

A courier to deliver it to your pharmacy (in keeping with cold chain requirements) at no extra cost.

Other specials:

• 2 x Lamotrigine Genrx 50mg, Exp 10/12 $7 each
• 1 x Lisinopril Sandoz 20mg, Exp 12/13 $5
• 2 x Sandoz valproate 500mg $5 each

___________________________________________________________________________________________________

• 3x Caduet 5/10mg 30tabs, Exp 07/12 =  $ 32 ea
• 2x Fareston 30 tabs, Exp 10/12 = $ 44 ea

• 3 x Alphagan-P 1.5 Eye Drops, Exp 12/12, originally $12.18 now $5 each, 3 for $10
• 5 x Comtan 200mg Tab 100, Exp 02/14, originally $128.70 now $120 each, 5 for $500
• 1 x Cozaar 50mg Tabs 30, Exp 05/12 originally $37.73 now $20
• 2 x Optium Omega Strips 50, Exp 04/21, originally $ 20.97 now $ 10
• 3 x Sotacor 160mg Tablets, Exp 11/12, originally $ 20.23 now $15 each, 3 for $30
• 4 x Nicorette Step 1 Patches 14, Exp 08/13, originally $ 47.63 now $35 each, 4 for $120

• Sunglasses   50% off
• Selected Shower Gels  25% off
• Laundry powder varieties 500g only at $2.99, and many more

• 1 x Adalat oros 20mg, Exp 11/14 @ $8.85
• 28 x Cialis 5mg,Exp 02/13 @ $115
• 2 x Coveram 5/5, Exp 03/13 @ $13.92
• 2 x Coveram  5/10, Exp 05/13 @ $18.85
• 1 x Creon 25,000, Exp 01/12 @ $46.24
• 1 x D-Penamine 125mg, Exp 02/13 @ $ 16.60
• 1 x Lescol 20mg, Exp 07/13 @ $12.80
• 1 x Madopar Tab 50/12.5, Exp 02/13 @ $11.15
• 1 x Natrilix 90′s, Exp 02/14 @ $11.15
• 2 x Stilnox cr 12.5mg x 14′s, Exp 09/12 @ $15.60

• Dispensary Cabinets
• All Shelving
• Counter & Benches

• Save time and your back. i-Robot copy. 14day trial/money back guarantee. 1 year warranty. Love it! $250.
• SHE Skin Care Range, cost less 20%.
• New model Coral Colours stand and stock, cost less 20%. Will separate. Free stock postage.

• 1 x Box Gopten 1mg, Exp 06/13   20% off list
• 1 x Livial, Exp 04/12  15%
• 1 x Toprol XL 190, Exp 09/12  20%

• 9 x Relenza 5mg, Exp 02/12, cost price $36.49 sale price $27.53

• 1 x Cozaar 50mg, Exp 05/12
• 1 x Lamictal 200mg, Exp 05/12
• 1 x Lamictal 50mg, Exp 10/12
• 1 x Cyprostat 50mg, Exp 11/12

• Tripod
• Flash (2)
• Timer

Ellie Harvison, Dispensary Manager
Charnwood Capital Chemist, ACT

I became a pharmacy professional because…
It has good opportunities, flexibility and
I can help the community
My friends say that I am… Loud, crazy, fun
My favourite Skin Care: Brand is… Dr Lewinn’s
My favourite Hair Care Brand is… Joyco
My favourite Gadget Brand is… Apple – iPhone
My favourite movie is… Arthur
My favourite hobby is…Reading, walking my dog with my Dad
My best getaway ever… Fiji!
I can’t live without… .chocolate, money, family, friends
A celebrity that I would invite to dinner… Enrique Iglesias

How Service & Range Can Make the Difference

By Simon Hambrecht, Director, Pharmacy Essentials

Service – the one thing an online retailer is unable to provide a customer and an important way for you to differentiate your business from them. This in conjunction with product ranging is the starting point for you to compete effectively.Time and time again I hear pharmacy teams say “we deliver on service”. The truth is they do offer service, but is it the best in their area? Have a look at the businesses renowned for their service standards and what they do to achieve it.

Retailers such as the Apple Stores, The Disney Corporation and locally retailers such as JB Hi-Fi are leaders when it comes to service standards.

What sets these businesses apart is they make their team accessible to the consumer. There are no counters to hide behind – everyone is on the sales floor– and in Apples case they even have an extreme ratio of one service person to every 10 customers. I have seen up to 40 team members on the floorserving customers at any one time in my local Apple Store ensuring the company standard is met.

It isn’t only availability that sets these businesses apart. The level of product knowledge their teams offer is exceptional. You achieve this by making a conscience decision to invest in your team making it clear you encourage them to invest in themselves. The by-product of this is an increase in the level of morale among the team.

Finally, what sets these businesses apart is the product they have available for sale. These products are available through online retailers however it’s the addition of service and product knowledge that create an emotional attachment or experience for the customer – something else you are unable to achieve online.

How can this be applied to our industry? For starters we have the challenge of changing the mind set of your team so they are more sales orientated and away from the counters. Make them available on the sales floorand actively integrating with the customers.

Invest in the team and train them as much as possible in all facets of your business. The more knowledge they have with your range the more they are able to achieve the add-on sale (remember, it is rare there is only one product to solve a customer’s problem). Online retailers are unable to offer this level of service and quite often rely on the customer to have completed some research as to what they require. A well trained sales assistant is far more effective in driving additional sales than an online equivalent.

When it comes to ranging products within your business, you shouldn’t be afraid to carry the same as what is available online. Where it’s possible though you should look to incorporate some points of difference and include product ranges in your offer which are unique to your business to help set it apart.The Team at Pharmacy Essentials always looks to achieve the ultimate service experience and we have proven strategies to ensure we achieve it.

With the flexibilitywe offer our members we can ensure we create the necessary points of difference in product ranging to not only differentiate ourselves to the online retailer, but all the businesses competitors.

In the next edition we will look at how to create loyalty within your customer base and retain them through the use of various tools.

CHOLESTEROL facts and figures

by Jo AndrewsB.Sc Chemical Engineering, BHlthSc(ComplMed), Adv Dip Naturophathy,Senior Lecturer of Australasian College of Natural Therapies

Cholesterol is an essential compound in our body. It is a building block for a number of critical products, without which we would not survive. So much attention has been paid to this special compound  that it can be confusing to sort out whether it is ‘good’ or ‘bad’, if we need to remove it from our diet entirely, or whether we need to prevent our body from making too much of it.

Ch olesterol in our body – the usefulness

Our cell membranes req uire cholesterol as part of their structure to modulate flexibilityand permeability, in order to control the movement of certain substances in to and out of our cells. In specificorgans in our bodies, we derive steroid hormones from cholesterol which have many different functions including:

• Mineralocorticoids – regulating sodium and potassium levels and subsequent blood pressure

• Glucocorticoids – regulating metabolism and resistance to stress

• Sex hormones – progesterone, testosterone and oestrogen

Cholesterol is also used to produce a chemical that is converted with sunlight to vitamin D in our skins, as well as to produce bile acids which act as powerful detergents in our intestine to emulsify dietary fats and enable digestion.

Chol esterol in our food – the amount of it

In most of us, our livers produce about 1 gram of cholesterol per day, which is about 80% of that required for use within our body. The remainder will be provided by the food that we eat. Only animal foods contain cholesterol, certain of which are particularly rich sources like liver and other organ meats, e ggs and seafood. To maintain dietary cholesterol intakes below 200mg per day would be a good target for most people. An egg contains just over this amount, so eating one per day, would not be detrimental. Phytosterols found in plant cell membranes are chemically similar to cholesterol, and compete with cholesterol for uptake in the small intestine. They are however, not recognised by the liver as cholesterol, andare subsequently excreted. In this way, certain foods like oats have the dramatic effect of decreasing blood levels. Bile salts, derived from cholesterol, are also removed from the digestive system by undigested plant fibreand are then excreted instead of being reabsorbed. This also lowers blood cholesterol levels, a further benefitof high fibre diets.

Cholester ol in our blood – the ‘good’ and the ‘bad’

As with other fats, cholesterol is insoluble in water. It must be transported from the liver to target tissues for storage or use, and this is carried out by plasma lipoproteins. These are large, complex molecules, spherical in shape. Special carrier proteins which are compatible with water are assembled around the outside, with cholesterol and other fat molecules contained within the core. Different combinations of proteins and lipids produce lipoproteins of differing densities, each having a well-definedrole to play in our blood. The largest are chylomicrons, assembled in the small intestine cells to carry dietary fats. When the diet contains more fatty acids than that required immediately for fuel, the liver packages the excess into very-low density particles (VLDLs), which are shipped off to fat tissue for storage or muscle tissue for fuel.  As these VLDLs move through the blood stream, they are stripped of their fatty acids mainly, and will eventually become low-density lipoproteins (LDLs). These particles are very rich in cholesterol and hence have been named the ‘bad’ cholesterol, as raised LDL cholesterol increases the risk of heart disease. High-density lipoproteins (HDL) are made in the liver and intestine as small, protein-rich particles, which initially contain very little cholesterol. As they move through the bloodstream, they pick up cholesterol molecules from chylomicron and LDL remnants, from artery walls and from storage in certain other tissues. The HDLs carry out ‘reverse cholesterol transport’ and arrive at the liver, where some cholesterol will be converted to bile and excreted. HDLs have therefore been labeled  ‘good’ cholesterol, or ‘H for Healthy’.  High HDL/LDL ratios are desirable to protect against heart disease and stroke.

Cholesterol – the effect on our health

Blood lipid profilescan alert people to possible cardiovascular disease risks, and serve as a warning that it is time to make some dietary and lifestyle changes. Cholesterol accumulating in the arteries will restrict blood flw and increase blood pressure. This would suggest that reducing dietary cholesterol is urgent. More importantly, it would be better to focus on reducing dietary amounts of saturated and trans fats. Triglycerides alone are considered an important independent predictor of cardiovascular disease. Animal foods are the main sources of saturated fats, and trans fats are most commonly found in deep-fried foods and hydrogenated margarines. Some people with elevated blood cholesterol have familial hypercholesterolaemia which is a genetic disorder and has no cure.

Treatment for high blood cholesterol levels

Treatment is aimed at reducing the risk of cardiovascular disease, heart attacks and strokes:

• Dietary recommendations are initially the main focus

o reduce saturated and trans fat and cholesterol intakes

o increase fibe and phytosterol intake

o lose weight by watching energy intakes

o reduce alcohol intake

• Lifestyle recommendations include

o exercising for weight loss and heart health

o stopping smoking to reduce damage to artery walls

• Supplementationo nicotinic acid or niacin – reduce cholesterol levels but high doses may cause cutaneous flushing

o Garlic – protects against lipid oxidation

o Essential fatty-acids – omega-3 fish oils lwer blood triglyceride concentrations

o Coenzyme Q10 – which is not produced in the liver when medicated with statins

o Folic acid – to reduce homocysteine levels which are associated with CVD risk

BLOOD LIPIDS AND CHOLESTEROL

The blood lipid profile is a routine test todetermine the concentrations of various lipids in the blood plasma.  The Heart Foundation of Australia recommends the following target blood lipid profile:

• Total cholesterol < 4mmol/L

• LDL-cholesterol <2.5mmol/L  (or <2.0 for high-risk patients with existing CVD)

• HDL –cholesterol > 1mmol/L

• Triglycerides < 1.5mmol/L

• Dyslipidaemia is the term used for abnormal amounts of lipids (cholesterol or others) in the blood

• Hyperlipidaemia is the term used for abnormally elevated levels of any or all lipids in the blood

• Hypercholesterolaemia is the term used for abnormally elevated  cholesterol levels in the blood

PHARMACOLOGICAL TREATMENT OF DYSLIPIDAEMIA

• Statins  – inhibit the enzyme HMG-CoA reductase – one of the fist enzymes used biochemically in the liver to produce cholesterol . This drug can reduce LDL-C cholesterol by 30-50%.

o Adverse effects include reduction in Coenzyme Q10 levels, elevated liver enzymes and muscular problems.

• Bile acid sequestrants – bind components of bile and prevent reabsorption in the small intestine. This drug can reduce LDL-C by 15-25%

o These drugs are not absorbed so adverse effects are limited to the digestive tract e.g. constipation, cramping and diarrhoea.

• Cholesterol absorption inhibitors – prevent absorption in the small intestine. These reduce LDL-C by 18%, but have no effect on HDL and triglycerides.

o These drugs are well tolerated, but can cause gastric disturbances

• Fibrates – these are usually used in combination with statins. They increase HDL levels and decrease triglyceride levels by effecting biochemical pathways in the body

• Combinations of certain of these drugs can also be prescribed

References:

Nelson, D.L. and Cox, M.M.  2008. Lehninger  Principles of Biochemistry.  5th Edition, Freeman, New York. Sarris, J. And Wardle, J. 2010. Clinical Naturopathy: An evidence-based guide to practice. Elsevier, Sydney. Whitney, E. , Rolfes, S.R., Crowe, T. Cameron-Smithy, D. And Walsh.

Diabetes Management – An Ongoing Opportunity for Pharmacy

byAnthony Tassone, B.Pharm (Hons), Cert IV (TAA), Dip Mgt, AACPA – National Professional Development Manager, Guild Pharmacy Academy – the Pharmacy Guild of Australia

With the allocation of $344 million under the 5th Community Pharmacy Agreement (5CPA) for the Pharmacy Practice Incentive (PPI) Program – the next few years provide an exciting opportunity for financialrecognition of participation in Professional Programs by Pharmacy.  One area of particular interest will be Diabetes, which as part of Primary Health Care forms one of the 6 Priority areas for the PPI Program (along with: Dose Administration Aids, Clinical Interventions, Staged Supply, Community Services Support and Working with others).

Eligible Pharmacies who are Quality Care accredited and have registered to provide PPIs will be able to participate in the program.

Participating in Diabetes as a Primary Health Care element would attract great demand for Community Pharmacies with 275 Australians thought to develop or be diagnosed with Diabetes every day. Diabetes is also believed to be Australia’s fastest growing chronic disease with up to 60% of cases of Type 2 diabetes being preventable (1).With over 90% of Access Points (formerly known as ‘Sub-Agents’) being Pharmacies under the National Diabetes Services Scheme (NDSS), there will be great demand for the expertise and resources of Pharmacies in the future.

Diabetes forms one of the 5 elements of Primary Health Care, and through participation in this area – Pharmacies can further strengthen their role in management of Diabetes in the community.    As part of the Primary Health Care PPI – Pharmacies may choose to provide a Disease State Management and/or Screening and Risk Assessment service.

A Disease State Management service focuses on managing the health of patients suffering from chronic conditions that is patient centered, with the objective of reducing risk factors through: monitoring, counseling, education and enhancing consumer self-management.

A Screening and risk assessment service involves identifying individuals who are at a high relative or absolute risk of developing a health condition, for example Diabetes or who are currently undiagnosed.  This can occur through clinical testing, asking a series of questions and discussion of risk factors for a condition and using risk assessment tools. (2)

Whilst on face value this can be daunting for many Pharmacies being a perceived new area – it certainly isn’t a new area of Practice for many.  Using Diabetes as an example, many Pharmacies are conducting some if not all of the elements of Primary Health Care under the PPI program without realizing it.  There is no one standard procedure for achieving these elements of Primary Health Care for Diabetes, but thankfully, there is a set of standards and resources to guide the process as part of the Quality Care Pharmacy Program.

To help achieve the Screening and Risk assessment, examples that are already occurring in Pharmacies are the use of the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) – a self-assessment developed by the Baker IDI Heart and Diabetes institute for Patients available in both a pamphlet and an online interactive survey tool to help identify individuals who may suffer from Type 2 diabetes.  It is a readily available resource that would be valuable for Pharmacies to assist with having a structure to asking questions about possible risk for a condition.

As part of Disease State Management a Pharmacy may choose to provide an ongoing monitoring service, by either downloading test results from a Patient’s Glucose Monitoring device to help report it back to their Medical Practitioner.   An example is the Accu-Check® 360 Structured Self Monitoring Blood glucose (SMBG) service.  The Structured Testing Protocol (STeP) study showed that appropriate use of structured SMBG significanty improves glycemic control and facilitates more timely/aggressive treatment changes in noninsulin-treated type 2 diabetes without decreasing general well-being.

To assist with enhancing self-management, Pharmacies could provide services that assist with Medication Compliance, such as a Patient Medication Profileand also through in-house counselling and education sessions that help improve a Patient’s understanding of the use, dosage and possible side effects of a medicine.  This can also form part of a more formal Medicines Review (e.g. Home Medicines Review).  Support from Pharmacy staff in demonstrating Blood Glucose monitors is essential for not only newly diagnosed Diabetes patients, but long term sufferers.  There may be perceived barriers to monitoring including; cost, time and convenience or pain associated with taking a sample. The large number of and varieties of monitoring devices on the market help make the task of recommending a monitor for a particular patient much more flexile than it has in years gone by.

What is important is to ensure that staff are adequately trained to provide any service or part of the program, and adequate documentation is in place. The Guild Care suite of programs is one example of a recording method to keep records of appointments or discussions with patients – or referrals to another Health Professional.  Pharmacies may choose an alternative or their own manual system for achieving this.

The PPIs not only represent an opportunity for Pharmacies to be remunerated for services that in large are already being provided to a degree, but to also help form closer relationships with other Health Professionals. . Both Australian and international studies have shown the benefitsthat pharmacists can provide in direct patient care and better medication management . This research has also shown General practitioners are more likely to accept a Pharmacist’s recommendation if they have personal contact with them, rather than only receiving written recommendations. (3)

Although it can feel like our industry is changing at break-neck speed, the opportunities for building good-will, professional recognition and personal satisfaction are enormous.  As champion race driver Mario Andretti once said ‘If everything seems under control, you’re not going fast enough.”

References

Diabetes Care, Volume 34, February 2011Campbell. R Am J Health-Syst Pharm – Vol 59 Dec 1, 2002 Suppl 9 Role of the pharmacist in diabetes management Rigby. D Aust Prescr 2010:33:191-3 – Collaboration be-tween doctors and pharmacists in the community.

Please visit www.mycpd.org.au to answers questions related to this CDP Accreditation (CODE G201027) . Click on the ‘myCPD’ log in button to access your account and assessment (or myCPD register here) if you don’t have an account.

This activity has been accredited for 0.35 hours (0.7 Group 2 CPD credits) upon successful completion of assessment. These credits are suitable for inclusion on an individual pharmacist’s CPD plan.This CPD activity addresses the following competencies: 1.2.2, 2.3.1, 3.1.3, 6.1, 6.3

NDSS – National Diabetes Services Scheme

by Diabetes Australia

Pharmacies play an important role in delivering the National Diabetes Services Scheme (NDSS) to people with diabetes. There are nearly 4,000 NDSS outlets, known as ‘Access Points’, across Australia. The majority of these NDSS outlets are community pharmacies.

Access Points help to deliver NDSS products to people with diabetes who are registered on the NDSS. There are currently over 1,000,000 people registered on the NDSS and over 60% have been supplied with NDSS products over the past year.

The role of pharmacies extends beyond simply providing NDSS products; they also assist in the collection of important statistical information for the NDSS and in the provision of key services to those registered on the NDSS.

Every time a person with diabetes purchases products through the NDSS, information is entered into the NDSS database (NDSS Connect) which in turn provides important data and statistical information for governments, health professionals and researchers.  Through ensuring information is entered accurately, and that the contact details of the person for whom the products are purchased are correct, pharmacies assist in maintaining the accuracy of the NDSS database and in turn the accuracy of data and statistical information extracted from the database.

Pharmacies also distribute NDSS materials and link those registered on the NDSS to health professionals and important NDSS self-management support services provided by their local diabetes organisation (known as NDSS Agents). Pharmacies can refer people with diabetes to the NDSS helpline 1300 136 588 to access a range of services offered by their NDSS Agent including:

• Information and support over the telephone;

• Diabetes fact sheets and a wide range of materials including general diabetes information, information specificto diabetes type and information specificto particular population groups such as Aboriginal and Torres Strait Islanders and  people from culturally and linguistically diverse backgrounds; and

• Individual and group diabetes management services.

People with diabetes can also be referred to the NDSS website ndss.com.au and the website of their local NDSS Agent.

Clinical Refresher – Croup

By Anthony Tassone, B.Pharm (Hons), Cert IV (TAA), Dip Mgt, AACPA – National Professional Development Manager, Guild Pharmacy Academy – the Pharmacy Guild of Australia

In the Community Respiratory illnesses such as Croup and Asthma are a common presentation for Community Pharmacists during the Winter period.  What can be challenging for Pharmacists is differentiating between different presenting symptoms and discerning when to refer a patient.

Croup is a community acquired infection resulting in inflammation of the larynx, bronchi and trachea.

It is most common in children aged 6 months to 3 years, although it can be seen in children up to 15 years old and occasionally in adults. It is more commonly seen in boys. The peak age for viral causes of croup is 2 years^{. (2)} In children, it is generally mild enough to allow for outpatient treatment, but less common forms seen in adults can require hospitalization.

Aetiology of Croup

Croup may have both viral and bacterial causes.  Bacterial causes may be from; Mycoplasma pneumonia, Corynebacterium  diptheriae, or Streptococcus pneumonia^{. (3)} Viral causes are most often responsible for Pediatric croup and s also known as ‘laryngotracheobronchitis. Parainfleunzacauses more than 66% of cases of croup, with occasional outbreaks of influenza A and B being considered a cause^{. (4)} Whilst croup resulting from influenza A is less common, it is considered more severe than that resulting from parainfluenza. Other viruses that may cause croup include; adenovirus and rhinovirus amongst others. ⁽⁴⁾

The way that individuals transmit croup is via; direct inhalation, contamination of hands following touching of nose, eyes and mouth. ⁽⁴⁾

Symptoms of Croup

Patients generally experience an incubation period of 2-6 days, with a prodromal period of 2-4 days which consists mainly of: runny nose, low grade fever and a mild cough – resembling a common cold. ⁽¹⁾ As it progresses, there is secretion of exudate and inflammation resulting in a distinctive cough. ⁽¹⁾ The cough is described as a harsh barking sound resembling that of a seal and may produce hoarseness from swelling of the vocal cords. ⁽²⁾ It often worsens at night.

Another variant known as ‘spasmodic croup’ less commonly presents with the prodromal symptoms and fever, but will still have the barking cough and stridor.

Differential Diagnosis

A characteristic sign of croup is stridor, which is a loud breathing sound cause by turbulent airflow through coarse lung rhonchi arising from obstruction.

Pharmacists should be wary that any stridor that presents in a patient could be croup-related and referral is recommended. ⁽¹⁾ Other causes of stridor can include; epiglottis (a serious condition that has stridor but without the barking cough, has abrupt onset of high fever, dysphagia, drooling and protrusion of the tongue – not seen in Croup) or foreign body insertion.  All of which require referral. ⁽¹⁾

Many people think of asthma only when there’s wheezing – but asthma can present with symptoms including; feeling short of breath, coughing, chest tightness and pain.

Cough associated with croup resembles a bark and is much more severe at night, whereas cough from asthma may not present as suddenly and be more spread throughout the day.

Asthma may or may not be proceeded by a common cold – but also can be triggered by; allergens, cigarette smoke, exercise or physical activity. A cough at night can be a sign of worsening asthma.

Any form of significant and unresolved coughing, especially at night, should be referred.

Other reasons for referral include signs of poor oxygenation (lips turning blue or fingernails are blue), evident trouble breathing and obvious fatigue from trouble breathing.

Treatment of Croup

Most children with mild forms of croup appear normal and may not need active treatment.   Increasing moisture (e.g. steamy bathroom or inhaled vapor) with adequate hydration may be sufficient ⁽¹⁾ Corticosteroid therapy, oral prednisolone 1mg/kg is often effective to reverse the stridor, sometimes within 6 hours. ⁽¹⁾

Corticosteroids have been found to reduce symptoms, readmissions to hospital departments and shorten hospital stays.Croup of bacterial origin requires appropriate anti-biotic therapy.

Stridor at rest generally requires referral to a hospital until it has halted. ⁽¹⁾

For CPD Credits please visit www.mycpd.org.au where you will find all questions related to Croup Assessment – Acreditation CODE G201027.  Click on the ‘myCPD’ log in button to access your account and assessment (or myCPD register here) if you don’t have an account.

References

Pray. W (2006) Croup and its treatment: US Pharmacist 2006 31(7)Knutson D, Aring A. Viral croup. Am Fam Physician. 2004;69:535-540.Ausejo M. Saenz A, Pham B Kellner JD et al. The effectiveness in treating croup: meta-analysis BMJ: 1999;319:595-600Nakayama JM, Tokeshai J. A case report of adult croup: a new old problem. HawaiiMed J. 2005;64:246-247.Leung AK, Kellner JD, Johnson DW. Viral croup: a current perspective. J Pediatr Health Care. 2004;18:297-301Khater F, Moorman JP. Complications of influenza South Med J. 2003;96:740-743.Fitzgerald DA, Kilham HA. Croup: assessment and evidence-based management. Med J Aust. 2003;179:372-377.Chung. Y (2006) – Is it Asthma?: Children’s Memorial Hospital website: www.childrensmemorial.org/expertsSelf Care Card: Asthma, PSA (2010) – Chronic Conditions 0073

Accreditation Code: G/2012024.

This activity has been accredited for 0.35 hours and 0.75 Group 2 CPD credits upon successful completion of assessment. These credits are suitable for inclusion on an individual pharmacist’s CPD plan.This CPD activity addresses the following competencies: • Standard 4.2 Consider the appropriateness of prescribed medicines• Standard 6.1 Assess primary health care needs• Standard 6.2 Deliver primary health care• Standard 7.1 Contribute to therapeutic decision making• Standard 7.2 Provide ongoing medication management• Element 7.1.3 Initiate monitoring and intervention.