Public campaign messages should be modified so people are better informed about the actual level of protection they are achieving with sunscreen. Widespread sunscreen use in babies under six months is generally not recommended because of their skin sensitivity. When the UV Index is 3 and above, primary sun protection is recommended for babies under 12 months, including avoidance of direct sunlight, minimising time outside in the middle of the day, protective clothing and shade.
A small amount of sunscreen may be used occasionally on some parts of the skin, using suitable products for babies e. If reactions occur, they may present after single or repeated use.
Sometimes fragrance and alcohol cause minor stinging or irritation, but this is less likely with creams and milks formulated for sensitive skin. Patch testing could be trialled before more widespread use. Potential oestrogenic effects of some products e. Current sunscreens would need to be , times more potent to exert any hormonal effect. Also, newer ingredients have been formulated with a high molecular weight for decreased skin penetration. Sunscreens are regulated by the TGA to ensure safety and efficacy.
Some public health groups have questioned the safety of nanoparticulate-based sunscreens. There is a concern that it is absorbed systemically and causes cancer. Research into the safety of zinc oxide and titanium dioxide products found that, in the presence of UV light, in vitro nanoparticles NPs can damage cellular components, but there is no evidence that they penetrate skin, even compromised skin.
They remain on the skin surface and the outer layer of the stratum corneum, and do not reach significant concentrations in the systemic circulation. Australian research confirmed no evidence of skin penetration or toxicity with repeated application of zinc oxide-NP broad-spectrum sunscreen. On current evidence, the known benefits of NP-containing sunscreens clearly outweigh potential minor risks. Artificial tans are safer than sunbathing and solarium use, but some individuals assume they protect against sunburn and UV damage.
Fake tanning procedures, e. Some sun exposure is necessary for production of vitamin D, but all sun exposure is associated with skin and eye damage and risk of skin cancer. Population studies have shown regular sunscreen use has little effect on vitamin D levels.
A few minutes of sun exposure rather than long periods may be more efficient at producing vitamin D, and daily exercise also helps. Supplementation may be considered for people at risk of vitamin D deficiency.
Pharmacists can provide accurate information on the appropriate use of sunscreens, and allay fears about suspected harms. The benefits of daily sunscreen use are clear in reducing UV damage, photo-ageing and skin cancers, including melanomas.
Recommendations start with appropriate sunscreen choice — one that has a high SPF of 30 or more, is broad spectrum and water resistant.
Sunscreen should be applied 20 minutes before going outside. Advice on the amount of sunscreen to apply is particularly important, as underuse is common. Inform patients that the benefits of a high SPF are only valid when sufficient quantities are applied and reapplied frequently.
Other sun protection measures should be implemented per public campaigns — protective clothing, shade, hat and sunglasses. Sun protection is important for patients taking photosensitising drugs or immunosuppressants and in those with photodermatoses or hyperpigmentation disorders.
If both a sunscreen and insect repellent are needed, a combination product is preferable to application of separate products that may reduce the efficacy of both. Reassure consumers that nanoparticles in sunscreens do not penetrate the skin to cause systemic harm, that fake tans are not protective, and that sunscreen has minimal effect on vitamin D absorption.
You advise Matt to apply a broad-spectrum, water-resistant sunscreen that is SPF30 or above in addition to other sun protection measures, regardless of the UV index, explaining cumulative UV radiation exposure to him.
Sunscreens are safe and effective in protecting the skin from UV damage. For best coverage, a broad-spectrum high SPF sunscreen applied according to directions will protect against sunburn, photo-ageing and skin cancer, including melanomas. Sunscreen users need to be aware of the actual benefit when the product is underused.
Humans have evolved structures and mechanisms to provide protection against harm from exogenous substances. Toxicity occurs when the dose of a pharmaceutical passes a point above which it causes adverse effects. The major toxicity from a given pharmaceutical is usually seen in only one or two target organs, which may not necessarily be the site of initial exposure or highest concentration.
This article focuses on poisoning by pharmaceuticals to provide specific information to pharmacists about substances they are likely to deal with in their usual practice.
In Australia, Poisons Information Centres PICs receive calls from the public and health professionals seeking advice about exposure to poisons. They are physically located in New South Wales, Queensland, Victoria and Western Australia, and use a referral system to provide a national hour service see Figure 1.
In Australian PICs received calls related to nearly , poisoning exposure events involving more than 1, different substances. Six of the 10 most frequent classes of substances reported to PICs in across all age groups were pharmaceuticals. These, along with the most common substance reported in each class, are listed in Table 1.
In , The circumstances of exposure varied across age groups see Table 2. The number of deaths 1, in the 12 months to 30 June associated with poisoning by pharmaceuticals in Australia is small compared to the number of calls received by PICs more than 16, Many of these deaths involved more than one of these substances. Consideration of the different circumstances and substances involved in pharmaceutical poisoning in different populations can help pharmacists provide tailored advice regarding safe use of medicines for individuals.
The treatments mentioned are intended as summaries of key points which may be of interest to pharmacists. The referenced source material should be consulted for details.
Medication errors, unintentional and deliberate self-poisoning. References: Huynh, et al, 3 Huynh, et al 5. Paracetamol is one of the most common drugs involved in poisoning worldwide, in part due to its perceived safety, widespread use and accessibility. At therapeutic doses, paracetamol is metabolised in the liver and generally eliminated without causing toxicity.
In overdose however, the relative contribution of a usually minor CYP1A2 pathway increases, where paracetamol is oxidised to the electrophilic N -acetyl- p -benzoquinone imine NAPQI intermediate, which is then conjugated with glutathione and eliminated. Signs and symptoms of paracetamol poisoning include abdominal pain, nausea and vomiting from acute liver injury, kidney impairment and mild coagulopathy. In more severe cases, hypoglycaemia, severe coagulopathy, metabolic acidosis and hepatic encephalopathy from liver failure and death can occur.
All people with suspected acute intentional paracetamol poisoning or suspected ingestion of a toxic dose of paracetamol should be referred to hospital for assessment. The antidote acetylcysteine or N-acetylcysteine, NAC is effective when given promptly, preventing hepatotoxicity in most cases if given within 8 hours of an acute ingestion.
Serum paracetamol and serum ALT are measured to determine the need for and duration of treatment. Activated charcoal is sometimes given to remove unabsorbed solid-dose paracetamol after recent 2—4 hours ingestion of immediate-release formulations, or within 4 hours of ingestion of modified-release preparations. NSAIDs, particularly ibuprofen, are commonly associated with poisoning in children and adolescents.
Toxicity is a consequence of excessive inhibition of the COX-1 enzyme. Treatment is primarily observation and support for specific symptoms if they occur. Quetiapine is commonly involved in poisoning in adolescents and adults. Quetiapine is also prescribed off-label for other psychiatric conditions, such as treatment-resistant depression and generalised anxiety disorder, which are associated with an increased risk of intentional poisoning.
Quetiapine is an atypical antipsychotic, antagonising serotonin receptors and to a lesser extent dopaminergic, histaminic, muscarinic and peripheral alpha1-adrenoreceptors. In children, 25 mg may be toxic and doses greater than mg may be associated with severe toxicity. The toxic dose for modified-release quetiapine is not known.
Symptoms have delayed onset up to 12 hours, compared to up to 6 hours for immediate-release preparations and are prolonged up to 72 hours.
There is no specific antidote and treatment is supportive, as required, depending on the symptoms. Supportive care includes intubation, ventilation and intravenous fluid resuscitation. Activated charcoal is sometimes given to remove unabsorbed quetiapine after recent 2 hours ingestion of immediate-release formulations, or within 4 hours of ingestion of modified-release preparations.
Diazepam and temazepam are commonly associated with both intentional and unintentional self-poisoning in adolescents and adults, and are commonly involved in accidental and suicide poisoning deaths. When taken alone in overdose, usually only mild to moderate CNS and respiratory depression occurs, with a ceiling on the CNS effect despite increased exposure. Large overdoses may cause hypotension, bradycardia and hypothermia. The toxic dose varies widely due to tolerance.
Acute doses of 1—4 times the maximum daily dose may cause significant CNS depression in benzodiazepine-naive patients, whereas dependent patients may have few adverse effects with 10—50 times the daily dose. Treatment is usually supportive, including airway protection, intubation and ventilation if required. Decontamination with activated charcoal is not indicated because of the rapid onset of sedation in poisoning.
The antidote flumazenil is not commonly used as it can precipitate withdrawal in dependent people, cause seizures and unmask arrhythmias.
Treatment of toxicity from co-ingested substances is also important. Antidepressants are commonly associated with intentional and unintentional poisoning. SSRI poisoning is usually benign, sometimes with nausea, vomiting and drowsiness. Acute doses greater than mg of escitalopram or mg of citalopram are associated with QT interval prolongation.
Treatment is supportive, with specific treatment for hypotension, serotonergic toxidrome and arrhythmias if they occur. Cardiovascular agents are a large group of medicines with a wide range of mechanisms of action and toxicity. The most commonly reported cardiovascular agents involved in poisoning are beta-blockers; the most common among these is metoprolol.
Different beta-blockers have different toxicities, and metoprolol is considered relatively less toxic than propranolol and sotalol. The effects of beta-blocker poisoning are related to their action on beta-receptors, including bradycardia, hypotension, heart block, bronchospasm and hypo- or hyperglycaemia. Ingestion of more than 2 g of propranolol is associated with seizures, delirium and coma due to its lipophilicity.
Treatment of beta-blocker poisoning may require intubation and ventilation, especially if cardiac function is unstable or consciousness is reduced. Opioids, mainly heroin and methadone, are the most common cause of unintentional drug-related death in Australia, often in combination with other substances.
Poisoning causes respiratory and CNS depression by agonising mu2-receptors. Toxic effects are dose-dependent but vary widely due to tolerance. Long-acting opioids can cause delayed and prolonged toxicity. Treatment includes airway and breathing support and use of the antidote naloxone. Activated charcoal may be used within 2 hours if immediate-release formulations have been ingested or 6 hours where modified-release formulations are involved.
Pharmacists in many practice settings can respond to reports and questions about poisoning, especially by using and promoting the services of PICs. Pharmacists should promote the safe use of pharmaceuticals as a core part of their practice. Consideration should be given to populations, circumstances and specific medicines associated with increased risk of accidental and deliberate poisoning.
Pharmacists may use key aspects of pharmacy practice to reduce the risk of poisoning by pharmaceuticals, including 5 :. Pharmacists are the custodians of medicines and have an important role in ensuring their safe and appropriate use.
Knowledge of the substances and populations most likely to be associated with poisoning, either intentional or unintentional, can help to provide individualised information and support to minimise the risk of harms.
One of your regular patients, Angela, 43, comes to see you. She has just seen her doctor about some redness and cracking at the corners of her mouth, which has been present for 3—4 days. You are aware that Angela is taking iron supplements and also has coeliac disease. She is not taking any other medicines, has no other medical conditions, and is not pregnant or breastfeeding. Angular cheilitis is a common condition that presents as redness or maceration at the corners of the mouth.
Angular cheilitis often has an infectious cause. Infective organisms include Candida albican s, Staphylococcus aureus and Streptococcus. A number of factors may contribute to angular cheilitis, although it may also occur spontaneously see Box 1. This causes skin folds, which allows saliva to accumulate, leading to a constant moist environment and skin irritation from the saliva.
Angular cheilitis is common and affects both children and adults although it is more common in the elderly. Angular cheilitis is an inflammatory condition. It often presents as irritation, redness and skin maceration at the corners of the mouth, usually bilaterally. Angular cheilitis may last for several days or be an ongoing condition depending on the cause. The severity of pain with angular cheilitis can range from no pain to severe discomfort.
In the majority of cases, diagnosis is based on clinical examination and taking a patient history. Patients with angular cheilitis caused by Candida should also be assessed for oral candidiasis, as these two conditions may co-present. Symptoms of oral candidiasis include white patches in the mouth, redness, soreness, burning in the mouth and loss of taste.
Patients using dentures or other oral appliances are more likely to be colonised with Candida , while patients who regularly use face masks are more likely to have Staphylococcus aureus colonisation. Candida albicans , Staphylococcus aureus , herpes simplex. Most cases of angular cheilitis can be easily identified, however some cases may present similarly to other conditions. Patients should be referred when a definitive diagnosis cannot be made by the pharmacist, when the patient is unresponsive to treatment, or where a prescription medicine is indicated.
If a dental cause is suspected e. Treatment of angular cheilitis will depend on the cause. In many cases, it is a self-limiting condition and will resolve on its own; however, in other cases, prolonged treatment may be required. Topical azole antifungals are the recommended initial treatment for angular cheilitis with a fungal cause. Recommended treatments are 3 :. Topical clotrimazole and miconazole are generally well tolerated. If this combination is used, INR should be monitored and warfarin dose reduced where needed.
Treatment should then continue with a topical antifungal alone for 14 days after symptoms clear. Adverse effects associated with topical corticosteroids include folliculitis, skin atrophy, striae, depigmentation, acneiform eruptions, and infrequently allergic contact dermatitis. If Staphylococcus aureus infection is present, topical treatment with mupirocin applied to the corners of the mouth may be used.
Mupirocin cream is indicated for infected small skin lesions. The Australian Medicines Handbook recommends avoiding the use of topical sodium fusidate as its oral form is effective against methicillin-resistant Staphylococcus aureus MRSA. Using sodium fusidate topically can promote antimicrobial resistance. Infrequently, a rash, contact dermatitis, itch, burning or irritation may occur with its use.
Strategies to limit saliva coming into contact with the skin should be recommended. Using lip balms during the day and petroleum jelly or another barrier cream at night can protect the skin. Patients should use a new toothbrush once treatment has commenced for an infectious cause to avoid re-infection. The prognosis of angular cheilitis is usually positive. In most cases, the condition will respond to appropriate treatment.
However, recurrence is common if the underlying cause s are not identified and appropriately managed. Preventing further recurrences of angular cheilitis should focus on addressing and managing underlying or contributing factors e. Pharmacists can support patients with suspected or confirmed angular cheilitis by taking a thorough patient history. Based on these responses, pharmacists can advise patients on appropriate management and treatment, strategies to prevent recurrence, or refer for further medical review as required.
Supporting patients with potential underlying causes by ensuring adherence to medicines and supplements, and by providing lifestyle advice for chronic conditions, is also important. Angular cheilitis is a common condition that can occur in people of all ages, although it is most commonly seen in older people. It usually presents as redness and skin maceration at the corners of the mouth, and cracks, fissures, ulcers or blisters can develop.
A number of factors can increase the risk of developing angular cheilitis, including poor oral hygiene, poorly fitting dentures, nutritional deficiencies, other medical conditions and skin sensitivity. Management focuses on treating any infectious cause fungal or bacterial and addressing any underlying causes. Pharmacists should advise patients on available treatments and refer where required.
You advise that it must be used regularly to be effective, and continued for 2 weeks after the symptoms clear. She can also use a lip balm for her lips and corners of her mouth to protect from excess moisture. Angela mentions that the doctor has referred her for a blood test to check her iron and other blood levels. You advise her that nutritional deficiencies can increase the risk of developing angular cheilitis, and reinforce the importance of having the blood tests and seeing her doctor for the results afterwards.
Therapeutic Guidelines : Oral and Dental has information on the management of angular cheilitis: www. Frederick, 64, has type 2 diabetes and hypertension. He requests treatment for worsening reflux and mentions he has been drinking more lately.
You agree that alcohol can cause and worsen reflux symptoms, and you obtain his consent to ask a few questions about his alcohol use. Frederick tells you he drinks 2—4 cans of beer on most days and more on Friday nights. When you ask him how he feels about his alcohol use, he tells you it has increased more than he would like, especially during lockdown.
Alcohol is the drug most commonly used by Australians, with 1 in 4 Australians aged 14 or older drinking at harmful levels at least monthly. So what is alcohol dependence? There are various classification systems and terms used to define alcohol dependence.
Tolerance is defined as needing to drink a larger amount for the same effect, or the same amount having a lesser effect. Like all substance use disorders, alcohol dependence is frequently a chronic remitting and relapsing health condition, though often those with less severe disorders will resolve their alcohol dependence without formal help. Alcohol withdrawal severity can range from mild headache, anxiety, agitation, tremor, disturbed sleep, palpitations and sweating , to severe and potentially life threatening seizures, persistent vomiting, extreme agitation, autonomic instability, confusion, paranoia and delirium , making careful assessment and planning for withdrawal critical.
The onset of withdrawal symptoms can begin within 6—24 hours from the last drink, peaking after 2—3 days and subsiding after around 1 week. A score of 4 or more for men and 3 or more for women indicates risky drinking, with a higher score considered to indicate higher-risk drinking. To meet the criteria for ICD alcohol dependence, there are three broad features, which are usually evident over a period of at least 12 months; however, if alcohol use is continuous over at least 3 months, a diagnosis may be made.
The DSM-5 criterion for alcohol use disorder is the presence of at least two of the following symptoms occurring within a month period: craving; persistent desire to cut down; use in larger amounts than intended; use leading to a failure to fulfil role obligations; considerable time spent obtaining, using or recovering from alcohol; continued use despite persistent physical or psychological problems; or continued use despite alcohol exacerbating social or interpersonal problems.
To identify likely alcohol dependence in the pharmacy setting, there are a number of brief screening tools that have been validated against these diagnostic criteria. Scores of 4 or more in men and 3 or more in women are considered a positive screen for risky or hazardous use. This should trigger a review of recent alcohol use patterns to evaluate the likelihood of more severe dependence requiring medical assessment and management.
Where the three questions indicate hazardous use, using the full AUDIT may help determine the need for referral. There are good reasons for pharmacists to ask about alcohol use. We now know that alcohol use contributes to cancer, with greater consumption associated with greater risk.
For these reasons, the National Health and Medical Research Council guidelines now recommend drinking no more than 10 standard drinks a week, and no more than 4 standard drinks on any one occasion. Acute alcohol use can also increase availability of warfarin, risking haemorrhage, and enhance the effects of insulin, risking hypoglycaemia.
These are just a few examples of how alcohol can complicate management of a range of chronic conditions that make discussions on alcohol use in the pharmacy a key part of pharmacy practice. Long-term alcohol dependence can result in severe and persistent effects on cognition through direct effects on the brain e. Severe cases of thiamine deficiency can cause Wernicke—Korsakoff syndrome, which affects coordination, memory, and can cause psychoses. Liver dysfunction, including cirrhosis, is another common long-term effect of alcohol dependence.
A systematic review showed a more than fold risk for death from liver cirrhosis and mental disorders, a 7-fold risk for a fatal injury, and double the risk for cardiovascular and cancer deaths. Treatment for alcohol dependence often involves management of acute withdrawal symptoms in the short term and pharmacotherapies to support abstinence or reduced drinking in the longer term.
Often the first step in treating alcohol dependence is medically managed alcohol withdrawal. Alcohol withdrawal can be managed in a range of settings, with a careful clinical assessment required to determine the optimal setting. Many patients with mild to moderate alcohol withdrawal symptoms can be managed in an outpatient setting.
However, some patients will require inpatient management. This includes patients with a history of withdrawal seizures, severe symptoms of withdrawal delirium, and other substance-dependent or medical comorbidities that may complicate withdrawal management.
Benzodiazepines are the first-line treatment for alcohol withdrawal, and when commenced early can prevent severe complications, such as seizures and withdrawal delirium. For this reason, staged supply e. Staged supply is often used in combination with daily assessment of alcohol intoxication and withdrawal symptoms to mitigate risks.
Many services have their own policies and procedures for the management and treatment of alcohol withdrawal, including the use of the Alcohol Withdrawal Scale AWS and the Clinical Institute Withdrawal Assessment for Alcohol scale CIWA-Ar 27 to assess withdrawal symptoms, and a protocol for either fixed-dose benzodiazepines or symptom-triggered dosing. Other features of complex alcohol withdrawal include psychotic symptoms, agitation, delirium and dehydration. As long-term alcohol use often results in thiamine depletion, intravenous thiamine is often initiated at the same time — mg intravenously or intramuscularly daily for 3—5 days; the required dose is dependent on risk factors and symptoms; these will also determine the duration , with longer-term oral thiamine — mg daily also recommended.
Acamprosate and naltrexone can be used following acute withdrawal to support abstinence. Acamprosate and naltrexone reduce alcohol craving and disrupt the reward pathways. Disulfiram, an aversive medicine, causes flushing, nausea and vomiting when alcohol is consumed, by blocking aldehyde dehydrogenase. Disulfiram is used second-line in relapse prevention.
Disulfiram is commonly used with supervised administration, as the evidence for effectiveness outside supervised dosing is limited.
Where there is suspected nutritional deficiency, supplementation with multivitamins, zinc and magnesium may be considered.
In addition to pharmacological management, there are various important psychosocial aspects to consider. Individual psychological approaches such as CBT to address behavioural and thinking patterns that might contribute to ongoing alcohol use are effective, in addition to developing strategies to manage triggers and cravings. When talking to patients, one way to raise alcohol use is to discuss its relevance to the management of other chronic diseases.
For example, alcohol use can complicate the clinical outcomes for common conditions such as diabetes and cardiovascular disease. Brief interventions are appropriate for people with risky alcohol use, but are not effective or appropriate on their own for alcohol dependence. Motivational interviewing techniques can still play a role in supporting patients to make changes and follow up on referrals. Where you suspect a patient has developed tolerance and alcohol dependence, a referral for assessment and appropriate follow-up care is required.
Further information and a diagrammatic representation of this approach can be accessed at www. If patients want to seek resources themselves, www. This can enable patients to confidentially and anonymously seek advice, self-assessment, support and referral options, and to access online or telephone counselling.
Substance use, including alcohol dependence, carries an enormous stigma. Patients experience problematic alcohol use for an average of 18 years before seeking help. An individual interaction may not result in immediate change, yet the long-term and population-level effects of brief interventions are important. Pharmacists can play a crucial role by having regular conversations about alcohol use in a non-judgemental way and encouraging patients to access help sooner, reducing the potential severity of their dependence and health consequences.
Pharmacists can identify risky alcohol use and alcohol dependence, and facilitate patients to seek treatment. Discussing alcohol can be made relevant for patients in the context of common drug interactions, management of chronic conditions, broader health benefits of reducing alcohol, or in association with requests for non-prescription medicines.
Uncomplicated alcohol withdrawal can be managed in outpatient settings, and a range of pharmacotherapy options are available to support patients in maintaining abstinence following withdrawal treatment. You discuss that alcohol is probably contributing to his reflux and may also be complicating his diabetes management. Frederick recognises the potential benefits of decreased alcohol use and agrees to check in with you next week.
While substance abuse was a big issue for doctors, pharmacists in Victoria were experiencing frequent robberies, and DHAS suggested PSA establish its own targeted support service. So I put my hand up and said if anybody should do it, it should be PSA, because they represent all pharmacists.
I took the calls for the first 2 years. Similar outfits in the UK and US were just getting started. From 20 calls a year initially, PSS now handles about 10 calls a week and provides valuable, non-judgmental support to those in need. While PSS issues have changed over the years — bullying has become more prevalent, but there are fewer holdups — the service is just as relevant. I hope I have given back something to the profession I love.
This is witnessed by the use of community pharmacists as vaccinators during the present COVID pandemic. Action 4: Facilitate pharmacist prescribing within a collaborative care model. This will benefit pharmacists as well as the public and the government. He died in December aged A coal-face pharmacist who practices what she preaches. A pioneer. A community leader. Her pharmacy in Merimbula on the New South Wales south coast, which she co-owns with business partner Tania Dwyer, provides a wide range of professional services with a focus on personalised support and care.
During the —20 bushfires , the pharmacy remained open, supplying face masks, essential medicines and emergency support to the community, while Ms Badewitz-Dodd dealt with the threat of fire to her own home in nearby Tathra. From then producing a handbook for athletes, coaches and sport management staff was a logical progression and resulted in the first edition of Drugs in Sport in , she recalls. Ms Badewitz-Dodd and the other pharmacists in the group manage the ingredients and she additionally manages the brands for Australia, Canada and New Zealand.
The long hours took its toll on the young family the couple had children aged 2 and 4 at this point. And while she continued to raise their children, Mr Seeto and Mr Dodd went into partnership — until his tragic death in when he was hit by a car. Her advice for others is to be brave. The drive to empower pharmacists to practice to their scope of practice is a game changer for me professionally. Recognition that pharmacists can and do provide services to our community, such as vaccinations and administration of IM and SC medicines, is well overdue.
I am excited to see where this will take us. That is a difficult question as so many of the actions go hand in hand. But Action 4: Facilitate pharmacist prescribing within a collaborative care model has the most scope for our profession. For example with flu vaccinations, we already prescribe — we make the clinical judgment as to whether it is beneficial for a particular patient and then act accordingly.
Just 3 years out of university, Maria Berbecaru MPS made history by implementing an Australian-first aged care pharmacy service. She hopes her experience will inspire others and help make embedding pharmacists in aged care the norm. The first was assisting nursing staff during medicine administration rounds at a local residential aged care facility RACF , where she answered questions about the crushability of medicines and the correct administration techniques of eye preparations and inhalers.
A few months later, Ms Berbecaru shadowed the visiting consultant pharmacist who conducted medication reviews at the RACF, helping with patient interviews and sitting in on discussions about drug-related problems with the pharmacist and local GP.
Finishing her internship, Ms Berbecaru began working at Lindisfarne Amcal Pharmacy in Hobart and gained her accreditation.
The service began in a single RACF in January and expanded to a second location this year, providing care to approximately residents. Although there have been similar models trialled in Australia, most have relied on dedicated grants. She also does 3-monthly psychotropic reviews , which have had a measurable impact.
Pharmacists are the 'cogs' of the healthcare machine. While most interns were focused on simply surviving their first year of practice during a pandemic, Erin Cooper MPS found time to give back to her peers.
People were coming [into the pharmacy] wanting masks and Ventolin , and we could only have one of the doors open because there was so much smoke coming in.
And then came the pandemic. The Wanniassa pharmacy team was split into two groups to reduce the risk of infection, and Ms Cooper ended up on the opposite side to her preceptor. While finding her feet during the first half of her internship, Ms Cooper was also responsible for leading her peers through a time of great uncertainty as NAPSA President.
On top of this, they needed to start thinking about life after university. Before getting her internship in Wanniassa, Ms Cooper tried to gather as much information as possible, but found it hard to keep track of all the different requirements. In a bid to help others, and inspired by a previous NAPSA publication, she decided to create a guide to internships for the graduating class of I found it really difficult.
With the pressure of her intern year now behind her, Ms Cooper is currently enjoying life as a community pharmacist and the relationships she has developed with patients. It also leaves her with enough time to indulge in another passion — teaching ballet. I know this varies state by state, but at the beginning of my intern year pharmacists in the ACT could only administer vaccines for whooping cough and the flu to those over 16 years.
This is reflected through our ever-expanding scope of practice allowing us to provide services not previously available in the pharmacy. It is debatable as to who gets the credit for bringing the key ingredient of syrup of ipecac from Brazil to Paris centuries ago.
Did Piso, a Dutch physician, first bring a quantity of the dried root ipecacuanha — known as ipecac — in ? Or was it a traveller named Legros in ? Regardless, sources agree that in a physician named Helvetius — himself of dubious credentials — used the root in a medicine for dysentery. Impressed, the French government bought the formula and made it public in Use of ipecac soared in the 19th century thanks to English physician and privateer Thomas Dover.
Used to treat dysentery and fever, it was available in Britain until the s and in India until as recently as By the 20th century, chemists were using alcohol to extract the alkaloids cephaeline and emetine methylcephaeline from ipecac root. We may request cookies to be set on your device. We use cookies to let us know when you visit our websites, how you interact with us, to enrich your user experience, and to customize your relationship with our website.
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