IRISH PHARMACY NEWS - ISSUE 1 - 2012

IPN • January 2012 1January 2012

Volume 1 Issue 39

Shortlisted BUSINESS TO BUSINESS MAGAZINE OF THE YEAR 2009

THE INDEPENDENT VOICE OF PHARMACY

In this issue:

NEWS: PSI appoints Risk Review Group page 5

PROFILE: Denis Walsh, Community Pharmacist in Co. Galway gives an honest reflection on the business of community pharmacy page 9

REPORT: IPHA Annual Conference: Bringing the Best to Healthcare Through Partnership and Innovation Page 14

DEBATE: Advertising and promoting medicines in pharmacy: a transparent business practice or a dangerous enterprise? Page 18

FEATURE: Dr. Fenton Howell discusses Smoking Cessation as the New Year’s resolutions draw in Page 20

CPD: Continuing Professional Development focus on Warfarin Page 31

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Make sure to stock the new Lynx excite range,

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IPN • January 2012 3

Effective collaboration leads to improved health outcomes and congratulations go to Kinsale PCT, who won an award for demonstrating that ‘Learning to Work Together’ and collaboration, in their case between other healthcare professionals, encouraged integrated patient care and enhanced teamwork.

This is how all pharmacies should operate – by co-operation between each and every member of staff, and not forgetting the patients and customers.

Enhanced teamwork, together with patient care are two essentials in operating a professional – and successful - pharmacy and this is why Irish Pharmacy News has decided to recognise some of the leaders in this field – those who go that extra mile but whose light might possibly not shine quite so brightly without the efficient back-up of professional team work.

Merit within pharmacy frequently goes unrewarded – but not in 2012.

In May of this year, IPN is holding its inaugural Irish Pharmacy Awards in Dublin. The categories range from such standards as Pharmacist of the Year and/or Pharmacy Assistant of the Year to Hospital Pharmacist of the Year, the details of which can be found on page 35. Of course, such a prestigious event could not be held without sponsorship and the following companies have, so far decided which category they would like to sponsor. So grateful thanks go to all our sponsors.

But, there is one fly in the ointment… the awards’ ceremony cannot be held without the co-operation of IPN readers as the responsibility remains with them for nominating anyone who, they think goes that extra mile. Pharmacists, dispensary team members and counter assistants – even patients/customers - are urged to recognise the outstanding qualities in team members or anyone else you may know in pharmacy –you may even nominate yourselves, providing you think you have a valid reason.

Everyone within pharmacy, who provides help and support, in whichever way, to make patients feel that they receive the best possible care is a winner and there will be no shame in not winning first prize. Just to be nominated is sufficient prize in itself.

But, we need you to propose the best people possible. Please read how to do this on page 35.

Thank you

PUBLISHERIPN Communications Ireland Ltd.Carmichael House, Lower Baggot Street, Dublin 2 00353 (01) 6024715

MANAGING DIRECTORNatalie Maginnis [email protected]

EDITORBridget Casey [email protected]

SUB EDITORKelly Jo [email protected]

EDITORIAL [email protected]

JOURNALISTSinead O'[email protected]

ACCOUNTS Lorraine Moore [email protected]

SALES MANAGERLisa [email protected]

ART DIRECTEDSmart Page Design

IRISH PHARMACY NEWS

EDITORBridget Casey

ForewordContents

Irish Pharmacy News is Circulated to all independent, multiple and hospital pharmacist, pre reg pharmacists, students pharmacy student’s offi cial bodies, government offi cials and departments, Pharmacy Managers, Manufactures, Wholesalers. Buyers of pharmacy groups and healthcare outlets. Circulation is free to all pharmacists Subscription rate

for Irish Pharmacy News 60euro plus vat per year

All rights reserved by Irish Pharmacy News. All material published in Irish Pharmacy News is copyright and no part of this magazine may be reproduced, stored in a retrieval system of transmitted in any form without written permission. Pharmacy Communication Ireland have taken every care in compiling the magazine to ensure that it is correct at the time of going to press, however the publishers assume no responsibility for any effects from omissions or errors.

4

9

35

14

4 PSI appoints Risk Review Group following fl u vaccine mistake

6 A toxic shock for cosmetics

9 IPN talks to Denis Walsh, Community Pharmacist in Co. Galway who gives an honest account of business in community pharmacy

14 Dutch Courage - IPN reveals what was discussed at the IPHA’s Annual meeting

18 The merits of the PSI’s advertising guidelines are discussed in this month’s debate

Regulars26 Feature – What’s special within the Specials market

31 Continuing Professional Development Series – Warfarin

35 Launch of the Irish Pharmacy Awards

58 Managing your Finance with our monthly updates

61 Product Profi les

62 Appointments

Make sure to stock the new Lynx excite range,

as seen on tV, outdoor, cineMa and onLine.

Lynx Excite Pharmacy trade.indd 1 16/03/2011 14:46

4 January 2012 • IPN

News

news briefAs clear as mud?Clarification has now been sought from the Health Service Executive’s regarding its position on the reimbursement of the drug, Pradaxa. Previously, pharmacists had been told that they would only be reimbursed for one month’s supply of the drug, when it is prescribed for those patients who have undergone elective hip or knee replacement surgery.

Deputy Brendan Ryan, TD, Dublin North, asked the Minister for Health in the Dáil whether he would protect those medical card-holders, who cannot be prescribed Warfarin from being subject to a charge for Pradaxa, if it is removed from medical card-holders and the drug payment scheme.

Róisín Shortall, Minister of State with responsibility for Primary Care, said that the HSE is assessing the availability of resources in 2012 to consider long-term treatment with Pradaxa capsules of 150gr for the prevention of stroke in patients with atrial fibrillation. She said, “This is a complicated process with long-term implications.” She also added that the HSE did not intend to disturb established therapeutic regimes for patients, whose treatment with Pradaxa for the prevention of stroke was initiated prior to the recent clarification.

A spokesperson for the HSE told Irish Pharmacy News that it has advised GPs, pharmacists and other prescribing clinicians that no new patients should be prescribed Pradaxa for atrial fibrillation until the current assessment is completed.

The HSE has stated that it is not currently seeking to change existing medication regimes for any patient and that those patients who have been prescribed Pradaxa for this purpose can continue to receive it. The Executive confirmed that pharmacists will be reimbursed as per the GMS scheme.

Darragh O’Loughlin, President of the Irish Pharmacy Union described the situation as being, 'a communications' mess' and he told The Irish Times that he understood the statement made by the HSE to mean that if a patient was commenced on the drug before November 9, it would be funded for them, ‘but only for a fixed, limited period of time’. O’Loughlin added, that where doctors prescribed the drug after November 10, “for anything other than post-surgery implications, they [HSE] are not going to fund it.”

In The Irish Times, O’Loughlin was critical of the HSE for, “Making up their policy about the medicine on the hoof.” He concluded that the HSE is simply, “Reacting to circumstances.”

The Pharmaceutical Society of Ireland has appointed a Risk Review Group to examine the error, which occurred last November when some pharmacies gave their patients an ineffective paediatric dose of the seasonal influenza vaccine.

The Risk Review Group will look at what can be learned from the error and it is expected to report to the PSI by the end of March/April. The findings of the group will ultimately be reported to the Minister for Health.

Professor Peter Wheedle, adjunct Professor of Pharmacy Practice at the School of Pharmacy in University College Cork and independent community pharmacist has been appointed to chair the investigation. Other members of the Group include Ms Mary Culliton, former Director of Advocacy with the Quality and Patient Safety Directorate of the HSE, Mr Stephen McMahon of the Irish Patients Association, Mr Raymond Anderson, former President of the Council of the Pharmaceutical Society of

PSI appoints Risk Review Group

Northern Ireland and current President of the Commonwealth Pharmacists Association, Ms Marie McConn, community pharmacist practitioner and former member of the PSI Council, Mr Tom McGuinn, former Chief Pharmacist of the Department of Health, Dr Brenda Corcoran, Consultant in Public Health Medicine in the HSE National Immunisation Office and a member of the National Immunisation Advisory Committee and Dr Kevin Connolly, member of the National Immunisation Advisory Committee, who is also a member of the Irish Medicines Board’s Advisory Committee on Human Medicines and is the Irish representative on the European Medicines Agency Paediatric Committee.

It is hoped that the investigation will go some way towards restoring the reputation of the profession.

Professor Peter Wheedle


There are many lessons Ireland can learn from the Dutch healthcare experience, delegates a the Irish Pharmaceutical Healthcare Association annual meeting were told. The theme of the Irish Pharmaceutical Healthcare Association's annual meeting was Bringing the Best to Healthcare Through Partnership and Innovation.

The IPHA's president and chief executive,

Lessons to be learned

News

news briefSmall increase inBoots' turnover in 2011

In the year ending March 31, 2011, Boots Ireland increased its turnover by 0.6 per cent to €267.2 million and made a pre-tax profit of €15.9 million from its pharmacies, compared to €11 million in 2010.

Boots Retail Ireland Ltd said that dispensing revenue increased ahead of the market but that retail revenue growth was depressed as difficult trading conditions continued.

The company paid an €11 million dividend to its parent company, down from the €85 million it paid in 2010. The €15.9 million pre-tax profit compared to profit of €11 million the previous year. Shareholders’ funds of €117.6 million were declared at the year end.

The total number of Boots' pharmacies in Ireland has now increased to 70, up from 58 in March 2011.

PSI to relocate

The Pharmaceutical Society of Ireland is currently seeking to relocate to new premises, which would be suitable to accommodate all its various activities, including holding fitness-to-practice enquiries.

The PSI has already put up for sale its present headquarters in the Shrewsbury Road.

RCSI win contract to deliver CPDA year after the PSI issued an invitation to institutions to establish an Institute of Pharmacy, a four-year contract has been issued to the Royal College of Surgeons, Ireland. The Institute of Pharmacy will oversee the management and delivery of Pharmacy for pharmacists in Ireland ‘in line with international best practice and evolving healthcare needs’.

The PSI and RCSI are in a three-month

implementation phase and will be making formal announcements of the details after this has been completed.

The PSI is also hoping to make details of the ‘National Forum’ available shortly. The ‘National Forum’ will oversee the development and ongoing delivery of the new integrated programme of pharmacy education, training and assessment for roll out in 2012/2013.

Peter Gallagher and Anne Nolan both felt that there were new grounds for optimism within Pharmacy and that innovation in thinking, practice and technology should help to drive value within the limited resources of the health services.

Turn to page 14 for further details and photos from the conference.

Sean Sherlock, T.D., Minister for Research and Innovation and Anne Nolan, IPHA Chief Executive


News

news briefThe legality of new advice on domperidoneAs a result of new safety information issued by McNeill Healthcare Ltd. regarding domperidone, the Pharmaceutical Society of Ireland has issued guidance to pharmacists on the safe supply of this drug.According to the guidance, domperidone-containing medicines should only be supplied by a registered pharmacist and all pharmacists are required to carry out a patient consultation before supplying the drug to a patient.

It has been known for some time that the domperidone is associated with certain cardiac risks, such as QTc prolongation and ventricular arrhythmias. However, only recently have epidemiological studies provided evidence that domperidone may be associated with an increased risk of serious ventricular arrhythmias or sudden cardiac death. Studies have also found that these risks may be higher in patients older than 60 years of age or in oral doses of more than 30mg a day.

McNeil Healthcare Ltd. advised that domperidone should be used at the lowest effective dose in adults and children and that the risk- benefit ratio remains positive.

There are currently four authorised medicinal products containing domperidone that are available in Ireland without prescription through pharmacies only. These include; Motilium 10mg film-coated tablets PA 823/51/2 MA holder McNeil Healthcare Ltd; Motilium Fastmelts 10mg Tablets PA823/51/1 MA holder McNeil Healthcare Ltd; Motilium 10mg film-coated tablets PPA465/272/1 PPA Holder PCO Manufacturing; and Domerid Relief 10mg Tablets PA711/46/2 MA Holder Rowex Ltd.

One pharmacist in Co. Cork said that he was not surprised that the PSI has issued new guidance on domperidone-containing medicines because of its potent content. He said, “I have taken all of the domperidone-containing medicines off the shelves and moved them in with the codeine containing medicines.”

Solicitor, Mark Ryan told IPN that he questioned whether it was appropriate for the PSI to have changed the medicinal status of domperidone from an OTC medicine to the new category of 'pharmacist prescribed' medicines.

He said, “If, indeed new information has come to light, which casts doubt as to the safety of a medicinal product that is available without prescription, one wonders whether it would not be more appropriate for its OTC status to be changed to prescription-only rather than create a new class of product, which is not recognised in Irish law.”

The HSE laboratory annual report for 2010 has revealed that out of 31 cosmetic product samples tested, 16 breached the statutory 0.2% formaldehyde limit and some had levels as high as 9.5%. Formaldehyde is carcinogenic and can cause cancer if applied to the skin or inhaled over a long period of time.

During the investigation some of the industries involved had questioned the official EU testing methodology, stating that the method itself was destructive and produced the free formaldehyde during the analysis. The safety assessments of the products were also challenged, with arguments being made that the products contained methylene glycol, and not formaldehyde.

The HSE said that to ensure that the official testing results were consistent, the laboratory organised an inter-lab trial of five of the products with the official Dutch cosmetics control laboratory (NL VWA). Overall, the results were concurred with the HSE's.

Hair straighteners were found to have excessive levels of formaldehyde whilst 260 samples (lipsticks, lip gloss, face-paints, mascaras and make-up sets etc.) were tested for Lead (Pb) and Cadmium (Cd).

As there are no specific limits set for

A toxic shock for cosmetics

Heavy Metals in the Cosmetics Directive or Regulations, a Lead (Pb) limit of 20mg/kg and a Cadmium (Cd) limit of 5mg/kg have been adopted as an interim measure for official control purposes. It was found that four components exceeding the Lead limit of 20 mg/kg. A total of 1020 components or sub-samples were tested and screened.

The HSE also reported that 17 counterfeit samples of branded cosmetics were received from Dublin airport Environmental Health Officers. One such product, a red lipgloss, contained 638mg/kg lead, and 14 were found to have labelling irregulations.

The HSE said that the situation was unusual in that Ireland appeared to be the first country in Europe to have encountered and dealt with the problem. The formaldehyde issue represents the first case of cosmetics safety being investigated jointly by the HSE, the Department of Health and the IMB.

Having read the report, Fine Gael Senator for Dublin South West, Cáit Keane, expressing her alarm, said, “The cosmetics industry is worth billions of euro a year and we must ensure that everyone is educated about the products they use. It is imperative that information regarding what is in each product is made clear on the packaging, so that people can make an educated choice about which products to use.”

1 260 samples (largely multi-component cosmetics sets) consisting of 1020 sub-components were screened for lead & cadmium2 Analysis out-contracted

Note: Samples are submitted by the HSE authorized officers (Environmental Health Officers) to monitor compliance with the cosmetics regulations. Non-complying samples are dealt with by the EHOs in conjunction with the IMB as appropriate.

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Nexazole: for the treatment of erosive reflux oesophagitisPrescribing Information for Nexazole 20 mg & 40 mg gastro – resistant capsules, hard. Qualitative and Quantitative Composition: Each capsule contains 20 mg or 40 mg of esomeprazole (as esomeprazole magnesium dihydrate). Pharmaceutical Form: Hard, gastro-resistant capsule: Slightly pink body and cap, containing white to almost white pellets. Therapeutic Indications: Treatment of erosive reflux oesophagitis. Prevention of relapse of healed oesophagitis in long-term management of patients. Symptomatic treatment of gastroesophageal reflux disease (GERD). Eradication of H. pylori concurrently given with appropriate antibiotic therapy for treatment of H.pylori-associated ulcers. Treatment of NSAID-associated gastric and duodenal ulcers in patients requiring continued NSAID-treatment. Prophylaxis of NSAID-associated gastric ulcers and duodenal ulcers in patients at risk requiring continued therapy. Prolonged treatment after i.v. induced prevention of rebleeding of peptic ulcers. Treatment of Zollinger Ellison Syndrome. Dosage and Method of Administration: Capsules should be swallowed whole with liquid. The capsules can be opened and the pellets mixed in half a glass of non-carbonated water or if desired this solution administered through a gastric – tube in patients with swallowing difficulties. The capsules and / or contents should not be chewed or crushed. Treatment of erosive reflux oesophagitis: 40 mg once daily for 4 weeks. Long-term management of patients with healed oesophagitis to prevent relapse: 20 mg once daily. Symptomatic treatment of gastroesophageal reflux disease: 20 mg once daily. Eradication of H. pylori for treatment of H.pylori-associated ulcers: 20 mg with 1 g amoxicillin + 500 mg clarithromycin, all twice daily for 7 days. NSAID associated gastric & duodenal ulcers: 20 mg once daily for 4 – 8 weeks. Prophylaxis treatment: 20 mg once daily. Prolonged treatment after i.v induced prevention of rebleeding of peptic ulcers: 40 mg once daily for 4 weeks. Zollinger Ellison Syndrome: Initial dose is 40 mg once daily. Dosage should be individually adjusted. Daily doses up to 160 mg have been used. If the required daily dose exceeds 80 mg, it should be divided and given twice daily. Severe liver impairment: Patients should not exceed a max. dose of 20 mg. Contraindications: Hypersensitivity to esomeprazole or to any of the excipients. Esomeprazole should not be administered with atazanavir. Pregnancy and breast-feeding due to insufficient data. Children under 12 years. Special warnings and precautions for use: The possibility of a malignant gastric tumour should be excluded as Nexazole may alleviate symptoms and delay diagnosis. Regularly monitor patients on long-term treatment. Patients on on-demand treatment should contact their physician if symptoms change in character. If esomeprazole is used in combination with antibiotics, then the instructions for the use of these antibiotics should also be followed. Treatment with esomeprazole may lead to slightly increased risk of gastrointestinal infections such as Salmonella and Campylobacter. Contains sucrose – Patients with rare hereditary problems of fructose intolerance, glucose – galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine. Drug Interactions: Esomeprazole can affect the absorption of ketoconazole and itracanazole. Dose reduction may be required when administered with drugs metabolised by CYP2C19 as esomeprazole may increase their plasma concentration. Monitor patients when given in combination with warfarin or other coumarine derivatives. Undesirable effects: Common: Headache, abdominal pain, constipation, diarrhoea, flatulence, nausea/vomiting. Shelf Life: 2 years. Marketing Authorisation Holder: Pinewood Laboratories Ltd., Ballymacarbry, Clonmel, Co. Tipperary. Marketing Authorisation Holder Number(s): PA 281/146/1-2. This medicine is a prescription only product. Further prescribing information is available on request. Date of revision of text: July 2010.

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For oral short term use only, take one capsule 3 times daily swallowed with water. Not recommended for children or adolescents under 18 years.Gastrointestinal symptoms (eg nausea, abdominal cramps) may occur after ingesting Valdrian (Valerian root). The frequency is not known.

Marketing Authorisation Holder Bio-Health Ltd. Culpeper Close, Medway City Estate, Rochester, Kent ME2 4HUt +44 (0)1634 290 115 f +44 (0)1634 290 761 e [email protected] w www.bio-health.co.ukMarketing Authorisation Number TR 1492/001/001 Category GSL

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The carboy is half full inCounty Galway

Pharmacist, Denis Walsh, owner of Walsh’s Pharmacies in County Galway, discusses the ups and downs of running community pharmacies.

Dairy and Food graduate – turned pharmacist, Denis Walsh opened his first pharmacy in the rural village of Spiddal, Co. Galway sixteen years ago. Since then, he has opened three more pharmacies - one in Loughrea, one in the Medical Centre in Spiddal and the other in the Orantown Centre in Oranmore.

Walsh opened a pharmacy in

Oranmore in 2003, just after the regulations regarding new openings were rescinded by the Minister for Health. This meant that Walsh did not have to demonstrate to the local health board that there was a need for a pharmacy in the area but, in hindsight, he thinks that lack of regulation on new openings is not such a good thing.

He said, “The Minister threw out all the old regulations with regards to the opening of new pharmacies and, in a way that was a bad decision. With no controls whatsoever, in some parts of the country, pharmacies began to cluster

on top of each other as everyone scrambled to be as close as possible to the local GP practice.

“The new regulations also made it easier for the big chains to open up wherever they wanted.”

Maintaining a glass half full attitude, however, Walsh added, “There should have been some kind of controls in place but this is what we have to live with.”

Walsh cannot see new regulations being introduced any time soon, though because of the EU/ECB/IMF

Profi le

Generic

substitution

and reference

pricing will

enable our

patients to avail

of cheaper

medications.

It will take

money out of

pharmacy

but the patient

will be getting a

much better

deal.


Profi le

views regarding competition in the pharmacy sector.

However, he did point out that the Minister can, and does, control the sector with his powers under the FEMPI Act and that with the FEMPI price cuts over the last three years very few pharmacists are in a position to open new pharmacies

“There can only be so many cuts before our service begins to be affected,” said Walsh.

Despite the cuts, Walsh commended the work that has been carried out by the Irish Pharmacy Union through these difficult times. He said, “The IPU has represented us well, given the circumstances. The introduction of the flu vaccine into pharmacy and the opportunity to provide emergency contraception has been a very positive development for the profession and I think that pharmacists could and should - be providing more services like this.”

However, Walsh is a realist

He said, “We are living in times where money is scarce. Whilst I think that offering more such services to patients would be a fantastic opportunity for the profession, the question remains, who would be paying for those services?"

Instead of waiting for change to happen within the pharmacy sector, Walsh has embarked on his own innovations and services.

He runs an extremely modern, efficient operation across his four pharmacies and he puts this down to the ten years he spent working for the Kerry Group as Production and later

as Operation Manager in the Dairies Division before he went on to study pharmacy in Brighton.

Walsh has invested in the latest technology for the pharmacies' website where for example existing patients can order prescriptions online. This service is offered on the basis that their patient’s repeat prescription is kept in the pharmacy and prescriptions are ready for collection within two hours generally.

Walsh said, “In every pharmacy, some patients will ring up the pharmacist and ask for their prescription to be made up in advance as they don’t like to queue. Our service is an extension of this, using the web. As society is increasingly moving towards online services, it makes sense for us to have a presence online.”

For Walsh, the pharmacy business is all about the patient. He said, “My vision is for Walsh’s Pharmacy to be the pharmacy of choice in the community. We have to be professional, accessible and efficient in what we do and offer exceptional customer service to benefit our patients.”

As well as offering his patients a high standard of health care, Walsh maintains a modern and bright front of shop so that his patients can feel comfortable and welcome in his pharmacy and, for those loyal customers he also runs a loyalty card scheme.

Loyalty card members are entitled to exclusive special offers based on a points' system and points may be claimed through his pharmacies' EPOS systems.

The loyalty card scheme also provides Walsh with different ways to contact customers. He said, “We email or text our patients and customers about offers that are ongoing in the pharmacy, which may be of interest to them. However, we do not contact all of our customers because some may not wish to be contacted.

Another service he offers his patients is Information Days

“I strive to do as many as I can throughout the year, although they do take a tremendous amount of time to organise.

"We carryout in store promotions on skincare and tastings for nutritional products and also held a Baby Care Day. Most suppliers are more than willing to come on board to support us on any promotions we organise.

"Although these information days and promotions do help, the reality of life is that people just have less money to spend now and are constantly looking for value.

“We continue to stock branded products but we have to cut our margins so that we can give our customers the value that they are looking for.”

With four pharmacies to his name, Walsh has a pretty large buying force behind him. But, he has had a look at some of the other offers available through other mainstream buying groups.

“There are a growing number of buying groups, which appear to be setting up on a fairly regular basis.

The IPU has

represented us

well given the

circumstances.

The introduction

of the fl u vaccine

into pharmacy

has been a

very positive

development for

the profession

and I think that

pharmacists

could be doing

more services like

this and be paid

for the services

that we offer.


Profi le

“We have looked at some of their offers and worked with some of these groups but I think a lot of them are finding it difficult to break into the market and to offer anything better than what is already available. It has become difficult for them to source products for a better price than we can.

“Buying groups will survive only if they can react quickly to what is happening in the market place and offer better value and services than at present. Maybe some of these groups should join up to improve their purchasing power.”

Walsh conceded that the large pharmacy chains, such as Boots and Doc Morris have made life in community pharmacy more difficult but he does not feel threatened by them.

“Independent community pharmacy simply has to do what it does better, in order to compete with the large chains," he said. “One of the main things that independent community pharmacy has going for it, like ours is that we know our patients by name. We can have a chat with them and take up where we left off the last time they were in.”

Unphased by the growing presence of large pharmacy chains in Ireland, what worries Walsh most is the sudden decision by Government to make price cuts.

He said, “It has become quite difficult to put together a business plan for the year with so many cuts being announced on such a regular basis.”

With the introduction of generic substitution and reference pricing due shortly, pharmacists can expect further reductions to their income. Even so, Walsh

welcomes the introduction of generic substitution.

He said, “generic substitution and reference pricing will enable our patients to avail of cheaper medications. It will take money out of pharmacy but the patient will be getting a much better deal.”

Despite the plethora of new regulations, it seems that Walsh's philosophy still is that pharmacy is all about the patient and not about the pharmacist.

Left to Right: Ciaran Walsh, Denis Walsh, Clodagh Mac Mahon and Colleen Keogh


News

news briefAllergan to invest a further $350 million in manufacturing Allergan Pharmaceuticals Ireland has announced that the Company will invest $350 million to expand both its development and manufacturing capacity at its site in Westport, Co. Mayo, starting this year. The investment will enable Allergan to expand the manufacturing capability for BOTOX® (botulinum toxin type A) and to develop a manufacturing base for the next line of biologic products currently in the Allergan pipeline.

The expansion will create approximately 200 new jobs at the Westport site and approximately 250 building construction jobs in the next four years, whilst building the site. Allergan currently employs more than 900 people in Ireland.

Pat O’Donnell, Managing Director, Allergan Pharmaceuticals Ireland, said, “This is a really positive day for Allergan, for our employees and for the local community. This investment underscores the strategic importance of the Westport site within the Allergan manufacturing network. Based on Allergan’s present strategic plans, we anticipate that demand for BOTOX® will continue to grow, fuelled by recent approvals of the product for the treatment of neurogenic detrusor over activity and the treatment of chronic migraine.”

An Taoiseach, Enda Kenny, T.D. was supportive of the development in his home County. He said, “Allergan’s expansion of their Irish operation is a significant vote of confidence in our country. Developments like this will help us on the path to economic recovery. Allergan’s Westport facility is an important strategic site in their network and contributes more than 50% of global revenues from a range of products manufactured here. The expansion of this facility is a much needed boost for the region and will bring further high quality jobs to the West of Ireland. The IDA are to be commended for their work in this area. The Government's top priority is jobs and we will continue to focus on policies that support jobs and enterprise.”

Boots has opened its seventieth pharmacy in doors in Main Street, Bray, Co Wicklow. There will be a staff of 18.

Participating in the official ceremony to mark the launch of the new store were Cathaoirleach of Bray Town Council,

Boots notches up seventieth pharmacy

Cllr Ronan Mcmanus, President of Bray Chamber of Commerce, Ian Donnelly; Anne Ferris T. D., Councillor Tracy O'Brien, Councillor John Byrne, Councillor Sarah Wray, Councillor David Grant and Councillor Barry Nevin.

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News

Dutch Couragenews briefTotal Medicine Management System is a winner

Pharmacy Prime Ltd. took home the ‘Irish Innovation Award’ for its invention, ‘Biodose’ at the ActionCoach Business Innovation Awards.

Biodose is a patented system of Total Medicine Management for the elderly and other patients requiring medicine management.

Over 50 pharmacies in Ireland are using the Biodose system to manage medicines being administered to 3,500 patients in Ireland, although it is used extensively in the UK and is shortly to be introduced into Germany.

Medication Management is key in the care of the elderly. However, many studies have shown that medicine management is often poor.

A recent report at St. James Hospital in Dublin showed that over a 5-year period 4,200 prescription mistakes for more than 4,000 patients were recorded and 28% of these patients suffered harm from the errors. Other reports in Ireland and elsewhere throughout the world indicate a similar pattern.

The Pharmacy Prime system:

i) Systemises medicine use review by all care practitioners

ii) Systemises checks and balances on a patient by patient basis to ensure optimum use of medicines and to avoid mistakes

iii) Provides an on-going system of education for frontline staff administering medicines

iv) Provides systematic reviews and advice for the prescribers of the medicine – on a patient by patient basis.

The theme of the Irish Pharmaceutical Healthcare Association's annual meeting was Bringing the Best to Healthcare Through Partnership and Innovation.

The IPHA's president and chief executive, Peter Gallagher and Anne Nolan both felt that there were new grounds for optimism within Pharmacy and that innovation in thinking, practice and technology should help to drive value within the limited resources of the health services.

Of the various speakers during the day, Michel Dutree, Director of Nefarma in the Netherlands warned that, although there are many lessons Ireland could learn from the Dutch (healthcare) experience, he felt it would be advisable if the Irish government were to think twice about certain aspects of it.

In fact, he was referring to the private-public healthcare model that was adopted by the Netherlands in 2006, when private insurance companies were encouraged to compete for access to public health services. He commented that the Dutch system looked good in principle but was flawed in practice.

Dr. Steve Thomas, Lecturer in Health Policy and Management at Trinity College Dublin asked the rhetorical question: whether the government is (looking) to bring about

Professor Frank Lichtenberg, Columbia University Graduate School of Business, New York, Ms. Anne Nolan, IPHA Chief Executive, Dr. Steve Thomas, Lecturer in Health Policy and Management, Trinity College Dublin and Professor Ian Marison, Director, National Institute for Bioprocessing Research and Training.

genuine reform to healthcare delivery or whether it is simply wasting a good opportunity to do so. He concluded his address by saying that the planned universal health insurance model is a genuine effort towards reform but, he felt, the government has chosen the wrong model. He also pointed out the dangers of a neo-Dutch system, which the Minister for Health, Dr. James Reilly has advocated. Thomas

Professor Frank Lichtenberg, Columbia University Graduate School of Business, New York


News

warned that a multiple fund system would lead to an escalation in the cost of health

insurance and would result in it losing its affordability.

The Chief Executive of the Irish College of General Practitioners (ICGP) Kieran Ryan was concerned about GP practices. He pointed out that because 70% of recent graduates from the ICGP are female, Ireland will be facing GP shortages in the future if a new structure for the GP working day is not developed soon.

Investment and Innovation were subjects of further discussion. Presentations were made by Professor Ian Marison, Director of the National Institute for Bioprocessing, Research and Training and Dr. Graham Love, Director General of Science Foundation Ireland, who examined how investment in the international research-based pharmaceutical industry can not only be a driver of economic growth in Ireland but is also central to the best health outcomes for Irish patients.

Pat O’Mahony, Chief Executive of the Irish Medicines Board, speaking from a regulator's point of view encouraged more innovation within Pharmacy whilst honorary guest speaker Professor Frank Lichtenberg from Columbia University Graduate School of Business in New York presented on pharmaceutical innovation and its contribution to longevity and economic growth.

Funding threatens drug and alcohol misuse careIn November, Ireland’s longest-running community drugs project, the Ballymun Youth Action Project (BYAP), published two reports on substance misuse as part of its 30th anniversary celebrations.

Founded in 1981, after three young people from Ballymun died from drugs-related causes, the Project has continued to offer a community-based response to drug and alcohol misuse.

The reports were titled, ‘Seen but not Heard? – Thirty Years of Communities Responding to Drugs’ and ‘Fact or Fiction – A Study of Attitudes to Alcohol and Related Issues among Young People in the Ballymun Area.’

The first report presented the findings of a conference on substance misuse, which took place in Dublin Castle in March of this year. The second report highlighted young people’s attitudes to drugs and alcohol related issues and gave a detailed picture of their experiences, which helps to ‘personalise’ the

much larger general surveys, which are the norm for such research in Ireland.

Dermot King, Director of BYAP says that the two reports will make a significant contribution to the public’s understanding of the current drug situation as it affects local communities.

He said, “Taken together, the two reports offer a range of important insights into the drugs problem in Ireland today. In particular, the conference report outlines how substance misuse has changed over the decades and highlights the need for statutory, voluntary and community sectors to work together, in order to offer a holistic, more joined-up approach to the drugs' problem.

“These two reports can also serve as a resource for policy makers, academics and social workers.

“Ballymun Youth Action Project was founded at a time when heroin had begun to ravage entire communities, and Ireland was in the

midst of a crippling recession. We were the first project of our kind in Ireland and were founded by members of the local community, so they could deal directly with local problems caused by drug and alcohol misuse.

“Over the years, we’ve seen the nature of addiction issues change and new issues have emerged. Because we are grounded in the local community, we are able to respond quickly to these changing issues and reach out to people who may be wary of accessing support."

King concluded, “Like many communities, we are extremely concerned about the current economic situation in Ireland. There is a very real risk that frontline services provided within local communities will be lost. This would be a tragedy for all communities and particularly those affected by drug misuse. Our experience has shown that community responses can play a vital role in tackling drugs and alcohol problems in Ireland."

Dr Graham Love, Director General, Science Foundation Ireland, Mr. Sean Sherlock, T.D., Minister for Research and Innovation, Bryan Dobson, RTE (Moderator), Mr. David Gallagher, Chief Executive, IPHA

Bernard Kennedy and Caroline Lamb, Mundi Pharma Pharmaceuticals Ltd.

Yvette Murphy Skove, Jane Bishop, Novo Nordisk Edel Woods, Abbott, Darragh McLoughlin, IPU, Nichola Mellotte, Abbott


Obesity

The rise in obesity figures worldwide is not a new phenomenon. Obesity is becoming ever more widespread - and Ireland is no exception.

The cost of obesity to the nation's health and wealth is growing in significance with every expanding waistline. Elasticated tracksuit pants, sported by those suffering from the unfortunate disease have grown too tight

and something has to give.

Obesity in Ireland

According to the 2011 National Adult Nutrition Survey, carried

out by the Irish Universities Nutrition Alliance at University

College Cork (UCC) and University College Dublin (UCD), obesity has

increased more than three-fold in men and 1.7-fold in women in Ireland

over the last 20 years. In 1990, 8 per cent of men were obese whilst today, 26

per cent of men are. Likewise, 13 per cent of women were obese in 1990 and today that

figure stands at a staggering 21 per cent. That means that about a quarter of all men and women

in Ireland are obese.

The food diaries submitted by the participants of the survey showed that they ate too much fat and salt and

did not include sufficient fruit, vegetables and fibre in their diet. The survey also found that two-thirds of Irish adults eat more fat than the recommended intake.

Childhood diabetes

Sedentary lifestyles and unhealthy diet are prevalent today and children brought up in such an environment

are likely to carry on being like this in adulthood. This has become evident in the rise of Type 2 diabetes in children, a phenomenon unheard of in the past.

Dr Tony O'Sullivan, policy committee chairman of the Diabetes Federation of Ireland said in Irish Health, “There used to be a huge divergence in the diagnosis of diabetes. Type 1 was generally seen in five to 20 year-olds, then there was a big gap and type 2 was found in 50 to 80 year-olds. Now there is no gap and children as young as 12 are being diagnosed with Type 2 diabetes.”

Lifestyle

Speaking in Dublin recently, international obesity expert, Dr David Ludwig of Harvard University warned that an epidemic of childhood obesity in children is apparent.

He said that television viewing is displacing physical activity and encouraging the 'passive consumption of energy dense foods' amongst children.

Awareness

One major concern with obesity is that, in many cases people are unaware of the major health implications of being overweight. A recent consumer study conducted in Ireland found that, in general Irish people are aware that an unhealthy diet and lack of exercise are contributing factors to obesity but there is a severe lack of awareness of the serious diseases and health risks associated with being overweight.

Challenge for Society

As obesity-related problems continue to consume more of the country’s health expenditure, it is time for the government to step up their plan of attack in this battle of the bulge.

The Department of Health has conceded that concerted policy initiatives must be put in place if the predominantly negative findings of the research is to be accepted. To date, nutrition policies have depended on the Department of Health and Children. It may now be time for the government to follow in Denmark’s footsteps and take a look at policies that will influence the type and supply of food that people eat and the type of facilities that are available for physical activity.

The National Taskforce on Obesity reported that tackling the crisis in Ireland would involve addressing the obesogenic environment where people live, so that conditions could be created, over time, which would lead to healthier eating and more active living. Such changes would protect people from the widespread availability of unhealthy food and beverage options.

Change is possible

In a study of dietary change in Finland from 1972-1992, the mortality rate of coronary heart disease dropped by 55% amongst men and 68% amongst women. Approximately three-quarters of this decline was due to changes in the main coronary risk factors, the decrease in serum cholesterol being the most important.

So even though it may be twenty years before the problem of obesity is solved in Ireland, there is hope for the nation yet!

The Battle of the Bulge


Debate

Everyone is looking for the best deals and Irish consumers are no exception. Whilst consumers can compare the prices on offer in other retail sectors, pharmacy is one area where people are not given the opportunity to make such rational consumer choices. This is because the price of the medicines they are purchasing only becomes apparent when they are asked to pay for them at the point of sale. Irish Pharmacy News looks at whether or not the guidance is legal and whether changes are called for in this area.

Before Christmas, the Pharmaceutical Society of Ireland issued guidance to pharmacists in relation to the advertising, promotion and sale of medicinal products within pharmacy. These were to supersede the 2009 Guidance, which said that the promotion of OTC medicinal products, on the basis of price or quantity discounts was both unlawful and in breach of the Statutory Code of Conduct for Pharmacists. The new Guidance does not make the same claim and, yet it does not inform pharmacists that the law permits the advertising and promotion of medicinal products on the basis of price or quantity discounts.

Mark Ryan, Partner at Whitney Moore Solicitors, told IPN that the PSI Guidance is an inaccurate statement of the law and that the PSI, in issuing the guidance, was acting beyond its powers.

Advertising and promoting medicines in pharmacy: a transparent business practice or, a dangerous enterprise?

He said, “The law permits the advertisement of OTC medicines, subject to compliance with the requirements of the Medicinal Products (Advertising) Regulations 2007. No Guidance issued by the PSI can alter that or introduce restrictions, as the Pharmacy Regulator does not have power to legislate.”

One of Ryan’s concerns is that the latest PSI Guidance does not inform pharmacists that the law does permit the advertising and promotion of medicinal products

on the basis of price or quantity discounts. He added, “The tenor of the new guidance is such that pharmacists will continue to be under the misapprehension that price promotions are unlawful.”

The PSI, in issuing the Guidance said that it was exercising its function under Section 7(2)(b)(vii) of the Pharmacy Act 2007. The relevant section provides that the Society is empowered, ‘to make public statements about any aspect of pharmacy to which its functions relate’.

Ryan added that the legal status of the PSI’s Guidance is questionable because the Guidance does not amount to a public statement. He added, “Whether or not that view is correct, it is unsatisfactory for such an important issue to be dealt with by way of Guidance.”

Whilst an EU Directive which has been transposed into Irish law prohibits the advertisement of a prescription medicine, Ryan said that whilst he can understand that it would be wrong to promote one product over another within an advertisement, he can see no reason why there should not be price advertising of prescription medicines. He said, “If I’m a pharmacist, I should be able to inform my patients that I offer competitive prices on my prescription medicines. I think that Tesco pharmacy very cleverly went about doing this by advertising that they charge a mark-up of 20% and a dispensing fee of �3.50 per item.”

Cormac Tobin, Managing Director of Doc Morris/ Unicare Pharmacy is certainly in favour of Ryan’s interpretation of the law. His pharmacies already offer price promotions on OTC products. Tobin firmly believes that there should be more price promotions within pharmacy, on OTC and prescription products alike.

He said, “Pharmacies should be able to advertise the prices of a considerable number of prescription medicines as well as OTC products.”

One example he gave was that

Cormac Tobin, Managing Director of Doc Morris/ Unicare Pharmacy


of the contraceptive pill. He said, “A patient should be able to compare and contrast the prices being charged by different pharmacies in order to get the best value; ‘value’ being an equation of service, quality and price.

“In no other industry is there as much secrecy surrounding the pricing of products. The pharmacy sector is severely limited in what it can do to offer better competition to the benefit of the consumer. Pharmacy should engage in a dialogue with the government, highlighting these limitations.”

Tobin advocates that the pharmacy sector can learn from the mistakes that other commercial categories have made, such as the alcoholic beverage industry, where increased competition led to the price of alcohol being dropped to dangerous levels.

He said, “Lessons can be taken on board but I believe that customers should be entitled to greater transparency in the pricing of medicines. The PSI Guidelines need to be set down and discussed sensibly and responsibly with the legislator. Pharmacy is willing to help the legislator come to a sensible solution, just as it did with the delivery of the flu vaccine through pharmacy.”

Following the recent publication of a report titled, ‘Pharmaceuticals Delivery in Ireland. Getting a Bigger Bang for the Buck,’ by the Economic and Social Research Institute (ESRI), Paul K Gorecki, ESRI said that consumers need information in order to make sensible choices as to which pharmacy they should get to dispense a prescription. He said, “One element of that

decision concerns price. At the present time when a patient presents a prescription the only information usually available on price is the total. No information is provided to the patient with respect to the dispensing fee, the mark-up or the services that are provided by the pharmacist.

“This needs to change. Such information should be provided in a standard format in a clearly accessible place using a standard template. For example, the presentation of such information already occurs in pharmacies in Ontario, while the Dental Council in Ireland made fee posting in dental practices compulsory as part of the Code of Practice in 2011. It should be noted that what is being proposed is not the advertisement of particular drug products. Furthermore for prescription pharmaceuticals the patient is already in possession of valid prescription. The posting of information means that patients can make informed choices about which pharmacy to select, while at the same time encouraging pharmacists to respond to patient preferences.”

Boots and Tesco Pharmacies did not wish to comment on the issue. However, the feeling apparent amongst many independent community pharmacists is quite uniform. It would seem that, although most pharmacists believe that greater transparency in the pricing of medicines is important, there are other ethical and practical considerations to be taken into account.

Firstly, pharmacists are concerned that engaging in price promotions on OTC and prescription medicines in pharmacy would be unethical, in that it may distance the pharmacist from his or her role as medicines’ advisor.

Although most pharmacists would concede that price is an important factor, the main objective is to ensure that patients receive the appropriate treatment rather than ‘just the best deal’.

A pharmacist in Claremorris, Co. Mayo said, “I think that pharmacists should be allowed to advertise the price of vitamins and provide special offers on certain OTC products. And, If pharmacists were legally allowed to advertise the price of certain prescription medicines, I would happily get involved.”

Another pharmacist in Dublin made the point that a pharmacy is not a sweet shop and, therefore should not engage in the same promotional practices as other retail outlets.

Pharmacist John Brassil in Ballyheigue, Co. Kerry said, “Anything that is ‘pharmacy sale restricted’ should not be advertised on a ‘buy two get one free’ type deal. With regard to advertising the price of prescription medicines, I would prefer it if all pharmacies simply charged the same mark-

Debate

up on medicines rather than different mark-ups and that this should be made known to the public.”

Terry Dobbins, a pharmacist in Ballybofey, Co. Donegal said that his patients would regularly ask what the price of their prescription medicines are. He said, “If the price is too expensive for them, they have no problem going elsewhere.”

According to the vast majority of pharmacists, advertising the prices of certain prescription medicines, whether it be legal or not, is also wholly impractical.

One Dublin pharmacist said, “Because the prices of prescription medicines change sporadically, it is impossible to provide patients with a fixed price for their medicines. Often, the cost of a medicine goes down after we have purchased it for a higher price, so then we would be in a loss situation.”

Whatever anyone else’s opinion may be, the PSI is holding firm that the advertising or promotion of medicines is regarded as being the ‘commodification’ of medicinal products.

Spokesperson for the PSI, Kate O’Flaherty said, “Such promotions may have the effect of distracting patients from making an objective evaluation of their normative requirements. This may inadvertently encourage the stockpiling of medicines in the home with resultant safety risks and with the potential of loss of efficacy from inappropriate storage conditions.

“All pharmacists and pharmacies are expected to comply in full with the guidance of the PSI.”

In spite of the PSI’s insistence on these guidelines, it would appear that there may be some cause for confusion, in a legal sense.

Mark Ryan, Partner at Whitney Moore Solicitors

Kate O’Flaherty


Smoking Cessation

The HSE has invested in and launched a new health education campaign this year, aimed at encouraging smokers to quit. We want to reduce the numbers of smokers in Ireland, reduce the level of illness and deaths caused by tobacco use and reduce the cost of treating those illnesses, which will benefit everyone in our society.

We know that between 70% to 80% of Irish smokers want to quit and about 40% of all smokers try to quit every year. Most people quit successfully after a few attempts and, while many go it alone on will power, those quitters, who use supports such as our National Smokers’ Quitline, online help, smoking cessation services or medications provided by their pharmacists or GP, are more than twice as likely to succeed.

How are pharmacists helping?

Over 420,000 people in Ireland visit a pharmacy every week, making the community pharmacy the most accessible part of the health service. As we know, pharmacists are ideally placed to advise people on why and how to stop smoking, and to provide information on the supply of appropriate medications. The PSI and IPU are both on board as QUIT campaign partners, supporting the launch and

One out of every 2 smokers will die of a tobacco related disease – Can you live with that?

assisting in distributing QUIT promotional posters and stickers to pharmacies nationwide.

In addition to displaying information in their stores, pharmacists are playing an important role in providing brief advice to smokers who come in to the pharmacy. Smoking cessation guidelines recommend that all healthcare professionals, including pharmacists, should check on the smoking status of their patients/clients at least once a year and advise smokers to quit smoking. This brief advice can be delivered opportunistically during routine consultations, even when smokers are not directly seeking help with smoking cessation. Examples of opportunities for a brief intervention of this kind would include:

• Prescription service - The dispensing of many types of medication can be linked with smoking cessation advice, for example medication for respiratory or cardiovascular diseases, and women using oral contraception. There is also an opportunity to ask clients with a prescription for smoking cessation medication if they are receiving additional support.

• Minor ailment service - Pharmacies are often the first port of call for minor ailments – a patient presenting with a cough can be asked whether they smoke.

• Purchase of over-the-counter medications - it is appropriate to ask a customer purchasing a cold remedy whether they smoke, and advise accordingly.

Many pharmacists report reluctance to broach the question of smoking with their customers. However, it is worth knowing that most smokers are happy for the topic to be brought up by a health professional, once it is done in a supportive and non-judgmental manner. It is important to remember that 70% of smokers WANT to quit, so a pharmacist’s question, support and advice can help them make a new attempt.

The key elements for the pharmacists in giving smoking cessation advice are:

• Ask if the person smokes

• Advise them of the importance of quitting

• Help them if they want to quit by providing them with appropriate

information and advice.

It is not always necessary for the pharmacist to take control of the quit attempt but it is important that the pharmacist initiates that important discussion with the smoker.

What other supports are available?

While some pharmacists will give brief advice and follow through with smokers in their quit attempt, they may also wish to refer people on for further help and advice.

• Smokers can be advised to talk to their GP for support with prescription, medications such as NRT (for medical card holders), Buproprion and Varenicline.

• Smokers can also be advised to log on to the HSE’s online quit support tool at www.quit.ie , or to the quit smoking facebook page at www.facebook.com/hsequit. Thousands of smokers have logged on to these sites - they provide valuable peer support to each other in their quit attempts.

• Professional counselling is also available from the National Smokers Quitline at 1850 201 203 and from the local smoking cessation services (details available at www.quit.ie)

Dr Fenton Howell, Director Public Health, HSE

CAN YOU LIVE WITH THAT?

Nicorette® inhaler

The closest thing to smoking without smoking.

Whether you are cutting down gradually or quitting altogether.

www.nicorette.ie

NIK/210/00

Trade Name of the Medicinal Product: Nicorette 15mg Inhaler. Composition: Nicotine 15mg per cartridge. Pharmaceutical Form: Inhalation cartridge for oromucosal use. White to slightly coloured porous plugs in sealed, transparent plastic cartridges. Therapeutic Indications: For the treatment of tobacco dependence by relieving nicotine craving and withdrawal symptoms thereby facilitating smoking cessation in smokers motivated to quit and helping smokers temporarily abstain from smoking. In smokers currently unable or not ready to stop smoking abruptly, Nicorette inhaler may also be used as part of a programme to reduce smoking prior to stopping completely. Dosage: Smoking Cessation:The frequency of use should depend on the previous smoking habit of the individual. Nicorette Inhaler should be used whenever the urge to smoke is felt, up to a maximum usage of 6 cartridges per day.In the treatment of nicotine dependence, a course not exceeding three months is suggested, the patient stopping smoking completely at the start of the course.For up to 8 weeks the patient uses not less than 3 and not more that 6 cartridges each day to relieve craving.Over the following two weeks the aim is to reduce the number of cartridges used by half, over the next two weeks to reduce the number to zero by the last day.If abstinence has not been achieved, further courses of treatment may be recommended, if it is considered that the patient would benefit. Temporary Abstinence: During periods of temporary abstinence, the patient should use the Inhaler when required to relieve nicotine cravings and withdrawal symptoms. No more than 6 cartridges should be used in a 24 hour period. Gradual cessation: For smokers who are unwilling or unable to quit abruptly. Use the inhaler whenever there is a strong urge to smoke in order to reduce the number of cigarettes smoked as far as possible and to refrain from smoking as long as possible. The number of cartridges is variable and depends on the patients needs. Not more than 6 cartridges should be used per day. If a reduction in number of cigarettes per day has not been achieved after 6 weeks, professional advice should be sought. If the attempt to stop smoking completely has not been started within 6 months after the beginning of treatment, it is recommended to consult a healthcare professional. Concomitant disease:Only severe renal impairment would be expected to affect the clearance of nicotine or its metabolites from circulation. In patients smoking and undergoing haemodialysis elevated nicotine levels have been seen. A minor reduction in total clearance of nicotine has been demonstrated in healthy elderly patients, however, not justifying adjustment of dosage. Patients with obstructive lung disease may find use of the Inhaler difficult. Nicotine gum, patch, microtab or nasal spray may be preferred in such cases. Contraindications:Use in non-smokers. Use in persons hypersensitive to nicotine or any ingredient of Nicorette Inhaler. Special Warnings and Special Precautions for use: Nicorette should be used with caution in patients with cardiovascular disease, severe/moderate hepatic impairment, severe renal impairment, active and duodenal ulcers. Nicotine, both from NRT and smoking, causes the release of catecholamines from the adrenal medulla. Therefore, Nicorette should be used with caution in patients with hyperthyroidism or pheochromocytoma. Patients with diabetes mellitus may require lower doses of insulin as a result of smoking cessation. Nicotine in any dose form is capable of inducing a dependence syndrome after chronic use and is highly toxic after acute use. However, dependence with Nicorette Inhaler is a rare side effect and is both less harmful and easier to break than smoking dependence. Interactions with other medicinal products and other forms of interaction: Smoking (but not nicotine) is associated with an increase in CYP1A2 activity. After cessation of smoking, reduced clearance of substrates for this enzyme may occur. This may lead to an increase in plasma levels for some medicinal products of potential clinical importance and for products with a narrow therapeutic window, e.g. theophylline, tacrine and clozapine. The plasma concentration of other drugs metabolised in part by CYP1A2 e.g. imipramine, olanzapin, clonipramine and fluvoxamine may also increase on cessation of smoking, although data to support this are lacking and the possible clinical significance of this effect is unknown. Limited data indicate the metabolism of flecainide and pentazocine may also be induced by smoking. Undesirable Effects: Nicorette Inhaler may cause dose dependent adverse reactions similar to those associated with nicotine administered by other means and are dose dependent. Common (>1/100): Headache, Nausea, GI discomfort, hiccups, vomiting, Coughing, Irritation in mouth and throat, nasal congestion. Less common (1/100-1/1000): Palpitations. Rare (<1/1000):Reversible atrial fibrillation. Some symptoms such as dizziness, headache and sleeplessness may be related to withdrawal symptoms associated with smoking cessation. Increased frequency of aphthous ulcer may occur after smoking cessation. The causality is unclear. Marketing Authorisation Holder: McNeil Healthcare (Ireland) Ltd, Airton Road, Tallaght, Dublin 24, Ireland. Marketing Authorisation Number: PA 823/49/26. Date of (Partial) Revision of the text: June 2011. Legal Category: Product not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd.


Prostate Cancer

In Ireland, prostate cancer is the second most common cancer in men, after skin cancer. Each year in Ireland, approximately 2,500 new cases of prostate cancer are diagnosed. However, the disease is not always life threatening.

Prostate cancer is most commonly found in men over the age of 65, although it can affect men in their 40s and 50s. The incidence of prostate cancer is rising in Ireland but this may be due to the fact that more men are actively seeking Prostate Specific Antigen (PSA) testing because there are not any screening programmes available.

Cause of prostate cancer

The causes of prostate cancer are still being investigated but factors include:

• Age. Most men diagnosed with prostate cancer are aged over 60 years of age.

• Family history. Men, whose brother and/or father have developed prostate cancer at a young age also have an increased risk of developing the disease

• Race: African-American and African-Caribbean men are more at risk than other ethnic groups.

• Diet: Men who eat a lot of red meat and high-fat dairy products and insufficient green vegetables have, on balance a slightly higher chance of getting prostate cancer.

Testing for prostate cancer

PSA Test

Prostate Specific Antigen is a protein that is produced in the prostate gland and can be found in the blood stream. The PSA test is not specific to diagnose cancer but it can be used to detect problems in the prostate. A raised PSA, however does not, necessarily mean that someone has cancer. Other factors that may have caused raised PSA levels include an increase in the size of the prostate gland, recent injury and kidney infection. However, any rise in the patient’s PSA levels should be looked into further.

Further investigation may involve a Digital Rectal Examination

(DRE). This involves a GP putting a gloved finger into the patient’s back passage to feel the prostate and to assess if there are any cancers in nearby tissue.

Other tests conducted at the hospital include:

Transrectal ultrasound scan (TRUS)

A TRUS uses sound waves to build up a picture of tissue inside of the body. In order to scan the prostate gland, a probe is passed into the patient’s back passage and an image of the prostate appears on a computer screen. This type of scan is used to measure the size of the prostate.

Transrectal needle biopsy of the prostate

The best way to diagnose prostate cancer is by taking tissue samples. This is usually done at the same time as an ultrasound scan. A plastic probe is inserted into the patient’s back passage to take samples (usually six to 12) from the prostate. Laboratory technician and/or doctors and will look for any cancer cells in the sample later under a microscope.

Treatment

This depends on the stage, grade and size of the tumour, the PSA level, the patient’s age, general health, lifestyle and the likely side-effects of treatment.

Active surveillance

Some early stage prostate cancers may be very slow growing and treatment may be postponed. Active surveillance may be an option, though if the cancer is small and only found in one place in the prostate. Some men choose active surveillance because they feel that the side-effects of strong treatments outweigh the benefits. Active surveillance involves regular check-ups with PSA tests and rectal examinations and, in some instances biopsies. Should further symptoms occur or the patient's PSA begins to rise, it may be time for alternative treatments.

Surgery

Some men may decide with the consultant to have a prostatectomy if the cancer is

found within the prostate gland only. A prostatectomy involves the total removal of the prostate with the tumour.

External beam radiotherapy

This treatment involves high-energy X-rays. In early prostate cancer, the radiotherapy is aimed at the tumour in the prostate gland, with the aim of destroying the cancer cells.

Hormone therapy

Hormone therapy, known as androgen deprivation therapy (ADT) stops testosterone from being released or prevents it from acting on the prostate cells. By reducing the amount of testosterone in the body, the growth of cancer cells can be slowed down or stopped. ADT can also help to shrink the tumour and cure urinary symptoms, which often appear with the disease.

With anti-androgen hormone therapy, the drugs attach themselves to a receptor (a protein) on the surface of the cancer cells to prevent the testosterone stimulating them. Small amounts of testosterone coming from the adrenal glands can also be blocked.

Anti-androgen therapy is usually prescribed in tablet form and is unlikely to cause impotence or reduce sexual desire. However, some men may get breast tenderness and/or enlargement of the breasts (gynaecomastia) but this can be prevented by radiotherapy before the ADT treatment begins.

Examples of anti-androgen therapy include:

• Flutamide (also called Drogenil)

• Bicalutamide (Casodex)

• Cyproterone (Androcur)

Chemotherapy

Chemotherapy involves using cytotoxic drugs to kill the cancer cells. Chemotherapy may be used if the patient’s cancer has spread beyond the prostate and can no longer be controlled by hormone therapy. In some cases, chemotherapy will improve

the patient’s quality of life and symptoms. Chemotherapy is used to treat cancer cells in most parts of the body because it circulates in the blood stream.

Recent Developments

In November last year, the Irish Cancer Society awarded €1.3 million (out of a total of €3.1 million) of its research budget for prostate cancer.

Professor Caitriona O’Driscoll, Head of the School of Pharmacy at University College, Cork, was awarded funding to investigate methods of delivering a new class of drugs, known as small interfering RNAs to prostate cancer cells without harming healthy tissue.

Professor Ciaran Morrison of NUI Galway, an Irish Cancer Society Prostate Cancer Researcher was also awarded funding for his research into radiation therapy for prostate cancer.

Since 2009, Dr Antoinette Perry, of Trinity College Dublin and her team at St. James’s Hospital have been investigating some of the genes that drive prostate cancer and have been developing prostate cancer epigenetic biomarkers, working specifically on DNA methylation changes.

They have also been looking at the process of DNA methylation and microRNAs where changes in the chemical make-up of the DNA switch off the genes which regulate cell growth. Apparently, it is this methylation process that can cause prostate cancer cells to grow and spread throughout the body. The team is examining ways of evaluating DNA methylation and microRNAs through blood or urine 'liquid-biopsies'.

For more information on prostate cancer, visit www.cancer.ie or call the National Cancer Helpline on Freephone 1800 200 700.

Prostate Cancer

e ements

For further details contact:United Drug Telesales Dublin - 01 463 2300 /2307 /2311Limerick - 061 315 411Ballina - 096 72 555 Leonard Manly Customer Services Development ManagerTelephone 01 463 2308Mobile 087 268 8740Fax 01-463 2525 www.united-drug.ie

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News

Paul Higgins Memorial Prize sponsored by Cahill May Roberts for first place in Pharmaceutical Chemistry in the B.Sc. (Pharm.) Examination. Left to right: Professor Mary McCarron, Dean of Health Sciences, TCD; Mr. Brian Morgan (Cahill May Roberts); Ms. Claire Mullins (prize-winner); Professor Marek Radomski, Head of School of Pharmacy and Pharmaceutical Sciences, TCD.

The School of Pharmacy at Trinity College Dublin has held its Annual Prize-Giving Ceremony at the Science Gallery, Trinity College Dublin.

Winner of the Paul Higgins Memorial Prize, sponsored by Cahill May Roberts for first place in Pharmaceutical Chemistry in the B.Sc. (Pharm.) Examination was Claire Mullins.

The McNeil Ltd. Prize for first place in Practice of Pharmacy in the B.Sc. (Pharm.) Examination went to Fiona Mulligan whilst David Corcoran was awarded the Leo Pharma prize for first place in Pharmaceutics in the B.Sc. (Pharm.) Examination.

The Pfizer Healthcare Ltd. Prize for first place in Pharmacology in the B.Sc. (Pharm.) Examination went to Stephanie Donohue, who was also awarded the Glaxo SmithKline Prize for first place in Pharmacognosy in the B.Sc. (Pharm.) Examination and Caroline Walsh was presented with the Pfizer Healthcare Ltd Prize for best overall performance in the Junior Freshman (first year) Annual Examination.

Top pharmacy students

McNeil Ltd. Prize for first place in Practice of Pharmacy in the B.Sc. (Pharm.) Examination. Left to right: Professor Marek Radomski, Head of School of Pharmacy and Pharmaceutical Sciences, TCD; Mr. David Hall (McNeil Ltd.); Professor Mary McCarron, Dean of Health Sciences, TCD; Ms. Fiona Mulligan (prize-winner);Dr. Martin Henman, Associate Professor of Practice of Pharmacy, TCD.

Leo Pharma prize for first place in Pharmaceutics in the B.Sc. (Pharm.) Examination. Left to right: Dr. Anne Marie Healy, Associate Professor of Pharmaceutics and Pharmaceutical Technology, TCD; Professor Mary McCarron, Dean of Health Sciences, TCD; Mr. David Corcoran (prize-winner); Professor Marek Radomski, Head of School of Pharmacy and Pharmaceutical Sciences, TCD.

Left to right, back row: Dr. John Walsh; Dr. Lorraine O’Driscoll; Dr. Martin Henman; Ms. Fiona Mulligan; Mr. David Corcoran; Dr. John Quigley; Dr. Carsten EhrhardtLeft to right, front row: Dr. Deirdre D’Arcy; Professor Mary Meegan; Ms. Claire Mullins; Ms. Stephanie Donohue; Ms. Caroilne Walsh; Dr. Anne Marie Healy; Professor Mary McCarron; Professor Marek Radomski

Pfizer Healthcare Ltd. Prize for first place in Pharmacology in the B.Sc. (Pharm.) Examination. Left to right: Professor Mary McCarron, Dean of Health Sciences, TCD; Ms. Maura Kinahan (Pfizer Healthcare Ltd.); Ms. Stephanie Donohue (prize-winner); Professor Marek Radomski, Head of School of Pharmacy and Pharmaceutical Sciences, TCD.

Fannin

Supplying Specials & Extemporaneous medicationsLocal Manufacturing

Quality Service (Dedicated Customer Service team)

Discontinued Drugs, Medical Shorts, Pharmacy Drug Requirements

Quick turnaround

Assistance with re-imbursement issues

Quality of product manufactured

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Extemporaneous preparations

Fannin Limited, Fannin House, South County Business Park, Leopardstown, Dublin 18, IrelandTel 01 2907000 www.fannin.ie


Specials

Specials' manufacturing - or the manufacture of extemporaneous preparations - has been around since the discovery of medicine.

Specials are unlicensed medicinal products. Generaly speaking, a Special can be defined as any substance with a therapeutic characteristic that does not have a license in the local market, whilst licensed medicines are medicines licensed by the local regulatory authority for products to be used within their licence parameters, characteristics, requirements and restrictions.

Examples of unlicensed medicines/Specials

1. A medicine that has a product license (marketing authorisation) in the United Kingdom but not in the Republic of Ireland would be classed as an unlicensed medicine for use in the Republic of Ireland.

2. A tailor-made liquid made from tablet(s) licensed in the Republic of Ireland for patients (such as paediatric patients), is considered a special/unlicensed product.

3. A licensed formula manipulated for an elderly patient with special requirements that licensed medicines cannot meet would make the product a special/unlicensed.

4. Making a liquid for a patient, who cannot swallow 'licensed' tablets for whatever reason and if crushing the tablets and dissolving/dispersing them in a liquid is the only way to administer the medicine, then this product would become a Special/unlicensed product

5. Mixing a number of 'licensed' creams/ointments makes the new product a special/unlicensed.

It is important to distinguish between Specials' manufacturing and readily available unlicensed products. One example of this is that of Pirition liquid. This antihistamine was licensed and available in Ireland up until recently. Now, it is available from the UK and is supplied in Ireland as an unlicensed product. Pirition tablets, however, remain licensed and are available in Ireland. If the tablets that are licensed in Ireland are used to make Pirition liquid by a Specials' manufacturer, then that would be called a Special and would become

What's special within the Specials market?

unlicensed because it is a manipulation of the licensed formula

A Special, being a specially prepared formulation, is prescribed to meet the special clinical need/s of a patient, where there is currently no licensed version available. For example, a patient may need a particular strength, a preservative-free formulation or a particular product presentation or form.

A Special will only be prescribed if there is no equivalent, licensed alternative. If a licensed alternative does exist, there can be no Special.

Doctors may prescribe unlicensed medicines for the following reasons:

1. A patient may need to receive an unlicensed medicine as part of a clinical trial by agreement

2. The medicine may be awaiting approval from the local regulatory authority

3. A patient may have a special clinical need that cannot be met by a licensed medicine, for example, they are allergic to an ingredient

4. A doctor may prescribe medicine for a patient in a formula that is not available, to be made up as a special preparation by a pharmacist or in a Specials' manufacturing facility.

A patient may require a Special for the following reasons:

• The patient cannot swallow tablets and requires a liquid formulation.

• The Special is required to ensure compliance. For example, a patient pretends to swallow tablets but gets rid of them once a nurse/carer goes away.

• A patient may require 1mg of a tablet that contains 10mg. It is almost impossible to break the tablet into ten equal pieces. Making a liquid formation would help to obtain the correct dose.

• Babies and young children may require certain doses of medicines that are not available commercially in suitable doses.

• The patient may require the addition of certain excipients to improve taste and compliance.

• The patient may require a combination of medicines in one formula to provide a synergistic effect or for convenience.

• A patient may require a sugar free product that is only commercially available in unsuitable formulas.

Are unlicensed products/Specials safe?

Just because a medicinal product is unlicensed in the Republic of Ireland does not automatically make it unsafe. The product may continue to be licensed in other countries.

A Specials/unlicensed product may have been licensed in Ireland in the past but the Local Licensing Authority, which in Ireland is the IMB, decided to withdraw the Marketing Authorisation for safety reasons. Alternatively, the medicinal product may be unlicensed in Ireland because the Licence Holder (Manufacture/Applicant) voluntarily decides not to renew the licence or to terminate the licence for commercial reasons.

Most Specials can be made by pharmacists in the pharmacy for individual patients. This is known as 'extemporaneous preparation'. However, great care and stringent requirements are required to ensure the safety of these products. Extemporaneous preparation is one of the highest risk activities carried out in pharmacy today. The use of unlicensed medicines carries a greater risk of adverse drug reactions than the use of licensed medicines. Also, these medicines are commonly given to some of the most vulnerable patients in hospitals and in the community, such as neonates,


children, elderly patients, stroke victims and patients with feeding tubes. These people are often not capable of making their carers aware of any adverse drug events they are experiencing.

There are a number of examples of serious negative outcomes from extemporaneous preparation errors, including the Peppermint Water Case. This tragic case involved a pre-registration pharmacy student in the UK making up a peppermint water mixture for a baby. Too high a concentration of chloroform water was used and the baby tragically died. Both the pre-registration student and the supervising pharmacist were charged with manslaughter, although the charge was later reduced to one of supplying the wrong substance.

How are Specials regulated?

The Irish Medicines Board is the Authority that issues the licences to the Specials' manufacturers. Initially, the IMB must give the manufacturing facility a vigorous inspection to ensure its suitability. The IMB will also check all the manufacturers SOPs (Standard Operating Procedures) to ensure that all activities are conducted in accordance with the relevant regulations, Good Manufacturing Practice (GMP) and License conditions.

Licensed facilities are obliged to follow all conditions and regulations and to report to the IMB regarding these on a regular basis. The IMB’s strict requirements have earned the Irish pharmaceutical manufacturing industry the reputation of having some of the highest manufacturing standards in the world.

The IMB must approve of all persons working at such manufacturing facilities and must be satisfied, not only with the facility and procedures but also with the people who carry out the responsibilities and duties.

Although the Specials' manufacturing procedures are regulated by the Irish Medicines Board, the individual formulations that are made are not - these are the responsibility of the manufacturer. The

manufacturer must ensure that all of the the clinical and pharmaceutical issues, including testing are addressed.

The responsibility for prescribing the unlicensed medicine falls on the prescriber and that is also recorded.

Any number of formulations used in manufacuring, provided that there is evidence to support the medicine's safety and stability. Manufacturers must also keep detailed records of how and why and on what basis a certain product was manufactured.

In addition, if a Specials' manufacturer makes a product and a patient complains, for example, about a 'lumpy' shape in the medicine, then the manufacturer is supposed to report that complaint to the IMB, stating which ingredients were used, what is thought to have caused the lump and how the manufacturer intends to rectify the problem. Specials' manufacturers are required to have procedures in place to ensure that a problem does not re-occur. For example, if it is found that the suspending agent was the cause of the problem, this could not be re-used.

How much does a Specials product cost?

Specials are produced individually in very small quantities, at very short notice and normally despatched within 24 hours. Even though the ingredients are not normally terribly expensive, outgoings and expenses affect the overall pricing. These include:

• Licence fees

• Clean rooms' maintenance, environment and microbiological testing, time consumed

• Salaries of highly professional staff

• Training costs

• Research cost (especially for new formulations), with regards to stability, bioavailability, concentration and safety margin

• Transport costs. Cold chain products

have to be transported in containers and at specially controlled temperatures. Time restrictions are also imposed and must be complied with

• All ingredients have to be tested individually before they are used.

All these facts are reflected in the premium cost of such medicines.

How long is the life of a Special?

Most products have very short expiry dates and their 'shelf life' could be anything up to seven days.

Are Specials medicines reimbursed by the Health Service Executive?

In Ireland, some products (Specials and unlicensed) have agreed prices and some are reimbursed at the discretion of the authorities, depending on a range of factors.

What growth has the Specials' market seen in Ireland in recent years?

In the past, specials would have been prepared primarily in pharmacies or they may have been imported, mainly from the UK. Whilst there are a number of Specials' manufacturers now operating in the country, the exact size of the Specials' market is unknown. It is known, however that the use of Specials is not on a wide scale.

Pharmacy has seen a reduction in the amount of extemporaneous preparations that are carried out within the dispensary. One significant factor is that, in the past doctors used to prescribe more extemporaneous preparations than they do today. On the other hand, the complexity of new medicines, providing better care for certain categories of patients and new restrictions on making preparations within pharmacies may lead to a marked growth in the Specials' industry, albeit a small proportion of the total number of medicines prescribed and dispensed.

Specials


McLernon Computers have donated €350,000 worth of equipment to the School of Pharmacy at Trinity College, Dublin. The donation included, twelve networked high-specification PCs with MPS dispensary management system software, an EPOS till system and five years of both hardware and software support. The Pharmacy Dispensing Systems will be used for ‘Pharmaceutics’, extemporaneous compounding and dispensing and also in the ‘Practice of Pharmacy,’ practical classes for Pharmacy students in all years of the degree programme. Postgraduate students will make use the equipment in the practical training part of their degree.

McLernons’s MPS is a Windows-based pharmacy software programme, which allows for touch-screen dispensing, dispensary stock control, extensive drug information and management reporting.

Robin Hanna, Sales Director at McLernons, said, “As a company we recognise the importance of continued investment in the education of future generations of pharmacists and we are glad to be able to ensure that Trinity students are exposed to the very latest technology and software.”

McLernons donates €350,000 of equipment to Trinity College

News

news briefFirst unit dose traditional herbal medicine licensed in IrelandValdrian® Hard Capsules will become available in Ireland having been registered by the Irish Medicines Board, in accordance with the Traditional Herbal Medicinal Products Directive (2004/24/EC). The product has been available in the UK market since July 2008.

The Traditional Herbal Medicinal Products Directive was introduced in order to protect the health and interests of consumers and patients across Europe.

Prior to this time many herbal medicines available in EU countries were sold outside of a regulated system which meant that these herbal medicines were unable to prove that they had acceptable safety or quality. They also did not provide useful patient information or detailed labelling.

Based on the review of the data on quality, safety and traditional use, the IMB granted Bio-Health Ltd, the manufacturers of Valdrian®, a Certificate of Traditional Use Registration for Valdrian, which contains Valeriana officinalis L. Bio Health Ltd. are specialists in herbal medicine and nutritional food supplements.

Valdrian® is a traditional herbal medicinal product for the relief of symptoms of mild mental stress and is also used to aid sleep. Valdrian® hard capsules are additive free, suitable for vegetarians and are claimed to be 100% Natural and Organic.

The Valerian root in the product is collected from the wild in accordance with Good Agricultural & Collection Practice” (GACP).

Bio Health Ltd said that clinical research has documented the beneficial effects of the product on sleep latency, frequency of waking, tension and quality of sleep.

However, there is no requirement under the Traditional Herbal Registration Scheme to prove scientifically that the product is efficacious. The registration is based exclusively upon the longstanding use of Valdrian as a traditional herbal medicine and not upon data generated from clinical trials.

The product will be distributed in Ireland by TP Whelehan who celebrates its 125th Birthday this year.

Prof Marek Radomski, Head of the School of Pharmacy at TCD said, “The systems are indispensable for the state-of-the-art teaching in our school and will enrich the students' educational experience. The SoPPS is truly grateful to McLernons for this generous donation and for their continuing support of our programme."

Ger Kelly, McLernons, Cicely Roche, Senior Lecturer, Prof Marek Radomski, Head of School and Chair of Pharmacology, Robin Hanna, McLernons and Dr Anne Marie Healy, Director of Teaching & Learning (undergraduate)

Robin Hanna, McLernons, Prof Marek Radomski, Head of School and Chair of Pharmacology, Cicely Roche, Senior Lecturer and Keith McLernon, Managing Director.


News

In the present environment, some pharmacies are only surviving by a thread. The noose is tightening for many. We are all aware of price reductions, FEMPI, budget cuts, general recession, cuts to the drugs' budget and the Government banking fiasco.

The question that we have to ask is: “Is there anything we can do?”

Of course, there is action that we can take. Our business survival depends on us. Our patients, our staff, our suppliers and our families depend on us.

So, we should continually review the following checklist.

Expenses - We have to always examine our expenses, particularly wages, rent and bank interest. We have to reduce expenses.

Stock Control - We have to reduce stock levels and the value of the stock that we hold on our shelves. We should never have more than 30 days' stock of any item, no matter what the incentive is.

Better buying - We should be trying to buy more competitively all the time. Increasingly, we have to look at dispensing Generics and Parallels. The savings for patients, for the State and for ourselves cannot be ignored.

VAT - We should each review our VAT system. If you are paying more than 2% of your turnover in VAT to revenue then you need to do an urgent VAT review. (See the IPU forum).

Category Management - The front of pharmacy (FOP) is becoming more important as the financial return from the dispensary declines. A good category management review and refit will increase FOP sales by up to 15%. This is also a chance to review new products and new services. (Flu Vaccination).

Personal Spending - We should all review our personal spending. Maybe now is a good time to destroy all of your plastic cards.

Errors - There are many business errors in the pharmacy. We have to check invoices and credit notes all the time. At present there are errors on invoices on a daily basis. The main area for errors are our own HSE claims and the PCRS printouts. Ostomy products are where most of the errors happen. The combined errors, if

Pharmacy Business SurvivalMichael Tierney, owner of Tierney’s Pharmacy, Rathdrum, Co. Wicklow

left uncorrected are about 1,000 euros a month. Keep a copy invoice with the copy prescription and check it against the PCRS printout.

Productivity - Improving our own productivity is essential. We have to improve staff productivity through staff motivation. Our staff is our most valuable resource. It is really important to appreciate our staff and to improve our attitude to patients and customers.

IT skills - We need to improve our IT and computer skills all the time. Next year, much of our CPD will be online. We may need to think about texting patients, etc.

Mergers - Mergers were originally viewed as heretical. No longer. We will have to look at mergers with our neighbours and, in particular we will have to examine the prospect of getting involved in nationwide pharmacy groups.

Lobbying - We will have to improve our lobbying of State agencies, drug companies, etc. The IPU is really excellent at lobbying. They secured the vaccination service for us. Vaccination is small this year, but the service will only grow and expand. We do need more active members in the IPU to

help with lobbying. The IPU also gives help to members.

The above may give a glimpse of what we have to do to survive. Put simply, we now either survive or die.

The author is a member of the IPU and serves on the Business Steering Group (BSG) and on the IPU VAT advisory group.

"Good category management will increase FOP sales"

Biography - Eamonn Brady MPSI is the owner of Whelehans Pharmacy in Mullingar. He graduated from the Robert Gordon University in Aberdeen in 2000 with a Masters in Pharmacy. He worked for Boots in the UK before moving back to Ireland in 2002. He bought Whelehans Pharmacy in Mullingar in 2005. He undertakes clinical training for nurses in the midlands.

CPD 13: WARFARIN

Warfarin

Sponsored by Pfizer

How it works?

Warfarin is described as a blood thinner; however, this is not an accurate description. Warfarin does not actually thin the blood or make it less viscous. The blood needs vitamin K to be able to clot. Vitamin K is absorbed from the intestinal tract and it is then absorbed by and stored in the liver. Subsequently, vitamin K is used during the production of clotting Factors II, VII, IX, X, the anticoagulant protein C and its cofactor protein S. Warfarin acts by reducing the absorption of vitamin K in the liver. Warfarin indirectly prevents the production of Factors VII, IX, X, and II by the liver as these factors need vitamin K to be produced by the liver. Warfarin effectively competes for the same absorption sites within the liver needed for vitamin K uptake. Thus the levels of vitamin K within the liver are reduced. Reduced amounts of clotting factors VII, IX, X, and II are produced, and the clotting action of the blood is progressively impaired.

It works indirectly so has no effect on clots already formed. It is used to prevent rather than treat clots. Therefore, it is ineffective in treating myocardial infarction and strokes because the clots have already formed. It takes about 24 hours to exert its effect and has a half life of 36 hours. Its peak effect can take up to 3 days and may last up to 5 days.

Vitamin K is given for warfarin overdose as it reverses the effect of warfarin.

60 Second Summary

Warfarin is an oral anticoagu-lant. Its role is to prevent blood clots. Its main use is to prevent clots with atrial fibrillation (a type of cardiac arrhythmia that can lead to blood clots), artificial heart valves, deep vein thrombosis, pulmonary embolism and strokes.

Warfarin is sometimes used post myocardial infarction. However warfarin is not as effective as antiplatelet drugs at preventing or treating clots in coronary arteries. Hence, antiplatelet drugs, such as clopidogrel or aspirin are more often used after myocardial infarction.

Nearly 40,000 people in Ireland use warfarin1 and this number is likely to rise in the coming years as the population becomes older and there are better screening techniques.2

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Contraindications

Warfarin should not be used during pregnancy (can cause foetal haemorrhage, particularly in the first and third trimesters), severe hypertension, renal impairment (avoid if creatinine clearance is less than 10ml/minute) and in patients with peptic ulcers.3

Checking warfarin level

The narrow therapeutic index of warfarin and number of factors that influence INR make choosing the optimal dose challenging. The dose of warfarin that should be taken is determined by measurement of the International Normalised Ratio (INR). This is a ratio of the patient's prothrombin time to an international standard. Put simply, this test measures the clotting tendency of blood as compared to an international

standard. INR became the internationally recognised standard to measure the activity of warfarin in the 1980s. Up until then there was no internationally recognised standard to measure activity of warfarin due to variations of prothrombin time assays in different areas. This lead to problems as the rate of globalisation increased and people became more inclined to cross borders. INR became recognised by the World Health Organisation as the international standard of warfarin activity in the 1980s.

Many factors influence how the body responds to warfarin, therefore INR needs to be checked regularly. Patient factors that influence dose response include age, body weight, nutritional status, acute and chronic disease states, and changes in concomitant drug therapy and diet.

PSN/2012/001

CPD 13: WARFARIN

The INR is normally checked at least once a month but more frequent checking may be needed, depending on the patient’s condition and factors such as diet, other medication and other illness. The INR level required varies depending on the condition but a level of between 2 and 3 is normally required. The risk of bleeding increases greatly with an INR of above 5.

The optimal INR is uncertain, but there are some general guidelines depending on the condition warfarin is being used for. An INR of between 2 and 2.5 is recommended for prevention of deep vein thrombosis, including surgery in high risk patients, while a level of between 2 and 3 is recommended for prevention of clots during hip surgery and fractured femur operations. An INR between 2 and 3 is recommended for atrial fibrillation, artificial heart valves made from tissue (usually using a valve of an animal like a pig)*, deep vein thrombosis, pulmonary embolism, transient ischaemic attacks and strokes. An INR of between 3 and 4.5 is needed in some situations because of the increased risk of clot. This includes recurrent deep vein thrombosis and pulmonary embolism, arterial disease including myocardial infarction and mechanical prosthetic heart valves*.

*An artificial valve is a device implanted into the heart when a patient’s heart valves are damaged, known as heart valve disease. There are many causes of heart valve damage, including hypertension and myocardial infarction. Heart valve disease disrupts the flow of blood through the heart and leads to symptoms, such as shortness of breath and weakness. There are two types of artificial valves used to substitute damaged valves, a mechanical valve, which

is made from metal or a tissue valve, which is when the valve of an animal (eg. pig). The

mechanical valve has the advantage that it can last indefinitely, however

it damages red blood cells which can lead to clots, hence the

need for long term warfarin. The tissue valve has the advantage that there is less risk of clot, which means that patients often do not need to take warfarin after getting one inserted. However, the major disadvantage of a tissue valve is that it doesn’t last as long as mechanical

valves, often needing to be replaced after 15 years.

How often should INR be checked?

INR should be checked daily or on alternate days after starting warfarin. After the patient leaves hospital; weekly INR checks are recommended for 4 to 6 weeks. After this, INR checks can be extended to once every 8 weeks if the patient is showing good control.4 Changes in the patient's medical condition such as heart disease, liver disease, thyroid status or change in drug therapy may alter anticoagulant control and will mean more frequent INR checks are needed.5

Indications

There are many indications for warfarin. The most common indications are the treatment and prevention of deep vein thrombosis and pulmonary embolism, prevention of clots with mechanical heart valves and atrial fibrillation.

Warfarin for Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia. AF occurs when the atria do not contract simultaneously. This means that blood flow through the atria is not as constant thus increasing the likelihood of clots. AF is frequently caused by cardiac problems such as hypertension, heart valve disease, left ventricular hypertrophy, coronary heart disease, cardiomyopathy or pericarditis. It may also be triggered by non-cardiac problems including hyperthyroidism, alcohol abuse, pneumonia and pulmonary embolism. Because AF is often asymptomatic, it frequently goes unrecognised and untreated. However the likelihood of stroke in patients with AF is approximately five times higher than that of the general population. The prevalence of AF in the population doubles with each advancing decade of age, from 0.5% at age 50-59 years to almost 9% at age 80-89 years.

The attributable annual risk for stroke associated with AF increases steeply from 1.5% at age 50-59 years to 23.5% at age 80-89 years. Warfarin can reduce the risk of stroke by 60 to 70 per cent.

Dose of warfarin

The usual starting dose is 10mg for 2 days. A prothrombin time should be measured prior to commencement of warfarin to assess liver function. The dose should be taken at the same time each day, usually between 5-7 pm, and the INR measured 16 hours later, i.e. between 9 and 11am the next morning.7

The starting dose should be lower in the following situations: prolonged prothrombin time, abnormal liver function tests, congestive heart failure, parental feeding, underweight patients (BMI less than 18), medication that increase the affect of warfarin and in the elderly (over 80 years). For most patients, the daily dose of warfarin tends to fall between 3mg and 9mg. However responses can vary widely between patients and in the same patient over a period of treatment. Rarely a patient may have a hereditary resistance to warfarin and require large doses of warfarin or may respond more effectively to a different type of oral anticoagulant.8 In the UK and Ireland, warfarin tablets come in three strengths and each has a universally agreed colour to distinguish strengths. Warfarin 1mg are a brown colour, warfarin 3mg are a blue colour and warfarin 5mg are a red colour.

Changing brands of warfarin

It is not good practice to swap brands of warfarin due to potential difference in bioavailabilities between different brands. There have been reports of clinically significant variations in INR when brands of warfarin were changed and the dose remained the same. If a brand must be changed for a patient, due to a shortage of one brand, it is good practice for the patient to get their INR checked 5 to 7 days after changing the brand. The patient should be counselled about the change and potential issues and given a patient information sheet.

Side effects

Bleeding is the most important complication of warfarin. Other possible side effects include nausea, vomiting, diarrhoea, rash and skin necrosis (usually occurs on days 3 to 8 of therapy). Skin necrosis is an extremely rare side effect of warfarin. However, if it does occur treatment must be obtained immediately. Skin necrosis is basically death of skin tissue and usually starts with red skin. Other possible side effects include alopecia (hair loss) and purple toe syndrome. Purple toe syndrome is a rare condition that

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CPD 13: WARFARIN

can occur in the first few weeks of warfarin treatment. It is caused by deposits of cholesterol collecting in the toes. Usually the big toe only is affected and it is characterised by a blue or purple colour and, sometimes pain. Warfarin may need to be stopped if it occurs. Jaundice is a sign of liver problems so must be investigated immediately if taking warfarin. There is some evidence of a link between warfarin and osteoporosis.

Precautions

Warfarin should be taken at the same time each day. This ensures accuracy of INR results. A missed dose must be recorded. A missed dose should be taken within 12 hours and the normal dosing schedule resumed the next day. Never double up the next day if a dose is missed. Over the counter (OTC) drugs should be used in caution. Aspirin and NSAIDs should be avoided as they increase risk of bleeding. Paracetamol is safe to take as a painkiller while taking warfarin. The IMB has said that currently available evidence, as reflected in the product information, suggests that occasional doses of oral paracetamol have no significant impact on the anti-coagulant effect of warfarin however, prolonged regular use may potentiate its effect. Significant changes in intake of food high in Vitamin K (e.g. liver, green leafy vegetables) affects the action of warfarin and more frequent monitoring may be required. Alcohol consumption below 2 units per day (one drink per day) has no effect on the INR but going above this level can affect INR. Weight reducing diets can affect INR level so rapid weight loss should be avoided. A patient must be monitored more closely if they are losing weight. Avoid drinking cranberry juice as it can affect warfarin levels.

Bleeding is the most common side effect of warfarin. It more often occurs in the first month of treatment and is more common in patients over 65.9 Signs of bleeding to watch out for include excessive bruising, bleeding gums, nose bleeds, blood in urine, blood in stools (can be characterised by red or black stools), coughing up blood, excessively heavy periods and severe headaches. Patients must get immediate medical attention if they are unable to stop bleeding, are involved in an accident or get a significant blow to the head. If a patient has a nose bleed while taking warfarin, they should lean their head forward and pinch below the bridge of the nose firmly for ten minutes. If a nose bleed lasts for more than 15 minutes or the patient is having regular nose bleeds, they should get immediate medical attention. Patients should carry anticoagulant booklets for the recording of INR results and anticoagulation dose. Contact sport, such as Gaelic football or rugby is best avoided when taking warfarin. Use a soft tooth brush to avoid bleeding of the gums. Take extra care

when shaving, an electric razor is preferable when taking warfarin.

Recommendations for bleeds

Checking the INR and omitting doses when appropriate is essential if bleeding occurs. The INR should be checked 2 to 3 days after omitting doses to ensure INR is falling.

The British Society for Haemotology guidelines10 for bleeding while taking warfarin are based on the result of INR and whether there is a major or minor bleed. The recommendation for major bleed is to stop warfarin; give phytomenadione (vitamin k) 5-10mg by slow intravenous injection. Give dried prothrombin complex (factors II, VII, IX, X) at a dose of 30-50 units/kg or fresh frozen plasma 15ml/kg if dried prothrombin complex not available.

If INR is greater than 8 and there is no sign of bleeding, stop warfarin and re-start when INR is less than 5. If there are other risk factors for bleeding, give phytomenadione (vitamin k) 500mcg by slow intravenous injection or 5mg by mouth. For partial reversal of anticoagulation (eg. High risk of clots) give

smaller doses of phytomenadione (0.5-2.5mg) using the intravenous preparation orally. Repeat dose of phytomenadione after 24 hours if INR if still high.

If INR is between 6 and 8 and there is no sign of bleeding, stop warfarin and re-start when INR is less than 5. If INR is less than 6 but more than 0.5 units above target value and there is no sign of bleeding, reduce dose or stop warfarin and re-start when INR is less than 5. If there is unexpected bleeding at therapeutic levels, always investigate the possibility of an underlying cause such as illness or drug interaction.

Interactions

Warfarin interacts with more medication and foods than most drugs. Many drugs increase the effect of warfarin, thus increasing the risk of bleeds. These include antifungal medication, such as fluconazole and itraconazole and antibiotics, such as clarithromycin, erythromycin, metronidazole, ciprofloxacin and tetracycline. Other drugs which increase the effect of warfarin include NSAIDs, amiodarone, cimetidine,


CPD 13: WARFARIN

omeprazole, phenytoin, simvastatin, tamoxifen and thyroxine. Some herbs increase the effect of warfarin including gingko biloba and devil’s claw. Some drugs reduce the effect of warfarin including some sedatives, carbamazipine and trazodone. Herbs that reduce the effect of warfarin include ginseng and green tea.

How long does warfarin need to be taken for?

The length of time that warfarin should be taken depends on many factors. It can vary from a few days to prevent a clot after a hip replacement to lifetime treatment for somebody treated with a mechanical heart valve. Every case is different, so how long warfarin needs to be taken is determined on a case by case basis. For example, someone who has a long term risk of clots such as atrial fibrillation will need to take it for at least six months.

Surgery

To reduce the risk of bleeding during surgery, warfarin is sometimes discontinued for a few days before surgery. The European Society of Cardiology recommends that for major surgical procedures an INR of 2.0 or below is required.

This may require discontinuation of warfarin for several days with the patient changed to heparin instead before and after elective surgery as heparin does not have a risk of bleeds. Generally, for patients with a low risk of clot, warfarin will be stopped 5 days prior to surgery. For patients with a high risk of clot, warfarin will be stopped 4 days before surgery and substituted with heparin. In both cases, warfarin is usually restarted as soon as oral fluids are tolerated by the patient after surgery.

Warfarin for elderly patients

There are often concerns about commencing warfarin in elderly patients where monitoring INR may be logistically difficult and there may be concern about the risk of bleeding, especially in a patient at risk of falls. However, these concerns lead to less people receiving the most effective treatment since elderly patients are at highest risk and, therefore have most to gain from anticoagulation. A 2007 study showed that warfarin is as effective in preventing strokes in AF patients over the age of 75 as it is in younger patients.11 The annual risk of extracranial bleeding in patients taking warfarin was 1.4% compared to 1.6% in those treated with aspirin and there was no increased risk of intracranial bleeding in those taking warfarin.

Summary of pharmacist counselling points

Discuss with the patient the reason warfarin is being taken, interactions and side-effects.Include information on:

• over the counter (OTC) drugs especially aspirin and NSAIDs

• significant changes in intake of food high in Vitamin K (e.g. liver, green leafy vegetables) affects the action of warfarin

• alcohol consumption

• signs of over anticoagulation e.g. excessive bruising, bleeding gums, severe headache, blood in urine, coughing up blood, excessive menstrual bleeding, etc

Warfarin should be taken at the same time daily to facilitate interpretation of INR results.

A missed dose must be recorded. It should be taken within 12 hours and the normal dosing schedule resumed the next day. Patients must immediately inform their GP if they have excessive or prolonged bleeding. Patients should carry anticoagulant booklets for the recording of INR results and anticoagulation dose.

References

1. Garcia-Alamino JM, Ward AM, Alonso- Coello P, Perera R, Bankhead C, Fitzmaurice D, Heneghan CJ. Self- monitoring and self-management of oral anticoagulation. Cochrane Database of Systematic Reviews 2010, Issue 4. Art. No.: CD003839. DOI: 10.1002/14651858.CD003839. Publication 2.

2. Fitzmurray DA, Murray DT, McCahon D, Holden R, Raferty JP, Hussain S, et al. Self management of oral anticoagulation: randomised trial. BMJ 2005 Nov 5; 331 (7524):1057-1059.

3. Joint Formulary Committee. British National Formulary 2011. 61st Edition.

4. Drug Therapeutic Bulletin 1992: 30; 77 – 80

5. Journal of Clinical Pathology 1990: Vol 43; 177 - 183.

6. Beglan TP, Keelan DM, Watson HG. Guidelines on warfarin oral anticoagulation (warfarin). Third Edition-2005 Update.

7. Guidelines and protocols advisory committee- British Columbia Health Services. Initiation and maintenance of warfarin. 2004.

8. Arch. Intern Med. 1985: 145; 499 – 501

9. Lancet 1996; volume 346: 423 – 428

10. Guidelines on Oral Anticoagulation (warfarin): third edition (2005 update). British Journal of Haematology 2005; 132: 277-285

11. Mant J, Hobbs FD, FletcherK, Roalfe A, Fitzmaurice D, Lip GY, Murray E; BAFTA Investigators; Midland Research Practices Network (MidReC). Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 2007;370:493-503

Disclaimer: The information expressed in this CPD article is that of the author and is independent of Pfizer Healthcare Ltd. and/or IPN Communications Ltd.

Pfizer Healthcare Ireland are committed to supporting the continuous professional development of pharmacists in Ireland. We are delighted to be partnering with Irish Pharmacy News in order to succeed with this.

Throughout the year, Irish Pharmacy News will deliver 12 separate modules of continuous professional development, across a wide range of therapy areas. These topics are chosen to support the more common interactions with pharmacy patients, and to optimise the patient experience with retail pharmacy.

We began the 2011 programme with a section on the Gastrointestinal System. Other topics include Diabetes (Types I and II), the Cardiovascular System, Smoking Cessation, Infections, Parkinson’s Disease, Alzheimer’s Disease, Depression and others. We hope you will find value in all topics.

Pfizer’s support of this programme is the latest element in a range of activities designed to benefit retail pharmacy. Other initiatives include the Multilingual Pharmacy Tool, a tailored Medical Communications Programme, Educational Meetings and Grants, our Patient Information Pack, new pharmacy Consultation Room brochures and other patient-assist programmes including the Quit with Help programme and www.mysterypain.ie.

If you would like additional information on any of these pharmacy programmes, please contact Pfizer Healthcare Ireland on 01-4676500 and ask for the Established Products Business Unit.


Irish Pharmacy Communications Ltd is proud to annouce the launch of the Irish Pharmacy Awards 2012. This much publicised awards ceremony takes place on May 19th at The Burlington Hotel, Dublin.

Over the next 15 pages we profile the 13 Awards categories, entry criteria and our prestigious panel of judges. Furthermore, we include all the details for how you can enter these exciting Awards.

Awards Entry Criteria

The closing date for entries is April 18th, 2012 at 12 noon sharp. Each entry should be supported by a statement of no more than 500 words, as to why the entrant feels he/she/they should win that particular category.

Each submission will be judged by our prestigious panel of Judges (detailed on the preceeding pages). Each category will have a winner and two runner-up winners. Short-listed candidates will be invited to a gala dinner and awards ceremony at the Burlington Hotel on May 19th, 2012. For further information please see website: www.ipnirishpharmacynews.ie

Criteria:

You may enter more than one category but each individual entry can only be submitted for a maximum of two categories

You will need to submit a 500 word summary with supporting information contained within your application

Entries should generally cover the 12 month period from January 2011 - December 2011

Leave enough time to put together your entry and supporting material. Before sending your entry, make sure you have included all of the relevant documents:

• Completed application form(s)

• 500 word summary

Entries can be submitted by post or email so that they reach Irish Pharmacy Communications Ltd by no later than MIDDAY, WEDNESDAY APRIL 18TH 2012

Please note that entries arriving after this time will not be included in the judging process.

Closing date for entries April 18th, 2012

All entries will be handled in the strictest confidence and will not be made available to any party not involved with judging the awards

Judging takes place on May 9th, 2012 when our pretigious panel of Judges will gather to further discuss shortlisted applications, confer and unanimously decide upon a winner for each Award category

Each finalist can choose how to use this time to best effect to give further information judges to assist with the entry and why they should win the category

The judge's decision is final and no correspondance will be entered into

Due to quanitity of entries feedback on individual entries cannot be given

Finalists and winners must be willing to give interviews to Irish Pharmacy News and Hospital Pharmacy News about their acheivements

Joan Peppard - Joan Peppard is President of the Hospital Pharmacists Association of Ireland. She is Chief Pharmacist at the Midland Regional Hospital in Tullamore, Co Offaly.

The Judging PanelPeter Wheedle - Peter is a community pharmacist with over 25 years’ experience serving his community and local nursing homes. He is an adjunct Professor of Clinical Practice at the School of Pharmacy, University College, Cork (UCC) and formerly Registrar at the Pharmaceutical Society of Ireland.

For more information visit www.irishpharmacyawards.ieTelephone Kelly Eastwood on 00353 (01) 602 4715


The Judging PanelProfessor Marek Radomski - Professor Radomski is a medical graduate of College of Medicine Jagiellonski University in Krakow, Poland and received his PhD in pharmacology from College of Medicine Jagiellonski University. A highly-cited pharmacologist, he has worked both in academia and pharmaceutical industry in Poland, UK, Spain, Canada and the USA. He joined School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin in 2006 as Professor and Chair of Pharmacology. He served as Director of Research in School of Pharmacy and currently serves as Head of School and ProDean Faculty of Health Sciences Trinity College Dublin.

Yvonne Sheehan - Yvonne is a pharmacy technician at AMNCH. She is currently President of the National Association of Hospital Pharmacy Technicians. Founded in 1997 the National Association of Hospital Pharmacy Technicians of Ireland, formerly known as 'National Association of Hospital Pharmaceutical Technicians', is the national voluntary association seeking to both ensure and continually improve upon professional, educational and practice standards for Hospital Pharmacy Technicians.

Brian Murphy - Brian Murphy is currently Director of Primary Care with the Health Service Executive. He was formerly National Primary Care Services Manager.

Austin Baird - Austin is Managing Director of the Ravenhill Group, a group of companies based in Lisburn, Co Down, involved in investment and development within the commercial property sector. Between 1988 and 2005 Austin developed the family pharmacy chain, Bairds Chemist, into Northern Irelands’ largest pharmacy group. During this period the group also developed its property portfolio, pioneering collaboration with other healthcare professionals in the creation of private health centres.

Gary Collins - Gary Collins is Managing Director with Cahill May Roberts. Founded 1902 Cahill May Roberts has grown steadily over the past 110 years to become the leading Pharmaceutical distribution and wholesaling company in the country. Today the company is a subsidiary of Celesio which is the largest European service provider for pharmaceuticals.

Jim Eastwood - Jim Eastwood was a finalist on the BBC programme 'The Apprentice' 2011. Educated at Harvard University, Jim is now Director with Groupon for NI and Ireland. Groupon has been hailed as the 'most exciting thing to happen to retail since ebay.'

Stephen McMahon - Mr McMahon is Chairman and co-founder of the Irish Patients' Association (IPA), based in Dublin, a voice for patients in Ireland. Stephen is a member of the Governing Board of the International Alliance of Patients’ Organisations (I.A.P.O.) a global voice for patients advocating patient centred care in over 60 countries. He is also a member of the Irish Council for Bioethics, and has served as the Irish Delegate on a Council of Europe expert group on Media and Health.

Dr Aisling O'Leary - Dr O’Leary graduated from the School of Pharmacy, Trinity College in 1986 and was awarded her Ph.D. in pharmaceutical chemistry in 1991. She has worked in a variety of settings pertinent to the practise of pharmacy including industry, primary care and hospital pharmacy. She is currently based within the School of Pharmacy at the Royal College of Surgeons, Ireland.

Laverne McGuinness - Laverne is National Director for Performance and Financial Management with the HSE. In her role she has responsibility for the delivery of all health and personal social services across the country including hospital, primary, community and continuing care services. This also includes management of an overall budget of €14bn and a statutory and voluntary sector workforce of 110,000.

John Corr - John Corr has a BSc Hons in Pharmacy from John Moores University Liverpool. After qualifying, he worked at the O'Brien Pharmacy Group in Liverpool until 1994, having also spent six months working in hospital pharmacy in AustraliaAfter returning to Ireland, John purchased a pharmacy at Clonshaugh in Coolock, Dublin 17 in 1995. He has since opened a further four community pharmacies of which he is superintendent pharmacist and company director. John has served on the Department of Health methadone implementation committee as nominee of the old PSI and has also experience working on behalf of community pharmacy contractors with the health service.


The Judging PanelRaymond Anderson - Qualified in 1980 and currently running two community pharmacy shops in Portadown. Raymond Anderson joined the Council of the Pharmaceutical Society of Northern Ireland in 1997, he was the Chair of Education from 1999 to 2001. He was elected Honorary Treasurer in 2001 and Vice-President in 2005 and was elected as the President 2006 -09. He has represented the Pharmaceutical Society of Northern Ireland on a variety of external Committees. In 2010 Raymond was elected President of the Commonwealth Pharmacists Association.

Mark Lambe - Mark Lambe is the OTC Category Buyer at Unicare Pharmacy. He is responsible for Over The Counter Medicines, Vitamins, First Aid, Medicated Skincare, Footcare and the Christmas categories.

Rosemary McGrath - Rosemary is the Managing Director of United Drug Wholesale. United Drug provides commercialisation solutions to healthcare companies. They specialise in supply chain, packaging, marketing and medical/regulatory services and operate in 5 international markets, and employ over 4,500 people.Their aim is to provide effective, outsource options that allow healthcare companies to bring their products to market efficiently.

Roy Hogan - Roy Hogan is Chairman of the Business Steering Group at the Irish Pharmacy Union. He is also a community pharmacist based at Parnell Pharmacy in Dublin.

David Fitzsimons - David Fitzsimons is Chief Executive Officer of Retail Excellence Ireland. David was involved with the establishment of CREST sixteen years ago when he worked with South Dublin Chamber of Commerce. David oversees the strategic direction and operations of this not for profits organisation.

Biddy O'Neill - Biddy O'Neill was previously Interim Assistant National Director of Health Promotion and is now Director of Health Promotion with the Health Service Executive.

Brendan O'Connell - Brendan is Managing Director of Allphar Services Ltd. Brendan, who has worked at various levels in the wholesale and also agency distribution business since 1979,was appointed as a Director and General Manager of Allphar Services in 2002 and as Managing Director in 2006. He holds an Honours Degree in Business Studies.

Mark Beddis - Mark is the superintendent pharmacist at Tesco Pharmacy in Ireland. Mark was previously superintendent pharmacist at DocMorris/Unicare Pharmacy for two years and was on the Irish Pharmacy Union's Employee Pharmacists' Committee from 2005 to 2010. He obtained his BSc Hons pharmacy degree at the University of Brighton in 1997.

Keith Harford - Keith Harford is the Commercial Director at Pharbiz Ltd and Director of Advanced Business Services (ABS). Keith was Life Pharmacy Leader at Uniphar PLC where he led a team of six pharmacists and retailers, to develop what would become Ireland's first pharmacy franchise model. Before that Keith was the Strategic Repositioning Manager at IPOS after having worked in management at Superquinn for over twenty years.

John Arnolds - John Arnolds works with Health Express Ireland. Health Express Pharmacy is specifically created, stocked and staffed to understand and meet the needs of the modern Irish consumer.

Professor Caitriona O'Driscoll - Caitriona O'Driscoll is Professor of Pharmaceutics in the School of Pharmacy, University College Cork. She received a B.Sc. in Pharmacy from University College Dublin in 1976 and a PhD in 1983 from the University of Dublin, Trinity College. In 1977 she joined the faculty of the School of Pharmacy in Trinity College and held the posts of lecturer (1977-1994) and senior lecturer (1995-2003) in Pharmaceutics. In 2003 she was appointed as Professor of Pharmaceutics at UCC and was, at the same time, appointed as the first Head of the School of Pharmacy, UCC - a position she held until 2009.


Hospital Pharmacyof the Year

Sponsored byRoche Products (Ireland) Limited

Members of the hospital pharmacy team have a direct involvement in patient care, influencing treatment choices by being central to decision-making at the point of prescribing. Being part of a number of different teams, from nursing staff to consultants, internal departmental co-operation is essential.

The Hospital Pharmacy of the Year Award seeks to reward the pharmacy staff members of any hospital pharmacy department in Ireland; those who can show vision in improving patient care whilst supporting fellow colleagues. The categorywill recognise a team who has played a part in a health structure with minimal financial resources yet increasing pressures. Applicants will be expected to highlight how they have overcome such obstacles.

The definition of a team for this particular award is two or more people working within the same hospital in either day to day work or in a particular task or project.

Criteria:

How have you demonstrated good practice through team working?

What services of excellence have you undertaken or offered over the last 12 months?

What relevant obstacles did you encounter and how were these overcome?

How have you differed from other hospital pharmacy teams and what opportunities have you exploited?

What has been the broader contribution to the profession?

Applicants should be able to demonstrate:

Outstanding achievement on the job, actions that constitute performance beyond expected standards

An ability to contribute to the maximum utilisation of departmental resources

Involvement in interesting, challenging or new areas of practice

Improved performance or service as a result of team working

At Roche, we have built our success on innovation. We are leaders in providing pharmaceutical and diagnostic solutions that make a profound difference in people’s lives. We play a pioneering role in healthcare by creating innovative products and services for the early detection, prevention, diagnosis and treatment of diseases. These diseases include oncology, rheumatology, virology, transplantation, diabetes and immunology. Our diagnostic tools also assist researchers and clinicians working in the fields of clinical chemistry, molecular diagnostics, histology and research.

In Ireland, we contribute on a range of fronts to improving people’s health and quality of life. Roche has provided some of the first products that are tailored to the needs of specific patient groups (better known as Personalised Healthcare). We work in partnership with a broad base of healthcare professionals, healthcare facilities, professional bodies and patient organisations across the country to ensure that the diagnostics and pharmaceutical treatments we deliver meet the medical needs of today and of the future.

Our mission, today and tomorrow, is to create, produce and market innovative healthcare solutions of high quality for unmet medical needs.

Hospital Pharmacyof the Year

Hospital Pharmacyof the Yearof the Yearof the Yearof the Year

www.irishpharmacyawards.ie


Pharmacy Teamof the Year AwardSponsored byMcNeil Healthcare (Ireland) Ltd As Henry Ford once said: "Coming together is a beginning. Keeping together is progress. Working together is success!"

Great teamwork involves a number of key professionals directing their individual visions towards a united objective, hard work and the ability to utilise one another's strengths and skills.

This award is open to any pharmacy team offering an innovative process or service that pushes the boundaries. The juding panel will be considering applications that clearly demonstrate how the partnerships within the pharmacy business have impacted on patient care, staff motivation and morale, giving the pharmacy a competitive advantage.

The winner of this award must be able to demonstrate how a particular example of teamwork has improved the pharmacy, enhanced customer loyalty or enabled entry into new markets or product ranges. Judges will look for effective, innovative and forward-thinking teams.

This award will credit the team who have shown excellent levels of customer service backed by clear standards and adequate monitoring performance. The judging panel will look for evidence of clearly thought-out customer care strategies and proof of their delivery including client and customer satisfaction.

Criteria:

How big is the team and how is it structured?

How are team members motivated and team spirit fostered?

What is your methodology in going about a typical project? For example do you hold routine weekly or monthly meetings?

What is the evidence of your success as a team?


A pharmcy team of no less than 3 people

A team working within the same independent pharmacy or a group of individuals working together across a pharmacy chain

Staff working together to continually exceed customer expectations in all areas of their business

Evidence of customer satisfaction

McNeil Healthcare (Ireland) Ltd is delighted and proud to be this year’s sponsor of the IPN Pharmacy Team of the Year.

Over many years of working together with Irish pharmacy, McNeil Healthcare (Ireland) Ltd is only too aware of the valuable contributions pharmacy staff make to the community and to society as a whole. Their contributions extend above and beyond the role of dispensing prescriptions to the provision of valuable services such as support on disease management, advice on medicines and check up consultations.

This role is only to going to expand and accelerate. Society is going to be even more reliant on the provision of these services and access to healthcare in general that pharmacy provides. Pharmacy staff therefore will have the opportunity to embrace these challenges and to demonstrate their professionalism and enthusiasm in delivering enhanced healthcare service management to society. The Pharmacy Team of the Year will embrace the learning of new skills and demonstrate a real passion for taking on new challenges.

McNeil Healthcare (Ireland) Ltd, is part of the Johnson & Johnson Group of Consumer Companies. We embrace research and science - bringing innovative ideas, products and services to enhance the health and wellbeing of people. Our team in Ireland have long since been a supporter of Irish pharmacy and staff and we look forward very much to continued support and partnership. New innovations and training activities across the portfolio of brands will play a key role in delivering and enhancing that support to Irish pharmacy and to the Pharmacy Team of the Year.

Pharmacy Teamof the Year

Pharmacy Teamof the Yearof the Yearof the Yearof the Year



Actavis Academy Business Development

of the Year Award - Independent

Sponsored by Actavis AcademyPharmacy has never been more competitive and to simply rely on customer loyalty and doing what you have always done is not enough to keep your business growing. Independent pharmacy's are ideally positioned to succeed despite facing aggressive competitors. In order to push ahead and develop they must show they are more than just a pharmaceutical distributor. What are you doing to grow your business and what is your prescription for success?

The Business Development of the Year (Independent) Award seeks applications which can demonstrate an innovative approach to creating new strategies for driving the pharmacy business. Examples may include business relocation to larger or improved premises, a drive to offer enhanced patient/customer service and expansion of offered initiatives.

Entries should look at timescales, objectives and results and can touch on success in terms of sales, training, recruitment, customer service or other developments. Judges will be looking for a business initiative that stands out in terms of its scale, scope or approach.

Criteria:

Why did you change your business model?

How did you make the change? Include details of the process and outcome

What, if any, was the budget and how was this managed?

What was the evidence that the changes were beneficial?

In undertaking your business development, how did you take into account the pharmacy's current brand and future goals? Has the business development application submitted helped achieve these goals and how?


Outstanding achievement in all areas of business including performance against business objectives;

Success in overcoming challenges to drive forward the business;

Staff involvement and motivation to meet business objectives;

Future plan for continued growth of the business

Business Development

Actavis is one of the world’s leading player’s in the development, manufacture and sale of high-quality generic pharmaceuticals with operations in over 40 countries.

Globally the company has built a strong reputation for the production and efficient delivery of first class generic pharmaceuticals at affordable prices. There are currently over 830 Actavis products on the market worldwide and over 330 products under development and pending registration. These products are currently sold in markets all over the globe including the EU, US and Japan.

Actavis entered the Irish market in 2008, having identified it as a key market in Europe. Based in Cork with a dedicated sales and marketing team, Actavis is committed to providing pharmacists with long term sustainable value across a broad product portfolio. This commitment is based on a partnership approach with pharmacists with value, choice, service & support central to Company’s offering.

Actavis is delighted to be a proud sponsor of the “Actavis Academy Business Development Award”. This award is very closely linked with Actavis’ focus on the development of long-term partnerships, which evolve through added value services, education and development

The Actavis Academy was set up to support the development, education and training of pharmacists and to help them grow and develop their business.

Business Developmentof the Year - Independent

Business Developmentof the Year - Independent



BusinessDevelopmentof the YearAward - ChainSponsored by Irish Pharmacy NewsOpen to all pharmacy's with a minimum of 5 shops

This Award serves to recognise those who have displayed success in terms of sales, training, recruitment, customer service, product development or other areas of business development. Entries should demonstrate an innovative approach to creating new business, and outline the timescales, objectives and results of the initiative.

Judges will look for a business initiative that stands out in terms of its scale, scope or approach. This award will credit the individual or company that has demonstrated excellent levels of customer service backed by clear standards and adequate monitoring performance. The judging panel will look for evidence of clearly thought-out customer care strategies and proof of their delivery including client and customer satisfaction.

The winner of this award must be able to demonstrate, within the context of an overall strategy, how a particular initiative has improved market share, enhanced customer loyalty or enabled entry into new markets. Entries should indicate results against targets.

Criteria:

How have you and your team shown a strong business, sales and marketing strategy?

Outline examples of innovation and ambition

How have you demonstrated strong leadership in driving the business forward?

Demonstrate a comprehensive system for evaluation of training programmes including value for money, performance improvement statistics and examples of the benefits gained

How will improved performance be maintained and how will learning be used to move the organisation forward?


Excellent and outstanding achievement in all aspects of their organisation

Strong growth, innovation and leadership as well as a clear vision

How their people development strategy has improved business performance and created a committed, motivated and effective workforce

Irish Pharmacy News is proud to sponsor the Business Development of the Year (Chain) Award as this is an area we as a company are passionate about. IPN Communications are dedicated to working with Ireland's pharmacy market as the industry's professionals strive to build on previous successes, creating a stronger future. For us, it's the ability to work with pharmacy's, their owners and management teams to plan for the long term, grow the industry and transfer wealth from one generation to the next.

Pharmacy has many unsung heroes, so this Award is a great opportunity for us to be able to support the ongoing dedication and commitment, and help showcase the businesses that are the foundations of the Irish pharmacy market.

IPN is dedicated to helping pharmacy's and their owners succeed.

THE INDEPENDENT VOICE OF PHARMACY

Business Developmentof the Year - Chain

Business Developmentof the Year - Chain



Hospital andCommunity Pharmacy

Alliance AwardSponsored by Hospital Pharmacy News

Good patient care depends on teamwork between the members of the entire healthcare team, including both community and hospital pharmacists. The aim of this award is to highlight inspirational multidisciplinary working. Entries should show how groups of people have worked together to make a difference to the care of patients and those close to them. They may discuss the difficult process of developing an effective team and of overcoming barriers. Alternatively, the focus may be on systems that facilitate the communication of the information needed for different professions to bring their skills to help patients. Examples of cross-disciplinary learning and support will also be considered.

The winners of this award must be able to demonstrate, within the context of an overall strategy, how a particular initiative has improved patient care, enhanced services available and benefited cross-discipline working. Entries should indicate results against targets.

Criteria:

Clear demonstration of multidisciplinary working established to review procedures and modernise patient experience

Development and results of new care pathways

Evidence of assessment and documentation of objectives, targets and outcomes

How have you/the team worked together in identifying team membership and roles

How will the team move forward into the future? Please give examplesof anticipated further working relationships


Excellent and outstanding achievement in all aspects of their organisation

Strong growth, innovation and leadership as well as a clear vision

How their people development strategy has improved business performance and created a committed, motivated and effective workforce

Community Pharmacy

Hospital Pharmacy News is proud to sponsor the Hospital and Community Pharmacy Alliance of the Year Award. Hospital Pharmacy News is dedicated to working with Ireland's pharmacy market as the industry's professionals strive to build on previous successes, creating a stronger future. For us, it's the ability to work with pharmacy's, their owners and management teams to plan for the long term, grow the industry and transfer wealth from one generation to the next.

Team working is an essential aspect for success. Within Ireland we are witnessing more frequently multidisciplinary working between hospital and community pharmacists and their staff; with the ultimate goal of improving health initiatives for patients, whether that is in a hospital or community setting.

Pharmacy has many unsung heroes, so this Award is a great opportunity for us to be able to support the ongoing dedication and commitment, and help showcase the businesses that are the foundations of the Irish pharmacy market.

Hospital Pharmacy News is dedicated to helping pharmacy in Ireland continue to drive success, even in the face of obstacles, challenges and adversity.

Hospital and Community Pharmacy Alliance

Hospital and Community Pharmacy Alliance



Innovation in Service Development Award(Chain 5 + pharmacies) Sponsored by Clonmel HealthcareThis award will give recognition to the winning entry which demonstrates continuous innovation at the forefront of the pharmacy market; leading the way for others to follow. The judges will choose a winner based on core competence, offering patients a bespoke service with clear objectives, improving the reputation of the industry overall.

Team or individual entries will be considered. Entries should demonstrate a unique approach to creating new business, outlining timescales, objectives and results. The entry could touch on success in terms of sales, training and customer service as long as it relates to pharmacy. Judges will be looking for evidence of individuals or businesses that stand out in terms of implementation, scope or fresh approach.

Judges will be looking for exceptional work, including research, that has resulted in an improved patient experience, improved health outcomes, or a greater level of efficiency and effectiveness of service.

Criteria:

Applicants showing novel techniques or originality in provision of services, demonstrably superior to previous delivery of care

Genuine improvements in the delivery of care to the local community

Describe how the need for the service development was identified and the particular role of the team in addressing it

How can this project be transferred to other locations or pharmacy's to enable improvement of service delivery more widely?


A truly unique approach to the delivery of care or to service development

In-depth description of identified need, core objectives and results

Evidence of improved outcomes for patients

Evidence of increased levels of efficiency and/or effectiveness of service

(Chain 5 + pharmacies)

In 2006 Clonmel Healthcare embarked on a brand redevelopment strategy following the findings of a major customer research report commissioned by the company. In early 2007 the new corporate identity was launched. The new distinctive brand mark represents Clonmel Healthcare’s core values of quality, customer service and dynamism and retains the strength of our heritage and strong link to our Irish roots.

Clonmel Healthcare currently has a large portfolio of products covering three distinct business units; Prescription medicines, Speciality medicines and the ClonMedica Consumer Division. Our prescription products cover a wide range of therapeutic areas including CNS, cardiovascular, NSAID, gastro-intestinal and anti-infectives. Within the Special Products Division we have medicines for the treatment of Parkinson’s disease, Testosterone Deficiency Syndrome and the management of diabetes. The ClonMedica product range focuses on three main areas; women’s and babies health, skincare and health supplements.

Our commitment is to provide efficacious, cost effective, prescription and non prescription medicines to patients and healthcare professionals.

Innovation in Service Development (chain+5)

Innovation in Service Development (chain+5)Development (chain+5)Development (chain+5)Development (chain+5)



CommunityPharmacist of the

Year AwardSponsored by Pinewood Healthcare

* This Award may be entered through individual application or nomination

The Community Pharmacist of the Year Award is one of the most prestigious. The recipient of this award will be selected for their professional excellence, exemplary service and dedication to advancing the profession and public health.

At the forefront of community care, pharmacists are often the first point of contact for patients seeking their advice and knowledge on a range of areas of medication issues. The judging panel will be looking for someone who can display that they are always ahead of the curve in a service that gains more prominence each year as pharmacists distinguish themselves from their competitors by finding additional ways to fulfill their patients' health needs.

Criteria:

How have you/they made a contribution which has helped advance the profession?

What services or innovations have you/they been instrumental in developing?

What additional members of the team did you/they engage in achieving the objectives of the above, such as contacting neighbouring pharmacy's in a health promotion initiative or lobbying the HSE?

What challenges have you/they encountered and how did you overcome them

What tools or systems have you/they developed that will directly impact care or the profession and/or serve as a template for other professionals to follow?


Examples of furtherment of the profession of pharmacy through community service and embodied those qualities of attitude and leadership which exemplified the profession

Leadership qualities, problem solving skills, adaptability and perserverance and an ability to motivate

An understanding the goals of pharmacy, and significantly contributes to how these goals may be accomplished

Pinewood Healthcare was established in 1976 and is the leading and fastest growing branded generic company in Ireland. Currently employing over 350 people, the company manufactures liquids, creams/ointments and powders from it’s Tipperary facility and also markets and distributes branded generics to retail pharmacies throughout Ireland and supplies a wide range of services and pharmaceuticals to hospitals from its purpose built facility in Dublin.

With a broad product portfolio, Pinewood Healthcare’s product range includes antibiotics, cardiovascular, analgesic, dermatological, gastrointestinal, CNS, rheumatology, hormonal, urological, dietetic, respiratory and allergy products.

This extensive product portfolio coupled with excellent sales and marketing expertise has generated strong and sustainable growth in sales over many years. An increasing proportion of the Company's profits are reinvested in their product development programme. This commitment has resulted in an extensive number of new product launches in recent years. Pinewood Healthcare last year saw the successful launch of a number of new products and 2012 will see further expansion of its product portfolio with 9 more products being launch.

Quality products, competitively priced, delivered on time and backed by individual customer service, technical advice and marketing support has always been Pinewood Healthcare’s commitment to customers and they take pride in delivering on this commitment.

Ireland’s No. 1 Generic Healthcare Specialists

20 mg & 40 mg gastro-resistant capsules, hard

Esomeprazole

Nexazole

Nexazole: for the treatment of erosive reflux oesophagitisPrescribing Information for Nexazole 20 mg & 40 mg gastro – resistant capsules, hard. Qualitative and Quantitative Composition: Each capsule contains 20 mg or 40 mg of esomeprazole (as esomeprazole magnesium dihydrate). Pharmaceutical Form: Hard, gastro-resistant capsule: Slightly pink body and cap, containing white to almost white pellets. Therapeutic Indications: Treatment of erosive reflux oesophagitis. Prevention of relapse of healed oesophagitis in long-term management of patients. Symptomatic treatment of gastroesophageal reflux disease (GERD). Eradication of H. pylori concurrently given with appropriate antibiotic therapy for treatment of H.pylori-associated ulcers. Treatment of NSAID-associated gastric and duodenal ulcers in patients requiring continued NSAID-treatment. Prophylaxis of NSAID-associated gastric ulcers and duodenal ulcers in patients at risk requiring continued therapy. Prolonged treatment after i.v. induced prevention of rebleeding of peptic ulcers. Treatment of Zollinger Ellison Syndrome. Dosage and Method of Administration: Capsules should be swallowed whole with liquid. The capsules can be opened and the pellets mixed in half a glass of non-carbonated water or if desired this solution administered through a gastric – tube in patients with swallowing difficulties. The capsules and / or contents should not be chewed or crushed. Treatment of erosive reflux oesophagitis: 40 mg once daily for 4 weeks. Long-term management of patients with healed oesophagitis to prevent relapse: 20 mg once daily. Symptomatic treatment of gastroesophageal reflux disease: 20 mg once daily. Eradication of H. pylori for treatment of H.pylori-associated ulcers: 20 mg with 1 g amoxicillin + 500 mg clarithromycin, all twice daily for 7 days. NSAID associated gastric & duodenal ulcers: 20 mg once daily for 4 – 8 weeks. Prophylaxis treatment: 20 mg once daily. Prolonged treatment after i.v induced prevention of rebleeding of peptic ulcers: 40 mg once daily for 4 weeks. Zollinger Ellison Syndrome: Initial dose is 40 mg once daily. Dosage should be individually adjusted. Daily doses up to 160 mg have been used. If the required daily dose exceeds 80 mg, it should be divided and given twice daily. Severe liver impairment: Patients should not exceed a max. dose of 20 mg. Contraindications: Hypersensitivity to esomeprazole or to any of the excipients. Esomeprazole should not be administered with atazanavir. Pregnancy and breast-feeding due to insufficient data. Children under 12 years. Special warnings and precautions for use: The possibility of a malignant gastric tumour should be excluded as Nexazole may alleviate symptoms and delay diagnosis. Regularly monitor patients on long-term treatment. Patients on on-demand treatment should contact their physician if symptoms change in character. If esomeprazole is used in combination with antibiotics, then the instructions for the use of these antibiotics should also be followed. Treatment with esomeprazole may lead to slightly increased risk of gastrointestinal infections such as Salmonella and Campylobacter. Contains sucrose – Patients with rare hereditary problems of fructose intolerance, glucose – galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine. Drug Interactions: Esomeprazole can affect the absorption of ketoconazole and itracanazole. Dose reduction may be required when administered with drugs metabolised by CYP2C19 as esomeprazole may increase their plasma concentration. Monitor patients when given in combination with warfarin or other coumarine derivatives. Undesirable effects: Common: Headache, abdominal pain, constipation, diarrhoea, flatulence, nausea/vomiting. Shelf Life: 2 years. Marketing Authorisation Holder: Pinewood Laboratories Ltd., Ballymacarbry, Clonmel, Co. Tipperary. Marketing Authorisation Holder Number(s): PA 281/146/1-2. This medicine is a prescription only product. Further prescribing information is available on request. Date of revision of text: July 2010.

Nexazole_IPN_A4.indd 1 27/07/2010 11:40:05

Community Pharmacistof the Year

Community Pharmacistof the Yearof the Yearof the Yearof the Year



Health Promotionof the Year AwardSponsored byPfi zer Healthcare IrelandChronic diease is one of the major causes of death and behavioural factors including smoking, obesity and alcoholism are amongh the biggest contributing factors. Pharmacists are ideally placed to offer advice and guidance on health promotion services and initiatives.

Pharmacists are increasingly involved in specific health promotion areas and activities, acting as health advisors to patients. Health promotion is now a core role for community pharmacists, being the key group offering opportunistic advice those who want to stop smoking or adopt healthier lifestyle choices.

The judges of the Health Promotion Award will be looking for those who can show ambition in this field, through achievement of betterment in their local community's overall wellbeing.

Criteria:

What health promotion initiatives have you undertaken within your pharmacy in the last twelve months?

Explain how you went about achieiving your goals and the subsequent results?

How did you involve other members of the pharmacy team?

How have you made a difference to your customers?


A 'can-do' attitude with a drive to set and achieve objectives whilst sticking to time-frames and budget

Genuine benefits to the health of the local community

Examples of working with and involving the wider multi-disciplinary team

The management skills and ability to turn an idea into a practical, lifestyle changing initiative

Pfizer Working Together for aHealthier World®

At Pfizer, we apply science and our global resources to improve health and well-being at every stage of life. We strive to set the standard for quality, safety and value in the discovery, development and manufacturing of medicines for people and animals. Our diversified global health care portfolio includes human and animal biologic and small molecule medicines and vaccines, as well as nutritional products and many of the world's best-known consumer products.

Every day, Pfizer colleagues work across developed and emerging markets to advance wellness, prevention, treatments and cures that challenge the most feared diseases of our time. Pfizer has been based in Ireland for over 40 years and employs over 4000 people across 8 locations. Consistent with our responsibility as the world's leading biopharmaceutical company, we also collaborate with health care providers, governments and local communities to support and expand access to reliable, affordable health care around the world.

Health Promotionof the Year

Health Promotionof the Yearof the Yearof the Yearof the Year



Counter Assistantof the

Year AwardSponsored by Sanofi

* This Award may be entered through individual application or nomination

It is a given that community pharmacies play a vital role in the health of their local population and as counter assistants are often the first point of contact for customers they are an integral part of the team.

If you don't take care of your customers, someone else will and the winner of this award will be someone who has brandished the aptitude and skill-mix necessary for improving the pharmacy customers' experience, offering them a knowledgable service.

As Roger Staubach once said; "There are no traffic jams along the extra mile!" Judges will want to see leadership by example, those applicants who have integrated with the pharmacy team and eagerly taken advantage of key educational opportunities in order to be able to offer a holistic heath promotion service.

Perhaps you have taken the initiative and introduced a new educational campaign within your pharmacy, established new guidelines or procedures for smoother operation or undertaken further study to develop new skills in clinical excellence? If so, this is the category for you!

Criteria:

What have you/they offered your pharmacy above the expected?

How have you/they worked with other members of the team?

What benefits have you/they brought the customer?

What lessons have you/they learned and how do you/they plan on putting these into everday practice?

Why are you/they most deserving of this award?


Key skills including always giving the customer more than they expect

Loyalty to and a desire to progress the profession

Ambition for better understanding of the retail element of pharmacy business

An undertaking of further education to improve skill mix

Sanofi, one of the world’s leading global healthcare companies, discovers, develops and distributes healthcare solutions to improve the lives of people around the world.

Our commitment is to provide the most efficient and reliable medicines to patients and also to improve their quality of life. Through partnerships with pharmacists; physicians; nurses and other healthcare professionals; as well as professional healthcare bodies and patient groups, we work actively to save lives and promote health.

Sanofi Ireland Ltd. provides patients and healthcare professionals with efficient and effective therapeutic solutions to diseases in areas of expertise: thrombotic and cardiovascular diseases, diabetes, central nervous system disorders, internal medicine and oncology.

Through our Pharmacy Care Team, Sanofi-aventis has been working closely with Irish pharmacists for a number of years in both Consumer Health and prescription medicines. We look forward to working with pharmacists around the country to improve the health of Irish people.

Our aim is to help pharmacists deliver better therapeutic solutions and services to their patients – because health matters.

Counter Assistantof the Year

Counter Assistantof the Yearof the Yearof the Yearof the Year



Young Community Pharmacist of theYear AwardSponsored byTeva Pharmaceuticals Ireland* This Award may be entered through individual application or nomination

The healthcare and pharmacy landscape is evolving and changing on a rapid basis. For those who have only recently entered the profession it is a challenging time. The Young Community Pharmacist of the Year Award is designed to recognise those who have made an immense impression and/or impact on the field of pharmacy in Ireland since embarking upon their career.

Today's young pharmacists have the sole responsibility of carrying the vision for the profession into the future. The judges for this category will be looking for those who openly embrace the challenges and opportunities and who display a determined desire to make a difference to patient outcomes.

The winner of this award will be able to show motivation, commitment and integration with the rest of the pharmacy and healthcare team.

Criteria:

What new project or services have you/they been involved in since starting your/their career in pharmacy?

How have you/they directly been responsible for improved outcomes for patients?

How have you/they integrated with and worked within a wider multidisciplinary team?

How have you/they extended your role within the pharmacy team?

Why do you/they deserve to win this Award?


A dedication and commitment to furthering the profession into the future

Innovation and forward thinking in expanding the role of the pharmacist

Working on initiative and within a team effort

Teva Pharmaceuticals is a leading global pharmaceutical company, committed to increasing access to high-quality healthcare by developing, producing and marketing affordable generic drugs. Teva's branded businesses focus on neurological, respiratory and women's health therapeutic areas as well as biologics in the oncology area. Medicinal products developed through biotechnology constitute an essential element of healthcare delivery to patients today and many medicines in the Teva development pipeline are biotechnology products.

Like the pharmacy sector, Teva also provides significant employment in Ireland, at its site in Waterford, which is focused on the research, development and production of next generation inhalation products for the treatment of respiratory conditions and at the commercial division based in Dundalk.

At Teva, we recognise and understand the challenges and opportunities facing community pharmacy today and we are committed to continuing to support community pharmacists through these changing times.

Young Pharmacistof the Year

Young Pharmacistof the Yearof the Yearof the Yearof the Year



Locum of theYear Award

Sponsored by TTM Healthcare

* This Award may be entered through individual application or nomination. We will accept nominations from anyone who was a locum during Jan 2011-Dec 2011 who has since gained full-time employment

Working as a Locum pharmacist is a flexible yet challenging task. Locums have the opportunity to work across a broad spectrum, from independents to chain, from town to town and sometimes on desired days. No two days in a working environment will be the same offering the chance to experience different practices and prescribing.

However it is not without its drawbacks. Being employed on such a varying schedule it may be difficult to establish working relationships. With a lack of regularity it is up to the locum to remain dedicated and hard-working to ensure the highest quality of patient care is maintained in the absence of a set agenda.

The Locum of the Year Award is designed to showcase those who, in facing the above, strive to excel in the services they are temporarily offering. Those who highlight the integral role of locums in maintaining frontline services in a sector facing the dual challenge of rising demands and tigether budgets.

Criteria:

What new services or initiatives have you/they brought to the pharmacy profession?

How have you/they measured the success of these?

How have you/they linked with additional members of the pharmacy team or profession as a whole?

What impact have you/they had on the pharmacy's customers and customer service as a whole?


Long-term, consistent dedication leading to the advancement of the profession

Contribution in any area of practice such as long-term care, smoking cessation etc

Working as part of a team within a particular pharmacy or within a number of pharmacies they have been employed in as a locum

An apparent desire for the furtherment of the profession

Sponsored by

TTM Healthcare is pleased to be able to support the Locum of the Year Award. TTM Healthcare is the largest independently-owned Healthcare recruitment business in Ireland with operations in Ennis, Cork and Dublin and international offices in London and Warsaw. A wholly Irish owned business founded in 2002, it has come along way.

As we approach our 10th anniversary we have chosen to give particular pride of place to our highly successful and ever growing Pharmacy divison.

TTM Pharmacy has a vision, a path to transform your recruitment exeperience and to take you to a place where sourcing the best people will mean just that. Where our uniqueness is our ability to source internationally based, and the best of Irish trained pharmacists, and pharmacuetical staff for our clients. and further to be able to to provide end to end recruitment solutions.

We recognise that the landscape is changing, TTM success has been well grounded in its ability to change, adapt and above all remember that its clients its candidates and its people are at the very root, the foundation on which future success will be built. With these foundations well layed we recruit with your business future in mind.

To underline our commitment to ethical recruitment practice we are members of the National Recruitment Federation, the Institute of Personnel Management and the Recruitment and Employment Confederation. TTM’s recruitment processes and procedures hold ISO 2001 quality accreditation and our systems are regularly independently audited.

TTM healthcare has grown by simply providing an outstanding service. And will continue to do so. With over 60 employees we are very proud of our achievements, but have much left to do. We recognise that to grow we must move forward. “The end of rainbow is always at the other side of the mountain at TTM.....!”

Locum of the YearLocum of the Year



Hospital Pharmacistof the YearSponsored byRoche Products (Ireland) Limited* This Award may be entered through individual application or nomination

The field of Hospital Pharmacy within Ireland has been blessed with some of the most brilliant professionals in Europe. As they say, the cream always rises to the top! Working to ensure patients in the hospital setting receive the best treatment, providing advice and help in all aspects of their medicines, the role of a hospital pharmacist often goes beyond this remit. Perhaps you know someone whose vision and dedication deserves recognition and reward.

The Hospital Pharmacist of the Year Award recognises individuals who have clearly demonstrated their excellence in the profession during the last twelve months. On shortlisting applications and choosing a subsequent winner, judges will be looking for an individual who can demonstrate creativity and ‘thinking outside the box’ in contributing to the field of hospital pharmacy throughout Ireland.

Applicants will be able to show how they, or their nominated colleague, have consistently met or exceeded challenging objectives to ensure the highest quality of provision of hospital pharmacy services.

Criteria:

What is your,their background in hospital pharmacy and how long have you/they been involved in this area in Ireland?

What campaigns or initiatives have you/they been involved in within the last twelve months in the field of hospital pharmacy?

What has been the success/outcome of these?

What benefits have others derived from your/their activities?

What has been exceptional about your/their contribution? What have you/they gained from your work in this field?


Open to any Pharmacist working within a Hospital Pharmacy Department in Ireland

Supporting information with applications must relate to the past twelve months

An individual who has had a significant impact in the area of Hospital Pharmacy

Someone who has had involvement in shaping any aspects of Ireland's Hospital Pharmacy arena

An ability to demonstrate outstanding commitment and contribution

Evidence of an ability to identify opportunities and develop them through initiative and strong interpersonal skills

Those nominating a candidate for this Award must include their own name and contact details. All information will be handled in the strictest confidence

At Roche, we have built our success on innovation. We are leaders in providing pharmaceutical and diagnostic solutions that make a profound difference in people’s lives. We play a pioneering role in healthcare by creating innovative products and services for the early detection, prevention, diagnosis and treatment of diseases. These diseases include oncology, rheumatology, virology, transplantation, diabetes and immunology. Our diagnostic tools also assist researchers and clinicians working in the fields of clinical chemistry, molecular diagnostics, histology and research.

In Ireland, we contribute on a range of fronts to improving people’s health and quality of life. Roche has provided some of the first products that are tailored to the needs of specific patient groups (better known as Personalised Healthcare). We work in partnership with a broad base of healthcare professionals, healthcare facilities, professional bodies and patient organisations across the country to ensure that the diagnostics and pharmaceutical treatments we deliver meet the medical needs of today and of the future.

Our mission, today and tomorrow, is to create, produce and market innovative healthcare solutions of high quality for unmet medical needs.

Hospital Pharmacistof the Year

Hospital Pharmacistof the Yearof the Yearof the Yearof the Year



Innovation in Service Development Award

(Independent)Sponsored by IPN Communications Ltd

Innovation breeds success. The applicants for this award category will be able to show how their business has substantially improved in areas of performance and commercial success. Judges will be looking for those who openly display achievements which are oustanding for the size of your pharmacy.

These achievements may range from invention, design, production, performance in services or products, marketing and support for local patients.

The winning applicant will be able to demonstrate a uniquely innovative approach to the delivery of care to patients. Furthermore, we are looking for those who have operated to a greater level of efficiency and effectiveness.

The innovation should demonstrate truly novel techniques or originality, obviously superior to previous delivery of care to the same patient population. The innovation should demonstrate a genuine improvement in the delivery of healthcare.

Criteria:

Applicants showing novel techniques or originality in provision of services, demonstrably superior to previous delivery of care

Genuine improvements in the delivery of care to the local community

Describe how the need for the service development was identified and the particular role of the team in addressing it

How can this project be transferred to other locations or pharmacy's to enable improvement of service delivery more widely?


A truly unique approach to the delivery of care or to service development

In-depth description of identified need, core objectives and results

Evidence of improved outcomes for patients

Evidence of increased levels of efficiency and/or effectiveness of service

Irish Pharmacy Communications Ltd is proud to sponsor the Innovation in Service Development (Independent) Award. IPN Communications are dedicated to working with Ireland's pharmacy market as the industry's professionals strive to build on previous successes, creating a stronger future.

Innovation is what gives life to a business in a market economy. The businesses that never get going or if they do, then fail or fail later under pressure of a changing economy or marketplace have all failed to innovate appropriately. In today’s fast paced working environment, creativity and innovation is a prerequisite for success, and perhaps even for survival. That is why creativity and innovation are now moving to the top of the agenda for most businesses around the country.

This Award will recognise the exceptional work ongoing by independent pharmacists in Ireland, which has resulted in an improved patient experience and/or improved health outcomes.

Innovation in Service Development (Independent)

Innovation in Service Development (Independent)IPN Communications Ltd

IPN Communications Ltd. 1 Knockbreda Park, Belfast, BT6 0HB Telephone Number: 00 44 2890 801195 Company Registration Number: NI604707 VAT Number: 970848678


2012 SUNGLASSES COLLECTION

Rathfarnham, Dublin 14, Ireland.

T: 01 2968080 F: 01 2965084

W: www.oceanhealthcare.ie • E: [email protected]

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Vitamins and Minerals

Vitamins and minerals are essential sources of nutrients, which the body needs in small amounts so that it can function properly. Most people should be able to obtain all the nutrients that they need by eating a varied and balanced diet. Pharmacists should make their patients aware that, if they are taking vitamin and mineral supplements, taking too much or taking them for too long, can cause harmful effects.

The following contains some useful information on vitamins and minerals that are essential for a person's health.

VitaminsThere are two types of vitamins: fat-soluble and water-soluble.

Fat – soluble vitaminsVitamin A - Vitamin A comes from two sources. One group comes from animal sources and are called retinoids, which includes retinol. The other group come from plants and are called carotenoids, which includes beta-carotene.

Absorption and storage - Approximately 70% to 90% of vitamin A from the diet is absorbed in the intestine. The absorption of vitamin A continues to be high (60-80%) as intake of the vitamin increases. Absorption of vitamin A is very fast, with maximum absorption occurring two to six hours after digestion.

Within the intestinal lumen, vitamin A is incorporated into a micelle and absorbed across the brush border into the enterocytes. Within the enterocyte, precursors of vitamin A (carotenoids) are converted to active forms of the vitamin.

What it is used for - Vitamin A is essential for growth, bone development, vision, reproduction, epithelial differentiation, brain development, pattern formation during embryogenesis, and hematopoiesis.

Vitamin A can help those with the following conditions:Anaemia Cystic fibrosisLeukoplakiaMeasles Night blindness

Dosage recommendations - For the average person 7,500 mcg of Vitamin A a day is safe. Recommendations for pregnant women are being re-determined. Currently, experts believe that less than 3,000 mcg is safe. Larger amounts could cause birth defects.

Toxicity - Hypervitaminosis A occurs when there is too much vitamin A in the body. Symptoms include:

Abnormal softening of the skull bone (craniotabes -- infants and children), blurred vision, bone pain or swelling, bulging fontanelle (infants), changes in consciousness, decreased appetite, dizziness double vision (young

children), drowsiness, increased intracranial pressure, liver damage, nausea, skin and hair changes, cracking at corners of the mouth, hair loss, oily skin and hair (seborrhea), skin peeling, itching, yellow discoloration of the skin and vomiting.

Vitamin D - Vitamin D is the body’s primary regulator of calcium homeostasis. It aids with bone mineralization and skeletal development.

Absorption and storage - The body makes vitamin D from cholesterol through a process triggered by the action of the sun's ultraviolet B rays on the skin.

Vitamin D undergoes two hydroxylations in the body for activation. Calcitriol (1,25-dihydroxyvitamin D3), the active form of vitamin D, has a half-life of about 15 hours, while calcidiol (25-hydroxyvitamin D3) has a half-life of about 15 days. Vitamin D binds to receptors located throughout the body.

What it is used for - Vitamin D helps the body to maintain necessary insulin blood levels. Vitamin D receptors are located in the pancreas, where insulin is produced. Supplementation might increase the secretion of insulin in those with type 2 diabetes.

Vitamin D has been used in those with the following health problems: Crohn’s Disease, Cystic Fibrosis, Osteoporosis and Rickets/osteomalacia.

It has also been demonstrated in human and animal studies that vitamin D can provide protection from autoimmune arthritis, multiple sclerosis, and juvenile diabetes.

Dosage recommendations - Vitamin D in supplement form can be obtained as vitamin D2 (ergocalciferol) or as vitamin D3 (cholecalciferol). Multivitamins generally contain vitamin D. Recommended dosage is 5-10 mcg each day.

Elderly patients and those with malabsorption syndromes, hepatic failure, and nephritic syndrome can receive supplements with 1,250 mcg, weekly for an eight week period. This should only be done under GP supervision.

Toxicity - Hypervitaminosis D is a condition that occurs after taking excessive doses of vitamin D. An excess of vitamin D in the body causes abnormally high levels of calcium in the blood which can eventually do severe damage to the bones, soft tissues, and kidneys. Symptoms include:

Constipation, decreased appetite (anorexia), dehydration, fatigue, irritability, muscle weakness and vomiting

Vitamin E - Vitamin E is a group of fat-soluble chemical substances that are biologically and structurally similar to alpha-tocopherol. Its precise biochemical role remains unknown.

Absorption and storage - Absorption of Vitamin E is highly dependent upon the

same processes that are utilized during fatty acid digestion and metabolism. Micelle and chylomicron formation are critical to both fat and vitamin E absorption. A lack of any component of these transporters will inhibit carrier formation and in turn vitamin E absorption. After the vitamin E passes through the enterocyte, the vitamin E is packaged into a chylomicron and prepared for circulation.

Once in the blood 15% to 45% of the total vitamin E intake can be absorbed by the cells. Researchers have found that the uptake of vitamin E correlates negatively with increasing doses of vitamin E.

What it is used for - The main function of Vitamin E within the body is to act as an antioxidant. Vitamin E also helps the body to process glucose. Some trials have shown that vitamin E might be helpful in treating and preventing diabetes and it has been suggested that it may provide protection against cancers and heart disease because of its antioxidant activities.

Vitamin E may protect the body against toxins, premenstrual syndrome, eye disorders such as cataracts, neurological diseases such as Alzheimer’s disease, ultraviolet radiation, and diabetes. There is no sufficient evidence to show that vitamin E enhances male fertility, sexual prowess, exercise performance, or that it can work to reverse the effects of skin aging. It may provide relief for muscle cramping.

Dosage recommendations - Recommended doses of vitamin E can vary from 100mg to 400 mg each day. However, recent studies have demonstrated that high levels of vitamin E (270mg) increase death by about 10% in patients over 60. There has been no increased risk of death with doses of 133mg per day or less, and there is evidence to suggest such doses might be of some benefit.

Toxicity - In most healthy adults, short-term supplementation of vitamin E is well tolerated and present minimal side effects. However, the long-term safety of vitamin E supplementation is questionable. Data suggests that there is a possible increase in mortality and in the incidence of heart failure with long-term use of vitamin E in patients with chronic diseases.

Vitamin K - There are three types of vitamin K. Vitamin K1, phylloquinone, found in foods; vitamin K2, menaquinone, which is made in the small intestine of the body; and vitamin K3, the synthetic form, called menadione.

Vitamin K is needed for blood clotting and there is increasing evidence that vitamin K is also needed to help stregthen bones.

Absorption and storage - Vitamin K is absorbed from the jejunum and ileum. Absorption depends on the presence of bile and pancreatic juices and is enhanced by dietary fat. Although the liver is the main

Vitamins and Minerals


Vitamins

storage site, vitamin K is also found in extrahepatic tissues, e.g. the bone and heart.

Compared with other fat-soluble vitamins, the total body pool of vitamin K is small and turnover of vitamin K in the liver is rapid.

What it is used for - Vitamin K is essential for the functioning of several proteins involved in blood coagulation.

Vitamin K helps the body to absorb Calcium and recent studies have suggested that vitamin K can help to treat or prevent osteoporosis and the loss of bone density.

Dosage recommendations - Adults need approximately 1mcg of vitamin K a day for each kilogram of their body weight.

Any vitamin K that the body does not need immediately is stored in the liver for future use, so it is not needed in the diet every day.

Toxicity - There is no known toxicity associated with high doses of the phylloquinone (vitamin K1) or menaquinone (vitamin K2) forms of vitamin K. However, studies have shown that the menadione form of vitamin K (K3) can be toxic.

Menadione can interfere with the function of glutathione, one of the body's natural antioxidants, resulting in oxidative damage to cell membranes.

Water - soluble vitaminsVitamin C - Also known as ascorbic acid.

Absorption and storage - Intestinal absorption of vitamin C depends on the level of dietary intake, decreasing with increasing intake levels. At an intake of 30mg to 180mg, about 70% to 90% is absorbed. About 50% of a single dose of 1g to 1.5g is absorbed and only 16% of a single dose of 12g is absorbed.

The storage capacity of water-soluble vitamins is generally low compared to that of fat-soluble ones. Humans have an average tissue store of vitamin C of 20 mg per kg of body weight.

What it is used for - Vitamin C has an immune stimulating effect and also acts as an inhibitor of histamine, a compound that is released during allergic reactions.

Vitamin C is a powerful antioxidant and can neutralise harmful free radicals and helps to neutralise pollutants and toxins. As such, it is able to prevent the formation of potentially carcinogenic nitrosamines in the stomach. Vitamin C is also able to regenerate other antioxidants such as vitamin E.

Vitamin C is needed for the synthesis of collagen and when combined with zinc, is important for healing wounds.

Vitamin C contributes to the health of teeth and gums by preventing haemorrhaging and bleeding.

Vitamin C also improves the absorption of iron from the diet and is needed for the metabolism of bile acids which may have implications for blood cholesterol levels and gallstones.

Finally, vitamin C has a crucial role to play in the eye's ability to deal with oxidative stress and can delay the progression of vision-loss in combination with other antioxidant vitamins.

Dosage recommendations - Doses can range from 500mg to 2 grams daily. Doses are sometimes increased to 4g or 5g daily, when a patient is trying to fight off a cold. This is done to cause antihistaminic action from the vitamin C.

Toxicity - Daily doses of 5g for a period of 4 weeks may inhibit Helicobacter pylori in the stomach and lead to stomach upset and diarrhoea.

Vitamin B6 - It allows the body to use and store energy from protein and carbohydrates in food, helping to form haemoglobin.

Absorption and storage - The human body absorbs vitamin B6 in the jejunum. Phosphorylated forms of the vitamin are dephosphorylated and the pool of free vitamin B6 is absorbed by passive diffusion.

Because it is a water-soluble vitamin, it cannot be stored.

What it is used for - Vitamin B6 is used to treat heart disease by reducing blood levels of homocysteine, a chemical that might be linked to heart disease and it is used to help clogged arteries to stay open after a balloon procedure to unblock them (angioplasty).

Women use vitamin B6 (pyridoxine) to treat premenstrual syndrome (PMS), "morning sickness" (nausea and vomiting) in early pregnancy, to stop milk flow after childbirth and to treat depression related to pregnancy or using birth control pills, and symptoms of menopause.

Dosage recommendations - Adults aged 19-50 years should have a daily intake of 1.3mg.

It is recommended that men over the age of 51 should have a daily intake of 1.7mg, whilst women in the same age group should take in 1.5mg of vitamin B6 daily.

It is needed in the diet every day because it cannot be stored in the body.

Toxicity - Vitamin B-6 toxicity cannot occur from eating natural foods, but it can occur from supplementing with its synthetic form, pyridoxine. The recommended dietary allowance of vitamin B-6 for adults is no more than 1.7 mg daily, but toxicity is not thought to occur until ingesting at least 100 mg daily for many weeks consecutively.

Too much vitamin B6 can lead to a loss of feeling in the arms and legs, known as peripheral neuropathy.

Vitamin B12 - Vitamin B12 is the largest and most complex of all the vitamins. The name vitamin B12 is generic for a specific group of cobalt-containing corrinoids with biological activity in humans.

Absorption and storage - Vitamin B12 from food sources is bound to proteins and is only released by an adequate concentration of hydrochloric acid in the stomach.

Gastrointestinal absorption of vitamin B12 occurs in the small intestine by an active process requiring the presence of intrinsic factor, a glycoprotein, which the gastric parietal cells secrete after being stimulated by food.

Estimates of total vitamin B12 body content for adults range from 0.6 mg to 3.9 mg.

What it is used for - It helps the body to make red blood cells and keeps the nervous system healthy, it helps release energy from our food and it is needed to process folic acid. Recent studies have shown that it is also important for women who intend to become pregnant. Mothers with low levels of vitamin B12 are more likely to have a baby with a neural tube defect like spina bifida than mothers with higher levels of B12.

Dosage recommendations - Adults need approximately 1.5 mcg a day of vitamin B12. Because vitamin B12 is not found in foods such as fruit, vegetables and grains, vegans may not get enough of this vitamin.

Toxicity - There is not enough evidence to show what the effects may be of taking high doses of vitamin B12 supplements each day.

Niacin (vitamin B3) - There are two forms of niacin - nicotinic acid and nicotinamide - both of which are found in food.

Absorption and storage - Niacin is absorbed in the intestine and is stored primarily in the liver. Any excess is excreted through the urine. Excessive consumption of sugar and starches will deplete the body’s supply of niacin, as will certain antibiotics.

What it is used for - Niacin is an important B vitamin that can raise a patient’s High Density Lipoprotein (HDL), “good” cholesterol. It has been used since the 1950s to lower elevated Low Density Lipoprotein (LDL), “bad” cholesterol and triglyceride (fat) levels in the blood.

Niacin helps the digestive system, skin and nerves to function. It is also important for converting food into energy.

Dosage recommendations17mg a day for men


Vitamins

13mg a day for women

Niacin cannot be stored in the body, so it is needed in the diet every day.

Toxicity - Some severe symptoms of Niacin toxicity include:

JaundiceBlurry visionStomach ulcersElevated blood sugarWorsening of diabetesYellow tinge to eyes and skinNiacin in high quantities has been shown to cause liver damage in some people.

Vitamin B2 (Riboflavin) - Vitamin B2 is important for body growth, red blood cell production and helps to release energy from carbohydrates.

Absorption and storage - Because vitamin B2 is water-soluble, it is not stored by the body and must be added to the diet on a daily basis through food sources or supplementation. Vitamin B2 is easily absorbed through the walls of the small intestine.

What it is used for - The body requires vitamin B2 for the metabolism of amino acids, fatty acids, and carbohydrates. It is needed to activate vitamin B6 (pyridoxine) and helps to create niacin. It may be used for red blood cell formation, antibody production, cell respiration, and growth.

Vitamin B2 also eases watery eye fatigue and may be helpful in the prevention and treatment of cataracts. Vitamin B2 is required to keep the mucus membranes in the digestive tract healthy and helps with the absorption of iron and vitamin B6.

Dosage recommendations1.3mg a day for men1.1mg a day for women

Vitamin B2 cannot be stored in the body, so it is needed in the diet every day.

Toxicity - There is no known toxicity associated with vitamin B2. However, prolonged ingestion of large doses of any one of the B complex vitamins, including vitamin B2, may result in high urinary losses of other B vitamins. It is often best to take a full B complex with any one B vitamin.

Thiamin (vitamin B1) - Works with other B-group vitamins to help break down and release energy from food.

Keeps nerves and muscle tissue healthy.

Absorption and storage - Absorption of thiamin into the body requires adequate supplies of vitamins B6, B12, and folic acid. A deficiency in vitamin B12 can increase the loss of thiamin in the urine, and vitamin B6 also appears to help regulate distribution of thiamin throughout the body.

What it is used for - Thiamin works with the other B vitamins to change protein, carbohydrate, and fat to energy. Thiamin is also essential for the functioning of the heart, muscles and nervous system.

Dosage recommendations 1mg a day for men0.8mg a day for women

Thiamin cannot be stored by the body so it is

needed in the diet on a daily basis.

Toxicity - Because thiamin is a water-soluble vitamin, it is not likely to reach toxic levels. There is little danger of thiamin toxicity when it is taken orally. However, it has been reported to cause anaphylactic shock in some people when taken intravenously. Symptoms of a thiamine overdose may include a feeling of warmth, weakness, sweating, nausea, restlessness, difficulty breathing, tightness of the throat and a blue tinge to the skin.

Folic Acid - Folic acid is one of the B vitamins. Folic acid and folate are both terms used to describe this vitamin. Folic acid describes the chemical compound, pteroylmono glutamic acid, which is commonly used as a vitamin supplement. Folate is the general term used to refer to any of the protein-bound or other conjugated forms of folic acid, which are forms generally found in foods.

Absorption and storage - The body readily absorbs up to 90% of folic acid (the form found in supplemements). Folate or protein-bound folic acid compounds cannot be absorbed until they are modified by enzymes in the body. As little as 50% of folate can be absorbed.

What it is used for - Folic acid acts as a coenzyme with vitamin B-12 and vitamin C in the metabolism of proteins and in the synthesis of new proteins. It is necessary for the production of red blood cells and the synthesis of DNA, as well as tissue growth and cell function. It also increases the appetite and stimulates the formation of digestive acids.

Synthetic folic acid supplements may be used in the treatment of disorders associated with folic acid deficiency, and may also be part of the recommended treatment for certain menstrual problems and leg ulcers.

Dosage recommendations - Adults need 0.2mg of folate a day and because it cannot be stored by the body, it should be consumed daily.

Women who plan on having children need 0.4 mg to 0.8 mg of folic acid so that their offspring will be less likely to have birth defects.

Toxicity - Folate intake from food is not associated with any health risk. The risk of toxicity from folic acid intake from supplements and/or fortified foods is also low. Because it is a water soluble vitamin, any excess intake is usually lost in the urine. There is some evidence that high levels of folic acid can provoke seizures in patients taking anti-convulsant medications.

MineralsCalcium - Calcium is the most abundant mineral in the body.

Absorption and storage - Serum calcium is very tightly regulated and does not fluctuate with changes in dietary intakes. The body uses bone tissue as a source of calcium to maintain constant concentrations of calcium in blood, muscle, and intercellular fluids.

The remaining 99% of the body's calcium supply is stored in the bones and teeth where it supports their structure and function. Bone itself undergoes continuous remodelling, with constant resorption and deposition of calcium

into new bone.

What it is used for - Calcium is required for vascular contraction and vasodilation, muscle function, nerve transmission, intracellular signalling and hormonal secretion, though less than 1% of total body calcium is needed to support these critical metabolic functions.

Dosage recommendations• Children aged 4 to 10: 800 mg

• Males from adolescence through adult: 800 to 1200 mg

• Women from adolescence though adult: 800 to 1200 mg

• Women during pregnancy and breastfeeding: 1200 to 1500 mg

• Post-menopausal women who do not take estrogen:1500 mg

Toxicity - An excessive intake of calcium can interfere with the absorption of zinc, magnesium, iron, phosphorus and other nutrients. An increased intake of calcium in the diet increases requirements for magnesium, which is also important for bone health.

Iron - Make red blood cells, which carry oxygen around the body.

Absorption and storage - Iron absorption occurs predominantly in the duodenum and upper jejunum. The physical state of iron entering the duodenum greatly influences its absorption. At physiological pH, ferrous iron (Fe2+) is rapidly oxidized to the insoluble ferric (Fe3+) form. Gastric acid lowers the pH in the proximal duodenum, enhancing the solubility and uptake of ferric iron. When gastric acid production is impaired (for instance by acid pump inhibitors such as the drug, Omeprazole), iron absorption is reduced substantially.

What it is used for - It is used to make the oxygen-carrying proteins haemoglobin and myoglobin. Haemoglobin is found in red blood cells and myoglobin is found in muscles. Iron also makes up part of many proteins in the body.

Low iron levels over a long period of time can lead to iron deficiency anaemia. Symptoms include lack of energy, shortness of breath, headache, irritability, dizziness, or weight loss.

Those at risk for low iron levels include:

Women who are menstruating, especially if they have heavy periods, women who are pregnant or who have just had a baby, long-distance runners, strict vegetarians, patients with any type of bleeding in the intestines (for example, a bleeding ulcer), people who frequently donate blood and people with gastrointestinal conditions that make it hard to absorb nutrients from food.

Dosage recommendations8.7mg a day for men14.8mg a day for women

Toxicity - It is unlikely that an adult patient would consume too much Iron. However, children can sometimes develop iron poisoning by swallowing too many iron supplements.

Patients with anaemia, who require frequent blood transfusions also are at risk of developing chronic iron toxicity.


Out and About

Last November, the Royal College of Surgeons (RCSI) saw 150 students graduate from its MPharm programme and awarded a total of 51 students with a BSc in Pharmacy. Overall, the RCSI conferred 717 students with undergraduate degrees and postgraduate awards at three different conferring ceremonies in the College. This was the largest number of students to graduate from the College in any one day.

RCSI confers latest cohort of pharmacy graduates

Yanette Bueno Diaz, Colm McDermott, Sinead Sullivan, Tadhg Reddan (Masters in Pharmacy Graduates)

Aine O’Connor, Bernard Rice, Mary Brennan, (Masters in Pharmacy Graduates)

Maryam Al Obaidly (BSc Pharmacy Graduate)


Out and About

Suhanniya Logeswaran, Rachael Stewart, Gillian Doyle (BSc Pharmacy Graduates)

Gillian Doyle (BSc Pharmacy Graduate)

Catherine Sweeney, Paul Hennelly, Sandra Sullivan, Jenny Reynolds (Masters in Pharmacy Graduates)

Aileen Cullen (BSc Pharmacy), Rachel Brady(BSc Pharmacy)


Finance

How much should I pay fora pharmacy?

How do you value a pharmacy in the current uncertain environment particularly with the threats facing the industry from issues such as government legislation and depressed consumer spending?

While the method of valuing a pharmacy has changed in recent years from a multiple

of turnover to a multiple of maintainable earnings, the key elements in arriving at the valuation amount remains the same. All of the methods used are rules of thumb aimed at arriving at an estimate based on a theoretical framework.

The value of any business asset is based on the projected future

cash flows from that asset, the perceived risk of achieving those returns and the cost of capital.

Maintainable earnings

This is the level of profitability you believe the pharmacy can maintain in future years. It will be arrived at after establishing the future turnover, gross margins and operating costs of the business.

Turnover

This will comprise dispensary sales and front-of-shop sales. As the dispensary is likely to represent 80% of the turnover, in my opinion the most important issue in determining the maintainable earnings is the number of items the pharmacy will dispense in future years. While margins and operating costs are very important, if the pharmacy is not attracting enough customers the investment will fail no matter how well you manage your margins and costs.

How do you estimate the number of future items you will dispense?

This will be arrived at by considering the following:

• Historical trends

• Industry trends

• Opportunities to increase volumes

• Threats

Historical and industry trends

Historical trends will be available from the seller based on the financial statements of the pharmacy and reports from the pharmacy dispensary system. The most up-to-date

information should be used and should be cross checked with the HSE returns. The turnover should be analysed by historic performance, Government scheme ( GMS/DPS), % of business with each GP, and nursing home business if any.

Industry trends on dispensing volumes are available from sources such as the HSE; general pharmacy sales from Retail Excellence Ireland; population demographics can be obtained from the latest census figures.

Historical facts and trends do provide a solid indicator of how the pharmacy will perform in future years but other growth opportunities and threats to the business must also be considered.

Opportunities

Typically these will occur where the seller may have been satisfied with the existing level of business and may not have made any serious attempt to actively grow the business. The following issues will need to be considered:

• Is there an opportunity to relocate the business and radically change the earnings potential of the pharmacy?

• Is there room for improvement in the relationship with the local GPs?

• Would the pharmacy benefit from refurbishment?

• Has the pharmacy been marketed properly? Have all local voluntary groups and retirement homes been visited? Have customer evenings been held?

Diarmuid Hayes


• Is there room for the level of service provided to be increased?

• Consider whether the staffing levels are appropriate e.g. has there been an overdependence on locums?

• In the front of shop, is there an opportunity for growth through improving the product offering or provision of incentive-based linked sales training to staff?

How do you measure these factors? For example what impact will a refurbishment have? A well thought out and properly executed refurbishment can add 20% to your turnover however a refurbishment can also have little impact if customers do not see the value in it. Clearly there is a considerable degree of analysis and subjectivity involved in assessing the impact.

It is important to realise that a strong degree of professional judgement is required in measuring these factors. While each case is different an experienced adviser will have dealt with similar issues and will be in a position to give a reasonable estimate of the impact these factors will have on projected turnover.

Threats

Turnover can be adversely impacted by the following factors

• Loyalty to existing owner.

• Increased competition – The entry of large multiples into the pharmacy market with in-store pharmacies, additional pharmacies opening.

• Government legislation - Prescription charges/Reference pricing changes.

• Relationship with GPs – Overdependence on one practice.

• Nursing homes – If the business has nursing home income they can easily transfer their business to another pharmacy.

Similar to assessing the growth

opportunities professional judgement will also be required in measuring these factors.

Gross margins

As the selling price of the item dispensed is largely determined by the HSE it is understandable that you may believe that there is little opportunity to improve the gross margin. The rollout of in-store pharmacies in Tesco and the impending introduction of reference pricing create further downward pressure on margins.

With all this downward pressure on margins is there anything can be done to influence margins?

• Increase the level of PIs(Parallel Imports) and generic purchases

• The target pharmacy may have a low % of purchases from PIs and generics and margins can be significantly enhanced by increasing the use of generics and PIs.

• Improving quality of HSE returns

• Are rejects followed up?

• Stock management

• Through negotiation with suppliers and monitoring stock levels it is possible to reduce your stock holding costs as a lot of cash is tied up unnecessarily holding excess stock.

Reference Pricing

How do you allow for the impact of reference pricing when you don’t know for certain when it will be introduced and what its impact will be? In the absence of specific implementation guidelines the most practical way is to make an allowance per item dispensed in the projections for future years.

Operating costs

It is important to establish what the true running costs of the business are - usually the main elements will be the property costs, wages and salaries. Once-off items such as the sale/loss on disposal of fixed assets and special pension

contributions need to be excluded from determining the annual operating costs.

Property costs

If the property is held on a long term lease it is important to note when the next review is due in order to factor in any potential increases. The outcome will primarily be decided by the difference, if any, between the existing rent and the market rent currently being achieved in the locality.

If a new lease is being entered into it is advisable to insist on a break clause as it provides you with the flexibility to relocate the business in a cost effective manner.

Wages and Salaries

It is important that a wages figure is reflective of the level of business that is projected in the turnover figure as opposed to historical figures. When looking at historical figures it is important to identify costs which will not be necessary when the business is acquired. Typically the owner’s pension contributions and salary may be in excess of what is required to run the pharmacy.

It is also worth noting that employees of the pharmacy are entitled to terms and conditions no less favourable than when they were previously employed.

Multiple

Having established the maintainable earnings figure how do you know what multiple to use?

Applying a multiple to a business is a subjective process and will depend on current market forces and the growth potential of the pharmacy. Typically the higher the earnings the higher the multiple you will pay. Where possible it is very important to establish comparables in order to determine what price should be paid.

Also, there is no absolute value for any business asset, it is dependent on a party’s view

of the future, assessment of the risk(s) involved and attitude to risk, cost of capital, and strategic or other motivations.

Valuing a business may appear risky but with detailed due diligence an accurate assessment can be made of the expected future earnings of the pharmacy, upon which a value can be based.

Deal structure

As this is likely to be one of the most significant investments you will make it is important to build in some safety mechanisms to the deal such as:

• Deferred consideration subject to agreed performance targets.

• Break clauses and turnover rents in cases where new leases are being established.

In summary valuing a pharmacy is a complex and sometimes subjective process with a very high degree of professional judgement required. It is very important that you receive proper professional advice and ensure you do not pay an unreasonable price for your investment.

About the Author

Diarmuid Hayes, BComm, ACA is a Corporate Finance Manager with Horwath Bastow Charleton in Limerick. Diarmuid trained with KPMG Cork and has over 15 years commercial experience working in financial services in London before relocating back to Ireland where he worked in the mobile telecoms and pharmaceutical sectors. In Horwath Diarmuid supervises the structuring of BES investments as well as providing corporate finance to the firm’s large and medium sized clients on valuations, sale of business and due diligence.

Email: [email protected]

Finance


Clinical Profi leCircadin 2mg prolonged-release tablets (melatonin) EU/1/07/392/x

Change in representative office, distribution channels and pack sizeFrom January 16th 2012 marketing responsibility for Circadin in Ireland will be transferred to Flynn Pharma from Lundbeck Ireland Ltd. Distribution will be by Phoenix Healthcare, Dublin.

For stock enquiries contact Phoenix Healthcare, 01-8068600

Medical enquiries should be directed to Flynn Pharma, [email protected], 0044 1438 727822.

The current 21 tablet pack will be replaced by a 30 tablet pack which will be available from all major wholesalers. The price per tablet is unchanged.

Prescribers have been notified of the pack change but prescriptions may be received for 21 tablets while the transition takes place. 21 tablet packs will continue to be available until stocks are exhausted. Prescribing software is being updated.

Olanzapine 20mg film-coated Tablets – Unique OfferingClonmel Healthcare is delighted to announce the launch of Olanzapine 20mg film-coated tablets, in addition to our existing strengths -

2.5mg, 5mg, 7.5mg, 10mg, and 15mg.

Clonmel Healthcare is the only company currently offering a 20mg film-coated tablet on the Irish market.

Olanzapine is the most recent addition to our anti-psychotic product portfolio.

Olanzapine 20mg is available in a 28 pack.

Full prescribing information for Olanzapine is available on request or go to www.clonmel-health.ie . This Product is subject to medical prescription. Olanzapine is GMS reimbursable from 1st January 2012.

Please contact Clonmel Healthcare on 01-6204000 if you require any additional information on Olanzapine.

Dovonex® Cream 30g Pack Launch – January 2012 LEO Pharma wishes to announce that Dovonex® Cream (calcipotriol 50mcg/g) 30g pack will be launched, effective January 2012 and is fully reimbursable under the GMS scheme.

If you require any further information, please contact the Marketing Department at 01 4908924 or email [email protected]

Dovonex® Cream 120g Pack DiscontinuationLEO Pharma wishes to announce that Dovonex® Cream 120g pack will be discontinued from February 2012. This discontinuation is not

due to any safety or quality issues with Dovonex® Cream, therefore pharmacists and patients may continue to dispense or use any pack presentations of Dovonex® Cream 120g that they currently have. Please note that Dovonex® Cream 30g will continue to be available.

If you require any further information, please contact the Marketing Department at 01 4908924 or email [email protected].

Robitussin* Packaging UpdatesFurther to the Irish Medicine Board’s healthcare professional letter in relation to cough and cold medicines, dated the 19th September 2011, Pfizer Consumer Healthcare has announced that revised packaging for Robitussin Chesty and Robitussin Plus cough medicines will be introduced from November 2011.

Pfizer Consumer Healthcare has taken the decision to remove dosing instructions for children under 12 years although it is still considered safe to use these cough medicines in children between 6 and 12 years of age on the advice of a healthcare professional in a pharmacy setting.

The products which are becoming available with the revised dosing instructions are Robitussin Chesty Cough 100 mg per 5 ml Oral Solution containing Guaifenesin (PA 72/34/1) and Robitussin Plus Oral Solution containing 100 mg of Guaifenesin and 30 mg of Pseudoephedrine per 5 ml (PA 172/35/1). The dosage for adults and adolescents remains the same, one 10 ml measure 4 times daily. Patients should always be reminded to follow the dosing instructions carefully and never to take these medicinal products with any other cough and cold products as they may contain the same ingredients.

For further information please contact: Pfizer Consumer Healthcare Ltd, 9 Riverwalk, Citywest Business Campus, Dublin 24 or look up, www.medicines.ie for the current Summary of Product Characteristics.


Product Profi le

New Slender Dream Slim & Go Slender Dream Slim & Go is a new natural, effective and easy to use weight-loss supplement. The product will be accompanied by a nationwide television advertisement campaign

The secret to Slender Dream Slim & Go’s success lies in its unique formulation, featuring fi ve of nature’s most powerful, proven fat binding & fat burning ingredients; chitosan, pomegranate, green tea, yerba mate and guarana

Slender Dream Slim & Go boosts the body’s own latent ability to burn and bind fat, whilst at the same time increasing energy levels and suppressing appetite.

Slender Dream Slim & Go is part of a range of Ireland’s No1 best selling slimming supplements and teas by Lifes2good Natural Healthcare.

Price €19.95 for 60 tablets.

ZiajaZiaja offers high

quality skin and body care products at very

competitive price.

Ziaja’s Natural Olive range offers a gentle and effective way to

moisturise and soften winter dam aged and dehydrated skin. The

natural based formulas for the face and body are suitable for all skin

types, and won't harm or damage even the most

irritable skin.

All ZIAJA products are dermatologically and allergy tested, have skin neutral pH and are not tested on animals.

The RRP €1.99-10.49.

For ordering product samples please contact Original Beauty on 01 444 0451.

Bio-Oil®

Bio-Oil® is a specialist skincare treatment that improves the appearance of scarring (new and old scars), stretch marks and

uneven skin tone. Its unique and clinically-proven formulation combines vitamin A and E with natural plant oils Calendula,

Lavender, Rosemary and Chamomile carried in a revolutionary ingredient, PurCellin Oil™, which ensures they are easily-

absorbed into the skin where they can provide targeted treatment. PurCellin Oil™ is a

breakthrough ingredient, which dramatically lowers the viscosity

(stickiness and density) of the formulation to create a “dry” oil

which is non-greasy. Bio-Oil can be applied on the face and body and should be applied twice daily for a

minimum of three months.

Bio-Oil is preservative-free and is not tested on animals. Available

from pharmacies nationwide including Unicare, McCabes and

Hickeys. (and Dunnes Stores, Superquinn and Supervalu)

60ml rsp €9.99125ml rsp €17.99200ml rsp €22.99

REN Skincare Signifi cant Price Reduction for Irish ConsumersREN Skincare has announced a signifi cant reduction in the RRP of each REN product in the Republic of Ireland. The new RRP is inclusive of the increased VAT rate of 23% and is now being put into effect at all REN stockists nationwide.All REN Cleansers (150ml) will now be priced at €20.00, previously €25.00. Moisturisers (50ml) will now be priced at €30.00, previously €38.00. Aidan Nolan, Managing Director at Blue Sky Products, the company responsible for distributing REN in the Republic of Ireland said, “We’ve been in talks with REN HQ in London for some time now in a bid to secure a fairer price for our REN customers in Ireland, both new and existing. We have fi nally been given the go-ahead to reduce the RRP euro price and are delighted to roll it out across our nationwide stockists for immediate effect. The new prices offer excellent value on all face and body products from such a fantastic hi-tech beauty brand such as REN.”REN is skincare as it should be; skincare that uses the latest hi-tech bio actives, is free from skin-unfriendly synthetic ingredients and is gorgeously pleasurable to use.For further information please contact:Cathy Cowan E: [email protected] or T: 01 461 0645


Appointments

United Drug has announced that Mr. Ronnie Kells, who has been a Non-Executive Director of the Company since 1999 and Chairman for the last six years, will retire from the

Board following the conclusion of the Company's Annual General Meeting on 7 February 2012.

Mr. Peter Gray, who has been a Non-Executive Director of the Company since 2004 will succeed Mr. Kells as Chairman. Mr. Gray is Vice Chairman and former Chief Executive of

ICON plc and is also a Non-Executive Director of Danica Life Limited.

Liam FitzGerald, Chief Executive, said: "Ronnie has been an outstanding Non-Executive Director and more latterly Chairman of United Drug. Under Ronnie's Chairmanship United Drug has continued to expand internationally and has developed considerably as a public

company. On a separate note, the Board greatly welcomes the appointment of Peter as incoming Chairman. Peter has served on the United Drug Board for seven years and has

chaired the Audit Committee since 2008."

Ronnie Kells

Peter Gray

Changes to the Roche Corporate Executive Committee

Roche has announced that Sophie Kornowski-Bonnet, currently General Manager of Roche Pharma in France, has been appointed Head of Roche Partnering. Kornowski-Bonnet was born in Paris, earned a Doctorate in Pharmacy from the University Paris V in 1986 and an MBA in Marketing and Finance from the University of Chicago in 1989. Before joining Roche in 2007 she assumed various management roles in other international pharma companies.

Sophie Kornowski-Bonnet will assume her new role on February 1, 2012, and will join Roche’s enlarged Corporate Executive Committee, reporting to Severin Schwan, CEO of the Roche Group. She will relocate to Group headquarters in Basel, Switzerland and succeed Dan Zabrowski.

Dan Zabrowski will take over as Head of Roche Applied Science in the Diagnostics Division, located in Penzberg, Germany, as of February 1, 2012. Zabrowski, who is an American citizen, earned a PhD in Organic chemistry at the University of Indiana in 1987. In 1993 he joined Syntex, which was acquired by Roche in 1994. During his career at Syntex and Roche he has held a number of management positions in Pharma Development.

Zabrowski will be a member of the Diagnostics leadership team and report to Daniel O’Day, COO Roche Diagnostics.

Commenting on the two appointments, Severin Schwan, CEO of Roche Group said, “Sophie Kornowski-Bonnet has an in-depth understanding of the healthcare industry. By running our French Pharma affiliate for the last five years Sophie has made tremendous contributions not only to the business but also to the development of a strong R&D hub in France. Assuming her new role as Head of Roche Partnering she can build on the great achievements Dan Zabrowski has made for the Partnering organization.

“As Head of Applied Science Dan will be key for driving this strategically important business with our customers in academia, biotech and pharmaceutical industries.”

Sophie Kornowski-Bonnet

Dan Zabrowski

Expert Group appointed to examine the A,B and C v Ireland judgement of the EcHR

Ireland submitted an Action Report to the Committee of Ministers of the Council of Europe on January 13, 2012, in relation to the A,B, and C- v Ireland judgment of the European Court of Human Rights. In line with Government commitments, the Action Report has conveyed that an Expert Group has been established to

examine the A, B and C v Ireland judgment and to report back to Government within six months with options on how to implement the judgment of the European Court.

The Expert Group will be chaired by Justice Mr Sean Ryan and consist of the following 13 members:

Dr Peter Boylan, Consultant Obstetrician and Gynaecologist, Dr Mary Holohan, Consultant Obstetrician and Gynaecologist, Dr Imelda Ryan, Psychiatrist, Dr Ailish Ni Riain, General Practitioner, Dr Mark Walsh, General Practitioner, Ms Christine O’Rourke, Office of the

Attorney General, Ms Mary O’Toole, Senior Counsel, Ms Joanelle O’Cleirigh, Solicitor, Ms Denise Kirwin, Solicitor, Dr. Deirdre Madden, Medical Council, Dr Maura Pidgeon, An Bord Altranais, Dr Tony Holohan, Chief Medical Officer, Department of Health and Mr Bernard

Carey, Assistant Secretary, Department of Health.

Justice Sean Ryan

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Documents

IRISH PHARMACY NEWS - ISSUE 1 - 2012