Changes for statin drugs ( cholesterol lowering drug)
In late February 2012, the U.S.Food and Drug Administration (FDA) approved safety label changes for statin drugs. In summary, the FDA changes are as follows:
1. Monitoring Liver Enzymes
Removal of the need for periodic monitoring of liver enzymes. Liver enzyme tests should now be performed before commencing statins and as clinically indicated thereafter, due to the rare and unpredictable nature of serious liver injury with statins.
2 Adverse Event Information
Addition of information about the potential for :
A)Cognitive adverse events
The FDA report suggests that rare post-marketing reports of cognitive impairment have been made, including reports of memory loss, forgetfulness, amnesia and confusion, associated with statin use. These are generally non-serious and reversible
**I have heard of the memory loss experience from a customer .**
B) Increases in glycosylated haemoglobin (HbA1c) and fasting plasma glucose
The Australian Therapeutics Goods Administration (TGA) is currently reviewing the evidence for these safety-related changes and will update the Product Information for these medicines where necessary.
Reference: RGH Pharmacy E-Bulletin Volume 45 (12): April 16, 2012
Some people claim that pharmacists are label stickers..
Well, it is true. Labels sticking is part of our job. I never understand how the label that I printed out from UniSA works until I started my placement..
So, I am going to explain a little bit about different "sections" of a label and where should they go.
Please note that different dispensing software produce different labels. The one that I am showing is the Amfac Healthlink label. I will talk about Minfos label next time.
In some pharmacies, they place the barcodes to the customer slip. They are scanned when the customers bring their items to the cashier.
Safety net stickers are given to the customer to be placed onto their safety net record card to keep track how much they have spent in a year. Once they have reached the threshold, they get their medication at a lower price.
1. Suppositories
Someone has used it without unwrapping the foil.
2. Spiriva
The common story : People swallow the capsule.
3. Suppositories ( use of slang)
" Stuck this to your back door every night"
Case: a pharmacist used the phrase" back door" (which refer to rectum ) while
counselling on a patient on the use of suppositories
Result : The patient did exactly what he/she was told. The suppository was placed at
the back door every night. ( I mean the real DOOR)
These examples clearly illustrate the importance of GOOD counselling to ensure that patient understand how to use their medication properly.
Many students might wonder why their tutors/lecturers get so fussy when it comes to counselling or instruction written on the labels. Read the stories below and you will understand why.
1. Antibiotic syrup ( for child)
"Give 5ml (by metric measure) twice a day until finished "
This antibiotic was indicated for treat ear infection.
Result : The parent placed the syrup into the child's ear twice a day.
Lesson : Always remind them to give it by mouth.
2. Inhaler
Due to poor understanding on the device, some patients :
- spray onto their armpits like using deodorant
- spray to the air, and inhale/sniff the medication with their nose
3. GTN spray
- indication: for angina, when experience chest pain
- result: someone spray the medication onto the chest to relieve the pain.
4. Bisphosphonate
" Remain upright for at least 30 minutes after swallowing the tablet"
Result : Patient's comment, " I hate taking this. I need to stand up for at least half an
hour in the morning after taking the tablet."
Upright was misinterpreted as "standing".
More medication gets into your lungs than if you use a puffer on its own.
Reduce the local side effects of inhaled steroids in preventer medications (because less of the medication sticks in your mouth and throat)
Don't need to coordinate pressing your puffer and breathing in at the same time
Reliever medication via a spacer is at least as effective as via a nebuliser in an asthma attack
Type of spacer
There are a range of spacers available, in different shapes, sizes and colours. There are two main differences: large volume and small volume.
Large volume spacers are an oval shape, and are bigger. One of the most common ones is the Volumatic spacer. These should be used only for adults or children over five years old, as younger children aren’t able to take deep enough breaths to empty the spacer out.
Small volume spacers are usually shaped more like a tube, or a cone. They are more convenient because they are smaller and so fit into handbags and schoolbags more easily. Children under five should use a small volume spacer. Many older children and adults also use small volume spacers because they are more portable.
How to use spacer
How to help your child to use a spacer device
Extra tips for use of spacer
When educating a patient who is new to spacer or puffer, I would say "fire" a few puff of your medication into your new spacer before use ( to coat a layer around it before use).
In cases where the puffer is new as well, instead of priming ( wasting a few puffs to ensure that the medication is loaded properly) in the air, I encourage the patient to prime it into the spacer.
When to clean my spacer?
- Wash it the first time before you use a new spacer and every MONTH thereafter.
How to clean my spacer?
- Take the spacer apart and soak it in clean warm water with dishwashing detergent. DO NOT PUT YOUR HAND INSIDE TO WASH IT .
- Let it air dry or dip dry. Don’t rinse the bubbles off it or wipe it, . (The residue of the bubbles from the detergent puts a coating on the inside of the spacer/ acting as a surfactant. This stops the creation of static electricity inside, which can make the medication stick to the sides of the spacer instead of travelling through it when breathed in.)
- Some spacers have a removable valve (a piece of rubber that you can take out and wash separately).
Tips for Tilade or Intal users
If you are using Tilade or Intal ( types of preventer medication) you should wash your spacer more frequently. These medications are quite sticky, and build up faster than other medications.
When should I replace my spacer?
Replace your spacer about every 12 months if you use it every day. If it breaks or cracks, get a new one straight away.
Other related devices:
turbuhaler, accuhaler, MDI inhaler/puffer, Handihaler, nebuliser
There are many inhalation devices available in the market for asthma control. This type of administration method aims to deposit most of the drug molecules in the lung. However, it is not uncommon to see patients with poor technique, causing most of the medication to deposit behind the throat instead of reaching the lungs.
Therefore, it is important to understand how to use each device in order to achieve the best result.
Handihaler
When counselling, remember to tell the patients ; DO NOT SWALLOW THE CAPSULE, I have heard story where patient swallowed the capsule. ( Funny, but this also tells us the patient has not been educated properly on the correct method to use the devices.)
Other important counselling point
1. Always throw away the empty capsule after use.
2. Press the button to create a hole on the capsule before you inhale the content.
Other devices : Accuhaler, puffer/MDI inhaler, nebuliser, turbuhaler, spacer
Byetta is increasingly popular among the prescribers ever since it is listed under PBS.
It is important to know how to use the Byetta pen.
The differences between byetta and normal insulin
1. Byetta must be kept in the fridge after each use. Insulin pen can be kept at room temperature for 28 days.
2. Byetta pen comes with a fixed dose/instruction. It is available in 5mcg or 10 mcg, to be injected twice daily within 1 hour before breakfast and dinner. Insulin dose varies according to individual's need.
3. Byetta MUST NOT be injected after a meal.
4. Byetta can be injected around abdominal area, arm and thigh. In the case of insulin, arm and thigh are less commonly used as site of injection.
SLOWS GASTRIC EMPTYING!!
Byetta slows gastric emptying and therefore potential interact with oral administrated drug.
1. oral medications that require rapid gastrointestinal absorption or medications associated with local gastrointestinal irritation, e.g. bisphosphonates or tetracyclines.
2. Gastroresistant formulations containing substances sensitive to degradation in the stomach, e.g. proton pump inhibitors, should be taken at least one hour before or more than four hours after exenatide injection.
3. For oral medications that are particularly dependent on threshold concentrations for efficacy, e.g. contraceptives and antibiotics, patients should be advised to take those medicines at least one hour before exenatide injection.
