Being a parent has in some way shaped my perspective in trying to understand such human behaviour and help me to find an answer to the perplexing question of why people don’t take their damn pills. Ever since the birth of my son, whenever he feels sick, my wife and I would take him to see the doctor. The doctor gives him a prescription and we religiously follow the instructions, even to a point of setting up the alarm clock to remind ourselves when the next dose should be. My wife and I realised that we are no longer that important compared to our little guy. He is much more important than us and we care more about his wellbeing than our own. On one hand, I understand why people could treat their pets like family members, but on the other, it still makes no sense to me as to why people would prefer their pets to themselves when it comes to their own health.

I’ve read a book written by Jordan Petersen a few years ago and I remember one of the chapters was about “treating yourself like someone you are responsible for helping”. The more I think about what he wrote, the more I understand that solving the adherence issue requires more than just a blister pack or proper medication counseling. In the chapter, he made a compelling case explaining why people don’t take good care of themselves – it’s related to how we perceive ourselves. He referred to the biblical story involving Adam & Eve.

According to the creation story, God places Adam in Paradise and created Eve as a partner for Adam. Within the Garden, there was the Tree of Life which had the fruit they could freely eat while the fruit on the Tree of Knowledge of Good and Evil was forbidden to touch. Despite the warning, both Adam and Eve ate the forbidden fruit. Hence, they both awoke with their eyes wide open, which gave them the ability to see the good and the bad, right and wrong. For the first time, they both became conscious, or perhaps self-conscious as the first thing they noticed was their naked body. I would imagine that becoming conscious that you are naked is a big deal for both of them as it was the first time, they saw each other’s flaws. Nakedness can have a negative connotation and is usually associated with vulnerability and weakness, exposed and unprotected. That is why Adam and Eve felt ashamed after their eyes opened because their flaws stood out.

This is particularly true when patients are diagnosed with a long-term clinical illness, they are finally coming to terms with how “naked” they are. Immediately they become defensive and frightened of being ill and this eventually progresses to a resentful stage where they feel ashamed and unworthy of medical attention and intervention. The reason they have such thoughts is that they believe they are the “flaws” of their life and are unworthy of “help”. These are the very same thoughts that Adam had about being afraid to walk with God because he was conscious of his nakedness and that God would judge him based on his high standards. Because of this, I really think that medication adherence is not just a simple matter of forgetting to take the medicine. It lies deeper into our human psyche where our transgressions, insufficiencies, and inadequacies are the fuel that leads us into thinking that our innocent pet is more deserving of our attention.

Sooner or later, we all need to ask ourselves an important question, “What will my health be like when I care for myself properly and start taking the medicine that I should?” Well, for a start, don’t expect your health will ever revert to 100% efficiency. However, knowing that it will not progress in a downward spiral is both relieving, and reassuring.

Ultimately, to reduce the cost of medication non-adherence, we need to get people to take their damn pills. The health system and healthcare professionals like us must shift our strategy slightly. We must make efforts to understand the human psyche and help individuals to remove the veil of unworthiness and resentfulness to reveal the self-confidence lurking behind so that people can finally stand up tall with their shoulders back and start moving forward without shame once again.

To taking your medicines regularly, as prescribed,

The post Why people don’t just take their damn pills! (Part 2) appeared first on Eastmed Pharmacy.

If I were to summarise the role of a pharmacist in two bullet points, it would be:

• To ensure safe and effective use of medicines
• To improve health outcomes through education and compliance promotion.

They certainly sound very PC, but we strive to do this every day behind the scenes. And trust me – they are very hard to attain.

The way we measure success is not very scientific but it mostly involves seeing my patients at three-monthly intervals for their regular medications. Three-monthly is a sweet spot, where people are not sick enough to see me every couple of weeks but also it’s not too long to be suspicious that they are not taking their pills regularly.  Striving to revert damaged health is often unrealistic and unattainable. However, we’ve always pleased to find out that our interventions have contributed in some way to not let their health slip to a stage of absolute hell.

After accumulating a few more wrinkles on my forehead, it’s made me realise that what appears on the surface may only be skin deep.  Seeing my patients regularly every three months does not mean that they are doing all they can to maintain their health. Medication adherence is a major problem that I see every day on the job. According to the American Heart Association, 12% of people that are prescribed a drug won’t fill the prescription. Approximately 50% of the remaining 88% will fill it, but won’t take the medication or they’ll cease taking it before they should.

Take this as an example, a regular patient of mine passed away recently, her daughter asked if we would help her discard her mother’s medication safely. Certainly, is always the answer as I’m a strong advocate of safe medicine disposal. However, I didn’t realise what I got myself into until I saw the two large boxes of medications that could easily equate to more than a year’s worth of medicines – untouched medications.

A scene like this is not foreign to me and happens more often than you think. What’s interesting is that many of our patients which we once thought were relatively compliant, based on the consistency of their prescription collection, were in fact the complete opposite. What’s worse is to imagine someone having a stroke and have undergoing procedures to bring him back to life. To keep them from having another stroke, they must take heart medications and blood thinners for the rest of their life. Most people are happy to accept the trade-off.

Despite the utility of these drugs, many people will eventually experience another stroke. It’s not because the drug is not effective, but rather not taking the drugs as prescribed. To allow yourself to have another episode of stroke and deteriorate your health further because you don’t want to take your medication? How could people possibly do this to themselves?  You would assume that being given another go in life would change someone’s perspective and be more proactive. But in reality, it doesn’t.

As a pharmacist, I tend to blame myself for my patient’s non-compliance. I have the tendency to assume that the failure of patients to follow my professional advice is the fault of mine, not the patient. Have I not explained properly the importance of taking the medication regularly? Have I not spent enough time with my patients?

I believe my job is ensuring my advice will be followed, my intervention will be respected and my follow-up may promote the correct use and assist my patients to achieve desirable health outcomes. Unfortunately, this can sometimes be wishful thinking.

In reality, most pharmacists are time-poor, we don’t have the luxury of time with our patients to the level we would like to be spending with them. That explains why sometimes I’m lacking the understanding as to why won’t they just take their damn pills? Don’t they want to get better? The truth is often fairly complicated. There are multiple variables to explain someone’s non-compliance. It could be psychological factors. It could be miscommunication between doctors/pharmacists and patients. It could also be a matter of affordability of the medicines.

The health system has continued trying to tackle the medication adherence issue. There is a lot of research and discussion on how to improve adherence. The discussion put forward often focuses on more engagement, better information and patient education about medication, and also potential changes to the medication supply chain and delivery leading to greater adherence. Despite that, compliance issues still at an all-time high. It is estimated the cost of non-adherence is $700m, mostly relating to unplanned and avoidable hospitalisation due to people not taking medication as prescribed. This makes me wonder if a different approach is needed and whether we need to dig deeper as to why non-adherence even exists.

Next week I will dive deeper into medication non-adherence and what we can do to help solve this problem.

To taking your medicines regularly, as prescribed,

The post Why people don’t just take their damn pills! (Part 1) appeared first on Eastmed Pharmacy.

So why is maintaining a healthy level of calcium important?  It’s simply because having adequate levels of calcium may prevent us from bone diseases (rickets and osteomalacia) that can soften and weaken our bones.

One of the fascinating things about our body is that whenever our body feels as though we are not getting enough calcium from our diet because of low vitamin D levels, it will trigger a cascade of responses from a small gland in your neck called the parathyroid gland to release a hormone called PTH (Parathyroid Hormone). This hormone is responsible for assisting our body to source sufficient calcium for the body to function properly. PTH mainly achieves this by promoting the release of calcium from the most abundant source – our bones. This triggering response can reduce our bone density gradually over time and increasing our risk of osteoporosis.

There is no doubt about the importance of vitamin D in keeping our bones healthy. In fact, several studies link low vitamin D levels with an increased risk of fractures in the elderly, and they suggest that high dose vitamin D supplementation may prevent such fractures from happening. However, the role of vitamin D in disease prevention and the benefit of taking doses beyond the recommended daily allowance is not conclusive.

How does vitamin D help with our immune system?

There have been numerous studies looking at the association between vitamin D deficiency and autoimmune diseases such as multiple sclerosis and type 1 diabetes. There is also emerging evidence showing vitamin D could assist our immunity and help boost our body’s defenses to fight infectious diseases such as colds and the flu. Vitamin D does this by tempering the damaging inflammatory response of some white blood cells, activating and proliferating certain microbe fighting proteins.

A randomised controlled trial in Japanese schoolchildren involving 340 children found that the influenza rates in children who were given a daily dose of vitamin D (1,200 IU) during the height of the winter flu season were about 40% lower than children not taking any.
So, now the important question is:

Does vitamin D deficiency increase the severity of COVID-19?

To answer this question, we must first look at the population most impacted by COVID-19 and also how this school of thought came about. Based on all the available information, ever since the start of the COVID-19 pandemic, we know that groups such as the elderly and rest-home residents are disproportionally impacted by COVID-19. Traditionally, people in these groups are usually vitamin D deficient. Hence, suggesting a possible link between vitamin D deficiency and COVID-19 severity.

What we also know is that the severity of COVID-19 infection is determined by the presence of conditions such as pneumonia, severe acute respiratory distress syndrome, all of which involve underlying inflammation. One of the major defense mechanisms in our immune system to control inflammation and combat against viral infection is through the works of a T-lymphocytes. It has been consistently reported that COVID-19 patients have low T-lymphocyte levels and are markedly lower in severe cases. It can be postulated that if the levels of T-lymphocytes can be somehow increased, it might have a beneficial effect in reducing the severity of COVID-19.

Now the interesting thing is that T-lymphocyte levels can be increased by vitamin D supplementation. In other words, if vitamin D does increase T-lymphocytes and sequentially reduce the severity of COVID-19, then the next question is would vitamin D supplementation be the panacea to decreasing the impact of the pandemic?

In reality, however, it might not be as straightforward as we think. According to The Lancet’s findings from the D-Health randomised clinical trial, more than 20 000 Australian adults were recruited from the general population. It suggested that monthly doses of vitamin D did not reduce the risk or severity of acute respiratory tract infections. Although the trial indicated a statistically significant effect on the overall duration of symptoms, the reduction was deemed to be small (half a day) and unlikely to be clinically relevant.

Final thoughts

When looking at COVID-19 specifically, there is at this stage insufficient evidence; or the evidence available is not conclusive to suggest whether vitamin D supplementation offers a relatively safe option to decrease the impact of the pandemic. Further studies are necessary to determine if vitamin D plays an important role in preventing or reducing the severity of COVID-19.

However, in saying so, as we approaching the end of summer in the coming months, the amount of time spent outdoors will be reduced as the weather gets colder. Hence, I think it would be wise for those who are at high risk of vitamin D deficiency (e.g elderly) to discuss with their doctor and get their vitamin D levels checked and corrected accordingly.

Low-dose vitamin D can be purchased from pharmacies. It is important to bear in mind that there is a potential for vitamin D toxicity if you take it more than the usual daily dose. It is important to talk to your pharmacist or doctor first before you start taking vitamin D to prevent unnecessary supplementation.

Stay safe everyone.

The post Does vitamin D reduce the severity of COVID-19? (Part 2) appeared first on Eastmed Pharmacy.

What is Vitamin D?

There is no doubt that many of you have heard of “Vitamin D” and you may also be aware that we can get it from exposure to the sun. However, not many of us understand exactly what Vitamin D is and why it is so important.  To set the scene and understand the role of vitamin D deficiency in COVID-19, we must first understand what Vitamin D is.
Vitamin D as the word itself suggests is a type of vitamin that our body needs to function properly. It is made up of fat-soluble vitamins that exist in two forms: Vitamin D2 and D3. Vitamin D, in general, is produced, stored, and released into the circulation by a chemical reaction that occurs in our skin. It’s triggered by and is dependent on UVB radiation from sunlight, hence its nickname, “the sunshine vitamin”.

What is the difference between vitamin D 2 and D3?

In general, vitamin D2 (ergoclciferol or pre-vitaminD) is extracted from plants and can be found in fortified food and supplements. Vitamin D3 (colecalciferol) on the contrary is naturally produced in our body or found in animal food sources. Vitamin D3 is usually the preferred form as it tends to increase blood concentration and last longer compared to D2.

What is the best way to obtain vitamin D?

Only a small amount of food contains vitamin D and because of its small role in assisting us to replenish vitamin D, exposing our skin to sunlight is still our best way of getting it naturally. Although the production of vitamin D from our skin is the natural source for us to obtain vitamin D, many people have insufficient levels particularly during the winter months where we spend most of our time indoors to avoid the cold. People with darker skin tones also tend to have lower vitamin D levels due to the skin pigment (melanin) acting as a shade in reducing the production of vitamin D.

Although the sun plays a crucial role in helping us produce vitamin D, there is little information available about exactly how much sunlight is necessary to make enough vitamin D3 to maintain a healthy body and promote strong bones. But what we do know is the danger of overexposure to sunlight and the risk of skin cancer. It should come as no surprise that Vitamin D deficiency only affects 5% of adults in New Zealand because of how much we love our beaches and the outdoors during the summer months. On the contrary, we have the highest incidence of melanoma (the most serious kind of skin cancer) in the world. Because of the intensity of the sun we have in New Zealand, we must achieve a balance between exposing ourselves to enough sunlight to maintain adequate vitamin D levels while still avoiding the risk of skin cancer.

According to the Ministry of Health, optimal vitamin D levels can be produced in a few minutes if at least the face, arms, and legs are exposed. This information prevents us from turning into burnt toast! Hence, there is no additional benefit in spending longer in the sun. The current recommendation for people who burn easily in the sun is only 5 minutes of sun exposure each day before 11 am and after 4 pm. While people with a darker skin tone may require up to 20 minutes instead.

Is there a thing with too much vitamin D?

Sourcing vitamin D through prolonged sun exposure is more likely to cause skin damage than vitamin D toxicity because our skin can produce a compound that protects the body from producing excessive amounts of vitamin D. In saying so, vitamin D toxicity can occur from overdosing on vitamin D supplements. Too much vitamin D may result in abnormally high levels of calcium circulating in our bloodstream, leading to confusion and arrhythmias.

Stay tuned next week for a look at the evidence of whether vitamin D could help fight COVID-19.

To smart sun exposure,

The post Does vitamin D reduce the severity of COVID-19? (Part 1) appeared first on Eastmed Pharmacy.

I’m not sure if you feel the same, but as we are approaching closer to the silly season, the presence of alcohol becomes more and more noticeable. It doesn’t help when there are so many opportunities and temptations which lie ahead in the next week or so – that having an affair with alcohol seems inevitable. If you were unfortunate enough to have been cursed with a prescribed course of antibiotics for you during Christmas and New Year, you must be wondering whether you had to abolish your intensive wine list?

Staying off alcohol when taking antibiotics has been consecrated advice from pharmacists and GPs for as long as I can remember. The negative connotation between alcohol and antibiotics closely resembles a pair of lovers that are destined to be apart despite many efforts to be together. Unless you are a woman who is looking for an excess to turn down an alcoholic drink because you are trying or in the early stages of pregnancy, and are not willing to give away the happy news so quickly; telling friends and colleagues that you are on antibiotics can be a bit off-putting and an anti-social thing to do.

So, is it true that you need to abstain from alcohol whenever you are on a course of antibiotics? The answer to this isn’t quite that simple.

It is difficult to work out exactly where the advice of avoiding alcohol with antibiotics came from. However, such advice can date back as far as the 1950s where penicillin was developed and first used to treat sexually transmitted infections such as gonorrhoea and syphilis. At the time, the advice came about not because alcohol makes penicillin less effective, but rather it was due to the fact that doctors worried that the risky sexual behaviour under the influence of alcohol could potentially undo the reputation of it as a miracle drug at the time.

Such observant remarks, although not backed by science at the time, there is now emerging evidence to suggest that people are generally more likely to engage in risky sexual activity when they are intoxicated.

There are a lot of myths out there where people would assume that alcohol can stop antibiotics from working effectively or cause serious side effects. From a pharmacological standpoint, alcohol does not post any detrimental effect when used in combination with most antibiotics. However, from a clinical standpoint, there are several compelling reasons to believe that all antibiotics should not be mixed with alcohol.

One is that if the patient assumes alcohol is contradictory to their treatment, then it would encourage them to skip their antibiotics over a glass of wine at dinner time. Doctors and pharmacists want to prevent this because such behaviour could potentially lead to the serious problem of antibiotic resistance.

Secondly, drinking alcohol while your body is trying to fight off infection may not be ideal because alcohol can promote dehydration by forcing your kidneys to lose more fluid, interrupt your circadian rhythm and affect sleep patterns. This can prevent your body from absorbing vital nutrients which can result in a slower recovery when you are ill.

Although most antibiotics are compatible with alcohol, there are a few exceptions. Metronidazole and Co-trimoxazole (sulfamethoxazole/trimethoprim) are the two examples of incompatibility. These antibiotics block one of the pathways where alcohol is metabolised, leading to a rapid build-up of a nasty substance called acetaldehydes. Such substance generally results in a host of unpleasant hangover symptoms such as nausea, vomiting, facial flushing, headache and rapid heart rate.

The interaction of this kind between alcohol and antibiotics is generally more unpleasant than serious. I usually advise avoiding alcohol completely for the duration of the course and for at least 72 hours after finishing your course of antibiotics before considering having a sip.

Although mixing alcohol with most antibiotics is not contraindicated. Both alcohol and antibiotics can individually and collectively cause unpleasant side effects. Such an experience will only get worse if you are ill or physically unwell. I always advise my patients to avoid the combination as much as possible regardless of whether you’re on one of the problematic antibiotics or not. Bear in mind that antibiotic treatment is often prescribed for short term use. So, put a halt on your heels and consider resuming alcohol consumption until after your treatment. This could only do more good than harm by reducing the potential side effects brought on by the antibiotic and also a greater chance of a speedy recovery.

So next time when you have prescribed a course of antibiotics, make sure you talk to your pharmacist to find out if you need to abstinence from alcohol and for how long.

To a joyful festive season,

The post Will antibiotics ruin your Christmas & New Year? appeared first on Eastmed Pharmacy.

We all like to think that New Zealand is a model for a self-sustainable society where we are proficient in looking after ourselves through our “Kiwi-made” produce, innovation, and ingenuity. At the same time, we are more than capable to look beyond the horizon by exporting the best we can produce in exchange for financial securities. This is the model New Zealand has built itself on for decades. However, are we a little delusional to think that we can sustain ourselves alone in this post COVID world? Even in the world before COVID, no country, including our own, could maintain a high standard of living without some sort of foreign trade. One of the reasons is because maintaining a very complex civilisation requires a wide variety of elements and there is simply no country on earth that contains all the raw materials that one needs for a civilisation to thrive.

Working as a pharmacist has allowed me to see the truth: that self-sustainability is desirable but not ideal. Recently a patient of mine asked me a very intriguing question, “Why is my medicine always out of stock?” That is a very good question and one that our team has had to deal with on a daily basis. I think a better question to ask is “Why are there medication supply issues in New Zealand or perhaps the world?” Medicine supply issues are not news to a pharmacist. Each year, there are bound to be a couple of hundred medication supply problems.

Many of you might think that it must be a human error that contributes to these shortages. That is very true, behind almost all of the drug shortage problems are some sort of human factor. Whether it is the manufacturer which cannot keep up with the demand due to short sightless, medication being recalled due to human error during production line leading to a backlog of orders that can’t be fulfilled, discontinuation of production, and the process of finding a new manufacturer to take up the role or simply “my factory burned down” are all some of the reasons that contribute to drug shortages both nationally and globally.

Besides the uncontrollable pandemic that the world is facing right now, medication shortages are the next crisis and are already brewing. The frequency of alerts and the number of drugs in undersupply at the moment is shocking for a first-world country like us. Take the most recent shortage of paracetamol tablets as an example. Many of you might think that how could such a commonly used drug be on the shortage list. That is so true, I simply cannot believe it myself either! The shortage we are seeing now is a direct result of limited export due to the COVID-19. India is the world’s largest supplier of generic drugs including paracetamol. The real problem is that India’s drug company relied on China for almost 70% of the active ingredients in their medicines and it happens that there are still many provinces in China that remain in lockdown. With the supply chain problem lying in plain sight coupled with the rapid rise in demand, irresponsible prescribing and panic buying. It created a perfect formula for a shortage crisis to occur. Sometimes we just simply have no clue the sort of impact the other country and most importantly our own behaviour will have on our livelihood.

Some of you might ask, wouldn’t it be nice if NZ can manufacture both the active ingredients and the paracetamol without relying on India and China. Yes, that would be fantastic in an ideal world. However, it is practically impossible and probably not desirable. The world is a much smaller place than it was 30 years ago. Nations around the world depend on each other for many things. It makes more sense to collaborate with other nations for mutual benefit. The idea of complete self-sufficiency simply does not work at least in the best interest of us Kiwis. Yes, if we do everything ourselves, we would potentially create more jobs here on our home soil. However, we need to bear in mind that different nations have different competitive advantages in producing different things, and cutting ourselves off from the producers who can produce the same goods at a much lower cost means that paracetamol could be more expensive both to manufacture and to purchase in NZ.

Rather than moving down the track of “doing it ourselves” mentality, the steps that each nation, FDA, WHO, and our one and only – Pharmac should do to prevent drug shortage crisis from happening is to improve data collection to track how manufacturing capacity is stacking up against medical demand. Through this tracking system, nations can compel drug companies to accelerate the production of certain in-demand drugs. Also, regulatory bodies around the world should make it compulsory for drug companies to disclose their raw ingredients supplier so that any production hiccups can be detected early to prevent progression to another shortage crisis.

Look, medication shortages will stick around like a bad smell at least for the foreseeable future. The best thing we all could do to stop this situation from deteriorating further is to play our part by not stockpiling medicines at home and panic buying. Do not buy 400 tablets of paracetamol or Panadol for the sake of stockpiling so that you and your family can have enough for the next 10 years. Panic buying is an irresponsible action that is detrimental to our health system and putting patients who need them the most at unnecessary risk.

So next time when you are in the pharmacy collecting your repeat prescription, do not be surprised that you can only have certain medicines one month at a time. It’s probably because there is a shortage occurring that you are not aware of.

To you and your family’s health.

Chris
Pharmacist

The post Why is my medicine always out of stock?! appeared first on Eastmed Pharmacy.

Just like climate change, we humans are doing that to ourselves. However, what’s disturbing is that the amount of coverage on the mainstream media is nothing compared to climate change even though the era of antibiotics is coming to a close, and the post-antibiotic apocalypse is within sight. As Britain’s chief medical officer has said in an interview that antibiotic resistance could kill us before the climate change dose if we don’t do anything about it.

Throughout history, human beings have the tremendous ability turn things around quickly when we are in grave danger. However, we are pretty hopeless at solving a problem that is growing very slowly.

To understand where we stand in our war against bacteria, we must understand what antibiotic resistance is and why it occurs. The term antibiotic resistance is self-explanatory. It is suggesting the resistance of bacteria. This means that bacteria survive despite exposure to antibiotics designed to kill them. Now, when we hear about the word “antibiotic,” we often relate to the treatment of a bacterial infection. While this is true, it is crucial to understand that “antibiotic” can also include “anti-parasitic” or “anti-fungal” drugs.

There are many ways bacteria can become resistant to antibiotics. However, to simplify things, there are 2 types of resistance; naturally occurred or acquired resistance. The way I describe naturally occurred resistance is like trying to use a key in a lock that doesn’t fit

On the other hand, acquired resistance is a result of genetic mutation either picking up, transfer or sharing of genes from or with another bacterium.

Now, some of you might ask me: – What trigger antibiotic resistance in bacteria?

That is an excellent question. Let me explain using business competition as an example. Being a bacteria is like running a business. There is an intense amount of competition between different businesses within the same field. Competition drives other businesses (bacteria) to develop new ideas (survival mechanisms) to make them stand out from the rest. Some business (bacteria) even develop their unique point of difference (antibiotic compounds) that could eliminate surrounding competition (bacteria) and put them out of business, hence increasing the business’s chance of survival. As a matter of fact, this was the whole basis of how penicillin was discovered! Some business (bacteria) may have the resilience and learn from other businesses ‘ failures (picking up resistance genes from another bacterium) and have evolved to adapt to the new environment. In other words, they are becoming resistant to other competition’s strategies (antibiotic).

Now going back to antibiotic resistance – besides the natural selection process, other factors that can lead to antibiotic resistance include:

· Prescribing antibiotics in situations that are not necessary

· Overuse of antibiotics in livestock farming

· Prolong courses of treatment with antibiotics

All those situations may put pressure on resistant bacteria to overtake the population and make them more difficult to treat.

This may lead to another question – Shall I stop antibiotics when I feel much better, or is it best to finish the course?

Always remember, a short antibiotic course might eliminate bacteria that are susceptible to the drug. However, it takes a full course also to eradicate those bacteria that are only partially resistant. In other words, if you stop your antibiotic too soon, you may un-intentionally giving partially resistance bacteria a chance to shine, which can be a problem to eliminate further down the track.

Antibiotic resistance is an important health problem because if not addressed properly, it could prolong your infection, make you more likely to have complications from the infection, and possibly pass your infection to other people.

So what can we do to stop or slow down antibiotic resistance?

To be perfectly honest with you all, it is not possible to eliminate the development of resistance. However, what we could do is to fight smarter. We could utilise strategies like:

· Rotating antibiotic treatments to reduce the chance of a particular type of antibiotic being exposed to the chance of developing resistance

· Doctors prescribing the shortest treatment period to eliminate an infection effectively

· Reducing the use of antibiotics in animal farming

· Creating new antibiotics treatment (usually not the primary goal of drug companies because of the cost involved in the developmental phase)

From your perspective, things that we could all do is by focusing on preventing the spread of infections by improving personal and family hygiene.

· Wash your hands often, with soap, for 20 seconds, and dry them well

· Clean kitchen and bathroom surfaces regularly

· Stay home if you are unwell

· Get immunised

It is important to remember; antibiotics should only be used when advised by your doctor for your current illness. Using antibiotics when they are not needed or taking the wrong antibiotic exposes bacteria to antibiotics unnecessarily, which encourages resistance.

Another thing to keep in mind is that just like food, antibiotics go off. Keeping leftover antibiotics may lead you to take expired medications, which means they may not work when you need them or even make you feel ill.

The risk of sharing antibiotics with others is also a contributing factor in promoting antibiotic resistance and is ones that I see people frequently do. The antibiotic you were prescribed may not work for your family member’s illness because, first of all, they may not need it at all. Also, they may need a different type or dose of antibiotics for their condition.

Lastly, I get asked quite frequently by many of my patients about whether it is okay to pour antibiotics down the toilet or sink. The simple answer is NO! There is always a risk that the antibiotics poured down the sink or flushed down the toilet may pass through treatment systems and enter rivers, lakes and even drinking water supplies. Antibiotics that get into the environment may drive bacteria to become more resistant.

This week we are running an “Antibiotic amnesty” campaign to promote the safe use and disposal of antibiotics. If you have any unused or expired antibiotics sitting in your medicines cabinet, then I would strongly urge you to bring it to us for safe disposal:)

The bottom line is that we all can do our part on preventing the progressing of antibiotic resistance by not only following the above mentioned but also always follow your doctor or pharmacist’s advice on how to take any antibiotics prescribed to you.

Once again, my team and I are always here if anyone has any questions about any antibiotics prescribed to you.

In much health and happiness,

Chris

Pharmacist

The post Our time with antibiotics is running out… appeared first on Eastmed Pharmacy.

One of the skills I’ve learned from being a pharmacist is the ability to create a meaningful relationship with drug(s). This unique set of skills gave me the ability to see beneath the beautiful and into the deepest corner. But at the same time have the optimism to see a glimpse of light at the end of the tunnel. Because of this ability, I do believe pharmacists generally understand that perfection is not possible, but we are willing to embrace both the good and the bad sides.

One terrible habit that my job has taught me over the years is never to trust anyone – not even ourselves. This is because I know too well that errors and mistakes happen more often than everyone thinks, no matter how bulletproof the system is.

I remember vividly during the graduation ceremony, the dean of our pharmacy school at the time gave a speech that had a significant impact on shaping my own set of principles as a pharmacist.

He said: “…We are there to safeguard the healthcare system. We are there to promote patient safety and to minimise the chance of harm to the patient…”

This statement is the core existence of pharmacists. The more I work, the more I realise that although it’s what we strive to do each day, it is not 100% attainable because at the end of the day we are all humans. Sometimes error does slip through the cracks. However, ensuring the right drug at the right dose is reached the right patient at the right time by the right route is the minimum standard by which a pharmacist can do to safeguard their patients.

After years of working as a pharmacist, the number of mistakes and errors I’ve seen myself and other healthcare professionals have made is avoidable. A lot of the times are due to our ignorance or overconfidence in what we do.

There is a famous quote from the “Dark Knight” movie that goes like this – “You either die a hero or live long enough to see yourself become the villain.”

With every job and profession, everyone will eventually reach a stage where they know their job inside and out and can pretty much develop the ability to “auto-pilot” our way through the day at the job. This, in my opinion, is the worst kind of habit or ability that none of the health care professionals should be developing, and in most cases it existence can contribute to our downfall.

“Assumption” is also another skill set that is destined to fail us. Assuming that the doctor knows how to calculate a paracetamol dose for an infant, assuming that the change in dose by the doctor is a sound decision, and assuming the doctor has stopped a medication because it was not prescribed on the prescription are only a few examples where assumption can have a negative impact on patients health.

This week is patient safety week, and I wanted to share with you all my thoughts about pharmacy and why everyone deserves more than just mediocre.

Practising pharmacy is a balancing act between promoting safety and providing quality of care. Most pharmacists would agree with me that sometimes we as pharmacists can get caught up with the technical aspect of patient safety while compromising on the quality of care being delivered. On the contrary, some patients value more on getting quality efficient service than the safety element that is necessary to keep them from harm’s way. In my opinion, both patient safety and quality of service go hand in hand. A well-balanced pharmacy will spend time promoting patient safety through effective communication and education but also at the same time investing in efficiency of care, focusing on doing things well to raise the ceiling, so the overall care experience is a better one.

Patient safety is, therefore, an important aspect of an effective, efficient pharmacy where quality prevails.

Most people’s idea of a health care team consists of their nurse, doctor, and pharmacist. However, one big piece of the puzzle that ties everyone together is themselves. It is important to remember that you, too, are a crucial part of the health care team. So next time when you are at your doctor’s office, or your local pharmacy, do take the time to share your experiences with them to make sure you are getting the best care possible. Always speak up if you see something that is out of the ordinary or not safe.

One of the things that I’m very proud of everyone at the pharmacy is that we actively make safety and quality information available to everyone in the community. We strongly believe that you deserve a pharmacy that can provide you with reliable information to make informed choices about your health. Because we understand that in this information abundance world, getting the most reliable source of information, on the contrary, is getting more difficult.

I feel that we must bring this information to light in a way that is easy for you – my inner circle of friends – to use.

The bottom line is that a pharmacy may have the most products and the greatest value compared to some, but unless it is preventing harm and eliminating errors, it is not delivering on a very basic premise: – ensuring the safety and the quality of care for you and your loved ones.

Once again, you can always reach us to my team or me when you have concerns about the safety and quality of care that you are receiving. We are here to listen and help.

In much health and happiness,

Chris

Pharmacist

The post Safety or Quality, or both? appeared first on Eastmed Pharmacy.

For those of you who don’t know much about vitamin D, it is a type of vitamin that our body does not store or produce, meaning that we need to replenish it regularly. Unless you eat a significant amount of food such as eggs, liver, oily fish or take supplements, the best way to get vitamin D is in fact from the sun – and the best part is that it is FREE!

Vitamin D is produced when our bodies are exposed to UVB rays from the sun. It is particularly important for kids because it can assist in bone growth and development. Lack of vitamin D can cause soft bones and increase the risk of bone fractures.

I strongly recommend parents to encourage their children to get out of the house more often. The best time to be outside is in the morning and afternoon but avoiding staying too long under the sun during midday. Ultimately, we want to increase our level of UV radiation exposure without increasing the risk of skin cancer. So please make sure to slip slop slap before heading outside.

Anyway, this week I wanted to share with all of you an interesting case that I came across recently. A regular patient of mind handed in her prescription written by a dermatologist. The prescription was for Doxycycline 100mg and the instruction was – Take half a tablet once daily for 1 month. After reading this prescription, it occurred to me that the dermatologist is aware that the 50mg strength is not available and hence asked the patient to half the tablet instead. However, the doctor was not aware that doxycycline is a type of medication that cannot be halved because it can irritate the oesophagus (food pipe). After several phone calls to the clinic, I managed to convince the doctor to change the instruction to “Take 1 tablet on alternate days”

These are some of the many instances which my team and I come across regularly. In fact, one of the most common questions that I get asked is “Is it okay to split my pills?”

Before I answer this. Let me explain why sometimes splitting pills can be an advantage. From a pharmacist perspective, splitting tablets can be beneficial when a doctor required a specific dose that does not come in the strength required. In this instance, the ability to split the dose will allow the doctor to prescribe a dose that is most suitable for their patients without the need of giving patients an excessive amount of medication that is not required.

Also, splitting tablets can make titrating dose up or down accomplished easily.

From a patient’s perspective, splitting tablets is ideal if they struggle to swallow a large tablet, they may split it into more manageable portions. Similarly, certain non-subsidised medicines are not cheap, so I understand why some patients consider splitting their pills. Sometimes, I’ve seen doctors prescribing the larger dose and asking the patient to split the dose into halves to stretch their medicine for twice as long.

However, not all pills and tablets can be split in half safely.

As a rule of thumb, avoid splitting any medication labelled as “enteric-coated tablet”, including some over-the-counter pain reliever medications. Those tablets or pills are designed to dissolve only when it gets to the intestines so that it does not irritate your stomach. If you split the pill, you’ll lose the benefit the coating was designed for. A good example of this is aspirin. Aspirin comes in 2 different forms for 2 different indications. Aspirin for heart protection is always enteric-coated to prevent absorption in the stomach. And it is therefore important to not split the tablet. However, aspirin for pain relief can be halved because it’s not coated and is intended to be absorbed in the stomach to provide faster pain relief. I always recommend taking either of the formulations with food to minimise the chance of getting stomach pain – Ouch!

Special formulations such as “controlled -release”, “extended-release”, “sustained-release” or “long-acting”, should never be crushed or split into halves either. Those formulations are intended to release the medication slowly over time and by cutting those pill, you can end up making the dose come out much faster and higher, which can lead to side effects.

Some of you might then ask – “How do I know if my pills are safe to split?”

One simple clue I always tell my patients is to see if there is a scored line down the middle of the tablet. If there is, it usually means that you can split the tablet into halves. The scored line is there to guide you where to split your tablet, so it breaks evenly.

However, to make it more complicated, some medications that are ok to split do not come scored along the centre of the tablet. And for that reason, I strongly suggest you talk to me or one of my team to see if your medication can be split before doing so.

If splitting your pills is a must, then I would recommend in investing in a tablet cutter which is relatively cheap and is available in any pharmacy. A tablet cutter can save you a lot of headaches by guaranteeing you get the same size and dose with each cut.

I usually suggest splitting your tablets right before you need to use it to minimise the amount of humidity being exposed to the increased surface area of the tablet. Unfortunately, it is not always a practical and convenient way. If you need to cut your tablets in advance, please make sure they are stored in a cool place away from direct sunlight and moisture. You could also place a desiccant in the tablet bottle to keep moisture away.

Next time before considering splitting your tablets, why not check with one of my team or myself first. We can help you find the best solution that works for you.

To you and your families health.

Chris

Pharmacist

The post To split, or not to split? That is the question appeared first on Eastmed Pharmacy.

I usually have a habit of writing “Talk” on the prescription receipt for any patient that I need to have a brief conversation with about their medicines.

Most of you who know me well understand that I love telling my patients the things they don’t know about their medicines. Most people usually show patience towards me when I explain their medications. However, I do occasionally receive comments from patients who try to cut me short or interrupt me by saying things like – “yup, yup, yup…I know”, “I don’t need to be counselled on my medication—I’ve been taking this drug for years” I’ve taken this before“ and “ I know what to do”.

In my younger days, I would get upset and offended when I hear comments like these. However, these days I am able to dodge their comments and still manage to sneak in a few pieces of information that they don’t know at all.

This time was no different… I got interrupted by the patient as I was trying to explain to him about the antibiotic he was prescribed.

Chris: “Now this is an antibiotic, and…”

Patient: ”I know what to do!”

Chris: “I’m glad that you know how to take this. However, what I was about to ask you was whether you had an allergic reaction to any antibiotics in the past?

Patient: “Oh…Yes, I’m allergic to penicillin.”

Chris: ”If that the case this antibiotic is not right for you because it is a form of penicillin”

Patient: “Oh…”

Chris: “May I ask what sort of symptoms did you get when you were given penicillin last time?”

Patient: “I actually had an anaphylactic shock where my lips and eyes were swollen and difficulty breathing.”

Chris: “ I think I need to talk to your doctor…”

These conversations do occur more often than you might think.

As a pharmacist, I’ve had come across many patients who would get upset or annoyed when I counselled them as they pick up the medication they’ve already been taking or have taken in the past.

I totally understand those patients. If you have been using medicine for years, it makes sense to assume that you know the medicine inside and out – how it affects your body and how your body responds to it. An analogy I refer this to is like driving your car. After years of driving it, you kind of developed the memory skills in your muscles that enable you to hop into your car and start driving without thinking. And to keep your car in top-notch condition, you need to get a WOF and service annually. Taking your medicine is the same, you need to update your knowledge about your medicine. The best person to easily get that reliable information is from your pharmacist.

Sometimes is not because you are not aware of the crucial piece of information about your medicine, but it is because you have developed a comfortable routine that overtime makes you start to forget or overlook certain small but important details. For instance, people who take thyroid tablets know that they should take it on an empty stomach. However, over time you might start developing a habit of taking it with a glass of milk or juice or even with a tub of yoghurt in the morning but in fact, you should be taking it on an empty stomach with water instead.

As a pharmacist, one of the most common questions that I ask my patients is whether they are allergic to any medicines or the medication that they are about to take. It is important to know if you could be truly allergic to the drug or the excipients used to make up the drug and sometimes it could be a fine line between the 2 and can be difficult to distinguish.

I also have come across many times patients that have told me they were allergic to a certain drug, but in fact, the reaction they described was actually a side effect. If a side effect was treated like an allergic reaction, it could lead to unnecessarily withholding of effective medication that could result in compromising the treatment for the patient.

So how can you tell the difference between allergies and side effects?

An allergic reaction occurs when your body’s immune system acts like a drama queen and makes mountains out of molehills. When your body come across a foreign object (such as a new drug) it immediately sends white blood cell troops to try to ID the molecule. If the molecule looks foreign, your immune system will start to tackle it to stop it from causing harm to your body.

However, in most cases, the actual harm is not from the drug itself but rather from your body’s own defence mechanism. This “freak out” state usually ranges from a simple rash, hives, itchiness or watery eyes to a potential serious life-threatening anaphylactic reaction such as swelling of the throat and hence cause trouble breathing.

When you take a medicine, your body sometimes acts like an eight-year-old throwing tantrum and demanding attention when they come across something they don’t like and hence manifest the response in an unpleasant way. I usually refer this type of response to “side effects”.

The main difference between an allergic reaction and a side effect is that your immune system triggers the allergic response and side effects are unwanted consequences that occur when the drug is working in your body.

A good example that I’ve come across this morning is a regular patient who came in seeking management for his leg cramps at night. After looking at his medication record, he is taking a fluid tablet to manage his heart problems. It appears to me that the muscle cramps he’s experiencing could possibly be a side effect of the fluid tablet that he is taking. Some of you might say – How? Well, the fluid tablet makes you pee, right? Hence, losing water can muddle up your electrolyte balance, or ultimately the amount of sodium and potassium in your body. When those minerals get too low, our muscles will be the first to suffer.

Many people think that one must stop taking the drug when they start to experience the side effect. However, nothing can be further from the truth because many side effects are mild and manageable, and sometimes they may go away as your body adjusts to it after a few weeks. It’s usually a good indication that your body is slowly adapting to medicine when your side effects are improving day by day.

Before you start taking a new medicine, please remember:

1) Keep an eye out on any unpleasant symptoms or responses after starting the medication

2) Tell your doctor or pharmacist if you are experiencing any unpleasant symptoms

3) Side effects can go away on their own as your body adjusts to the medicine.

4) Do not stop taking, or adjust the dose of your medication without talking to your doctor first.

If you are taking any long term medications and are experiencing any unpleasant symptoms, please contact me or one of my team. We are happy to help clarify any concerns.

To you and your families’ health

Chris

Pharmacist

The post Is your body acting like a drama queen? appeared first on Eastmed Pharmacy.