Ask the Pharmacist: HEAD LICE

Question: My 8 years old daughter lately developed into an itchy scalp. I am so bothered that she might have head lice (kuto). I don’t know how she gets it since I wash her hair every day. What can I do about it?

                                                                                       

Answer: Hearing the word head lice can gives shiver to anyone. What more if you found out that your child have it? I can imagine your reaction. But head lice infestation is common to children and they can get it once or twice. Though, it is not a sign of poor hygiene since lice do not have preferences whether clean or dirty hair.

You are not really sure that head lice are the cause of the itchy scalp. It may be due to other reasons. So the best thing to do at this stage is to check if there are lice. With the use of fine tooth comb (suyod), comb your daughter’s hair. It is best to do this after washing and conditioning the hair. Lay down a white sheet of paper and comb the hair over it. Pay attention at the nape and behind ears, for these are the parts which head lice likes to stay most. After combing for about 10 minutes, you will be looking for the live lice on the white paper or at the teeth of the comb. If you find live lice infecting the scalp, you need to treat your daughter. In this case, you also need to check the rest of the family. If you find live lice with any member of the family; they need to be treated at the same time.

There are products available over-the counter to treat head lice. It is always recommended to follow the instructions of each preparation.

1.      Kwell Reformulated Shampoo (Non-Rx)

Content: Permethrin

How to use: Apply enough shampoo to cover the hair and scalp. Leave it on for 10 minutes and rinse thoroughly with water. Use a fine-toothed comb to remove dead lice and eggs.

Packing: Kwell Reformulated Shampoo 10 mg/1 mL x 30mL

                 Kwell Reformulated Shampoo 10 mg/1 mL x 60mL

2.       Licealiz (Regular Shampoo) (Non-Rx)

Content: Pyrethrin

How to use: Apply sufficient amount to cover the hair and scalp. Gently massage and leave the shampoo on hair for 10 minutes. Then, rinse thoroughly with water. Use a fine-toothed comb to remove dead lice and eggs. Use twice a week for 2 weeks to treat head lice and once a week to prevent recurrence.

Packing: Licealiz Regular 20 mg/10 mL x 10 mL

                Licealiz Regular 20mg/10 mL x 60 mL

3.       Licealiz (Soothing Coolness Shampoo) (Non-Rx)

Content: Pyrethrin

How to use: Apply sufficient amount to cover the hair and scalp. Gently massage and leave the shampoo on hair for 10 minutes. Then, rinse thoroughly with water. Use a fine-toothed comb to remove dead lice and eggs. Use twice a week for 2 weeks to treat head lice and once a week to prevent recurrence.

Packing: Licealiz Soothing Coolness 20 mg/10 mL x 10 mL

                Licealiz Soothing Coolness 20 mg/10 mL x 20 mL

4.       United Home Sulfur Ointment (Non-Rx)

Content: Sulfur

How to use: Apply twice daily.

Packing: United Home Sulfur 10% x 15 grams

                United Home Sulfur 10% x 30 grams

                                                                                Photo Courtesy of Joanna Ibarra

Remember that head lice treatments are more successful at eradicating live lice than killing the eggs. That is why, it is recommended to re-treat your child’s hair with the same product after 7 days to kill any remaining insects. Further fine combing will possibly remove eggs that have been stuck after the treatment. If after the second treatment, you still find live lice, you should change the product you are using with another one having different content. Go back to the list above or consult your local pharmacist if you are not sure. To help prevent future infestations, use tea tree oil or shampoo. They normally chase the bugs away.

Practical Tips to Avoid Blisters

Blister is a vesicle filled with fluid. It is small, as tiny as the top of the pin or can be 5 to 10 mm wide.  Blisters break easily and discharge their fluid into the skin.

Causes blisters:

·         Chicken Pox

·         Eczema (Atopic Dermatitis)

·         Contact Dermatitis (poison ivy)

·         Herpes Simplex

·         Allergic reaction to drugs

·         Blistering skin diseases like porphyria 

·         Impetigo

·         Shingles (Herpes zoster)

·         Friction and Burns

Generally, a medical practitioner should examine the patient to verify what causes the skin rashes. There are over-the-counter drugs that can be use for some conditions including contact dermatitis and cold sores. But always call a doctor if you have any unexplained blister on your skin.

Photo Courtesy of Novakreo

Practical Tips:

·         Keep your skin intact. Broken skin will provide entrance to bacteria and increases the risk of infection.

·         Do not scratch it.

·         Cover blisters to avoid exposure. Use adhesive bandage for small blister and for large blister, use a porous, plastic-coated gauze pad that absorbs moisture and permits the wound to breathe.

·         To avoid a blister, use gloves, socks, a bandage or alike protective covering over the area being rubbed.

·         Use additional moleskin inside your shoe where it may rub such as the heel.

·         For Diabetic patient or someone with poor condition, consult your doctor first before considering any self-care measures.

Pharmacopoeia

Literally, it means “drug-making”. It is a book that encloses information for the identification of samples and the preparation of compound medicines and published by the power of a government or a medical or pharmaceutical body. It is simply a reference book of drug specifications. Different Countries may have different Pharmacopoeia.

Photo Courtesy of Takkk

The list is provided for reference purposes only and does not pretend to be complete. 

1. Argentina - Farmacopea Argentina
2. Austria- Österreichisches Arzneibuch
3. Brazil - Brazilian Homeopathic Pharmacopeia
4. China - Pharmacopoeia of the People's Republic of China
5. Czech Republic - The Czech Pharmacopoeia Pharmacopoea Bohemica MMV
6. Egypt - Egyptian Pharmacopoeia 
7. France - Pharmacopée française
8. Germany - Deutsches Arzneibuch/ Homöopathisches Arzneibuch
9. Greece - Greek Pharmacopoeia
10. Hungary - Pharmacopoeia Hungarica
11. India - Indian Pharmacopoeia
12. Indonesia - Farmakope Indonesia
13. Iran - Iranian Pharmacopoeia
14. Italy - Farmacopea Ufficiale della Repubblica Italiana
15. Japan - The Japanese Pharmacopoeia
16. Mexico - Farmacopea de los Estados Unidos Mexicanos/ Mexican Herbal Pharmacopoeia/ Mexican Homeopathic Pharmacopoeia
17. Philippines - Philippine Pharmacopeia
18. Poland - Farmakopea Polska
19. Portugal - Farmacopeia Portuguesa
20. Romania - Farmacopeea Romana
21. Russian Federation - State Pharmacopoeia of the Union of Soviet Socialist Republics
22. Slovak Republic - Pharmacopoea Slovaca Slovenský liekopis/ Slovenský farmaceutický kódex
23. Spain - Real Farmacopea Española
24. Switzerland - Pharmacopoea Helvetica
25. Thailand - Thai Pharmacopoeia/ Thai Herbal Pharmacopoeia
26. Ukraine - The State Pharmacopoeia of the Ukraine
27. United Kingdom - British Pharmacopoeia
28. United States of America - The United States Pharmacopeia/The National Formulary
29. Vietnam - Pharmacopoeia Vietnamica
30. Europe - European Pharmacopoeia/ Pharmeuropa
31. Africa - African Pharmacopoeia
32. WHO, Geneva - The International Pharmacopoeia

Reference Materials in Licensing of Drug Establishment/Pharmacy

These are laws and regulations that Pharmacists and Pharmacy Owners should be aware of before entering into a pharmacy business. These are vital in operating a drug outlet. Review them and remember them by heart for it will be handy in many situations in a Pharmacy.

• RA 5921 known as Pharmacy Law 
• RA 3720 known as Food, Drug and Cosmetic Act 
• RA 6675 known as Generics Act of 1988 
• RA 8203 known as Special Law on Counterfeit Drugs 
• RA 9257 known as Expanded Senior Citizen Act of 2003

For other laws and regulations related to pharmacy practice please visit the FDA website.

OVER-THE-COUNTER (OTC) PRODUCTS FOR EARWAX

Photo Courtesy of Didier Descouens

For impacted cerumen, softening agents are available in drugstore as Over-The-Counter products.

1.    Hydrogen Peroxide.

-It is a component of carbamide peroxide with weak antibacterial properties. To use as otic solution, it must be diluted with 1:1 ratio with warm water. Instill in the ear to soften the cerumen and aid in its removal.

2.    Carbamide peroxide

Dosage: Tilt head sideways and instill 5-10 drops in the ear. Do not insert applicator tip in the ear canal. Keep head tilted for several minutes before turning to the other side & repeating for the other ear. Insert cotton wool to keep drops in the ear. Use twice daily (bid) for up to 4 days.”

Contraindication: Not to be use for patients with perforated eardrum or with inflamed ear. For children under 12 years old with suspected cerumen impaction, a doctor should be consulted.

Brand available: Ear Clear® 

3.    Mineral Oil is recommended in removal of impacted cerumen. Instill 2 drops, once per week. 

4.    Olive Oil, also soften earwax and can ease itching.

Other common ear disorders except Excessive/impacted cerumen (earwax) are:

1.    Vertigo

2.    Tinnitus

3.    External Otitis

4.    Water-clogged Ear

5.    Furuncles

6.    Otitis Media

Do not forget your EARS

I decided to put a short review about the ear to freshen up our memories before we discuss Otic OTC products.  In this case, we can easily handle different disorders of ear.

Photo Courtesy of Chittka L, Brockmann

Parts of the ear:

1.       External ear

-          It extends much farther due to what it is made of.

a.       Auricle (pinna)

Its function is to collect sound and channel it toward the middle ear.

b.      External auditory canal (ear canal)

It is composed of small glands that are in charge of secreting cerumen (earwax)

c.       Eardrum

It is the outer surface of the tympanic membrane which separates the ear canal from the middle ear.

2.       Middle ear

-          It is an air-filled chamber which gives direct access to the inner ear and indirect way in to the nose and throat by the way of the Eustachian tube. It has three small bones (ossicles).

a.       Malleus

b.      Incus

c.       Stapes

3.       Inner ear

-          It is the most delicate part of the ear. It has two components.

a.       Auditory component of the inner ear (cochlea)

Cochlea is the snail-shaped structure attached to the stapes in the middle ear. It is filled with fluid. It is the one responsible for hearing.

b.      Vestibular component of the inner ear (semicircular canals and vestibule)

It is the one responsible for maintaining balance and equilibrium.

Announcement: FDA Seminar 2011

FDA has a scheduled "Seminar on Licensing of Establishments as per A.O. 56 s. 1989" on March 4, 2011, 8:00 AM to 5:00 PM. It will be held at Audio-Visual Room, 3rd Floor, FDA Annex Bldg.

Seminar fee is Php 1,200.00

For those who would like to attend this seminar, there is a Pre-Registration at Regulation Division II until March 3, 2011, 12:00 Noon. This is a first come, first serve basis for100 slots.

For more details contact Regulation Division II at 807-2843 or 809-4390 locals 1281 & 1282. You can also go directly at Room 128, Civic Drive, Filinvest Corporate City Alabang, Muntinlupa City.

Note: As Pharmacist of a certain drug establishment or drug outlets, certificate of this seminar is required by FDA Philippines. Drug establishment pertains to any of the following:

1. Drug Manufacturer

2. Drug Trader

3. Drug Distributor/Importer

4. Drug Distributor/exporter

5. Drug Distributor/Wholesaler

New Pharmacists and Drugstore Owners are recommended to attend this seminar.

Ibuprofen 5% W/W Gel (For External Use Only)

What is Ibuprofen Gel?

·         Non-Steroidal Anti-inflammatory Drug (NSAID)

·         An anti-inflammatory painkiller applied to the skin and absorbed through the skin.

·         It is use to treat different musculoskeletal conditions such as:

-          Backache

-          Sprains

-          Strains

-          Rheumatic pain

-          Muscular pain

-          Neuralgia

·         It can also give relief in common arthritic conditions.

Who can use Ibuprofen Gel?

·         Adults

·         Elderly

·         Children over the age of 12 years

How does it work?

·         It works by reducing the inflammation and swelling.

·         It also works by relieving pain.

Contraindication:

Do not us if...

·         Allergic to ibuprofen.

·         Asthmatic

·         Person suffering allergic runny nose.

·         Person with bad reaction with NSAIDs like aspirin in the past.

·         Pregnant or breast-feeding.

·         Person with broken or damaged skin.

Warning:

·         Apply with gentle massage only.

·         Avoid contact with eyes, inflamed or broken skin.

·         Discontinue use if rashes appear.

·         Use of large amount can result to systemic effects like asthma and hypersensitivity.

Doctors’ prescription is necessary. Always read the package inserts/leaflets before using the product. This is not a substitute for doctor's advice. This is written for the purpose of informing the readers about the drug.

Scared of Obesity? You Should Be!!!

What is Obesity?

It is the state of being well above the normal weight. An obese person has accumulated so much body fat. This might have a negative effect on their health. Traditionally, a person is considered obese if his or her bodyweight is at least 20% higher the ideal weight. Body Mass Index (BMI) between 25 and 29.9 are considered overweight. Obesity has precisely defined by the National Institutes of Health (the NIH) as a BMI of 30 and above.

What are the causes of obesity?

Main cause is lack of energy balance. The amount of energy that gets from food and drink must be equal to the amount of energy the body uses. Obesity happens when one takes more calories than he or she use.

There are other causes of obesity that we should be aware.

·         Smoking

·         Age

·         Emotional Factor

·         Health Conditions

·         Genes and Family History

·         Environment

·         Pregnancy

·         Lack of Sleep

·         An Interactive Lifestyle

·         Medicines

Health problems associated with obesity:

·         Diabetes Mellitus

·         Cardio Vascular Disease

·         Osteoarthritis

·         Gallstones

Factors that can worsen obesity:

·         Depression

·         Some drugs

·         Other psychosocial problems

Main Treatment:

·         Suitable diet

·         Smoking cessation (while maintaining body weight)

·         Increase Physical Activity

Courtesy of Alexander Gerl

Drugs used in treatment of obesity:

·         Orlistat

It is a lipase inhibitor, reduces the absorption of fat.

·         Sibutramine

      It inhibits the re-uptake of noradrenaline and serotonin.

Always consult a doctor before taking any medication for obesity. Proper and correct treatment comes from right diagnosis.

THRUSH TALK!!!

Have you ever experienced a lady who hesitantly approached the counter and asked for a treatment we can recommend for vaginal irritation? Oh, I believe in some cases, the male Pharmacist will hand over this situation to his fellow female Pharmacist on duty. Yeah, I know it’s a bit off topic for male, but unfortunately this is one of the many cases we should be familiar with.

If you want to recall thrush I am talking about, here it is...

Thrush is an infection caused by yeast called Candida. Small numbers of Candida lives on the skin and around the vaginal area. Aside from vagina, other areas of the body including mouth, groin, and nappy areas in babies are prone to Candida. Common inquiries in the pharmacy are oral thrush and vaginal thrush.

 Oral thrush is a Candidal infection in the mouth.

Courtesy of  Centers for Disease Control and Prevention, 

part of the United States Department of Health and Human Services 

Who usually gets Oral Thrush?
Candida commonly lives on healthy skin and in health mouth but due to certain conditions that promote overgrowth of Candida, oral thrush occurs.

1.      babies in their first few weeks of life

2.      older children

3.      adults who have completed their treatment with antibiotics

4.      adults undergoing steroid tablets or inhaled therapy

5.      Diabetic

6.      people wearing dentures

7.      people who lacks in iron, folic acid or Cobalamin (Vit B12)

8.      anyone having poor immune system

9.      smokers

10.  people with dry mouth due to lack of saliva

The usual symptom is white patches that become plaques when form larger spots. The colour can be yellow or grey. But in different conditions stated above, symptoms may vary.


Vaginal thrush can be externally or internally with a creamy white discharge or can be watery sometimes. The outside of the vagina (vulva) can be very itchy, painful, and swollen with redness and can cause discomfort. Symptoms can be slight and can clear up on their own. In case the discharge has different colour, the patient should be recommended to visit the GP.Thrush does not harm the vagina. It does not spread to injure the uterus (womb). It does not harm baby of pregnant woman.
Who are prone to Vaginal Thrush?
Vaginal Thrush can be common to the following woman but in most cases it is develop for no understandable reason.

1.      Pregnant

2.      Diabetic

3.      Woman who have taken antibiotics.

4.      People with poor immune system like those undergoing chemotherapy.

5.      Woman who are taking high dose of steroids.

Treatment:

·         For oral thrush in babies between 6 weeks and 2 years should be seen by Pediatrician.

·         For vaginal thrush, the use of an anti-fungal cream, power, solution, vaginal tablets/pessaries or vaginal suppositories is recommended.

·         Use of few drops of tea tree oil in the bath water can also be useful in the treatment of vaginal thrush.

Other conditions may be similar to thrush so if it the person suffers thrush for the first time, it is always recommended to confirm the diagnosis with the doctor. This is also true for pregnant women.

Practical Points (We can use this in counselling our customers.):

·         In order to prevent recurrence of oral thrush, oral hygiene is very important. Consider the use of a good mouthwash after recovery from the condition.

·         Taking of vitamins and other organic supplements can be very helpful in the treatment and prevention of thrush.

·         Regularly sterilize all the feeding equipments especially feeding bottles, dummies and mouth toys of babies.

·         Avoid using of soap, perfumed toiletries and disinfectants during vaginal or nappy thrush infection. Use of non-soap preparation like Oilatum and Cetaphil is recommended.

·         In prevention of vaginal thrush, always use cotton underwear. Synthetic underwear can promote warm, moist conditions in which fungus increase numbers.

·         After the symptoms of oral thrush have cleared, continue treatment for 2 days. For vaginal thrush continue treatment for 5 days.

Do you have anything to share about this topic? Feel free to comment.

Disclaimer: 
These are just prevention tips, practical points and not substitutes for doctor’s opinion. Visit your doctor for appropriate treatment.