Insomnia

Insomnia is described as randomly delay of sleep greater than 30 minutes, difficulty in maintenance of sleep or abridged duration of sleep. Insomnia can be classified based on cause or by duration. There are non-prescription drugs and non-pharmacologic intervention that can be considered in treating insomnia.

Classification based on cause: A. Primary Insomnia is a condition in which a person experiences constant insomnia with no medical condition or psychiatric condition accounted for. The source or cause of this condition is unknown but it can be treated. B. Secondary Insomnia can be due to substance abuse, medical condition, psychiatric disorder, lifestyle habits such as use of caffeine, or situational stress.

Classification of Insomnia by duration: A. Transient Insomnia is a self-limiting insomnia that can lasts to less than 1 week. It is due to acute situational stress or circadian issues like working in shift or jet lag. B. Short-term Insomnia is related to situational stress to work, medical or psychological issues, or family matter. It can last from 1 week to 4 weeks. If this kind of insomnia is not attended properly, it can lead to chronic insomnia. C. Chronic Insomnia is a kind of insomnia that requires proper assessment since it could be due to medical disorder. It is more likely associated to psychiatric problem mainly depression.  

Most of people are guilty of doing self-medicating in the effort to correct the condition. They often consider drinking alcohol just to get into sleep. As of the often, there are no data supporting the safe and effective use of complementary therapy as sleep aids. So before taking any medication for insomnia, it is better to consult a doctor first.

OTC medicines (sleep aids)

1. Diphenhydramine is a drug that blocks histamine making the person relieved from allergic cough and colds. It is also as sleep aid such as Unisom Sleep Gels, Simply Sleep, and Compoz (these brand names are available in US). Unfortunately, in some countries, this drug is not directly promoted as sleep aids. You can ask your local pharmacist about it.

Dosage: For person aged 13 or older, 25 mg- 50 mg per night can induce sleep. Greater than 50 mg dose will not give more beneficial effect but will only enhance the chance of experiencing adverse effects. A dose of 1 mg/kg/night may be given to children aged 6 to 12 but must be of doctors’ order. Diphenhydramine is not recommended for children below 6 years old. There is a decrease of efficacy if use more than 10 consecutive days.

Diphenhydramine has anticholinergic adverse effects. It can cause dryness of mouth, urinary retention, constipation, blurred vision, and decrease in perspiration. It is contra-indicted to person suffering from cardiovascular disease, dementia, glaucoma and benign prostatic hypertrophy.

2. Melatonin is another drug recommended for person suffering from insomnia specifically in circadian issues like jet lag and work shifts. Melatonin is a nocturnal neuro-hormone secreted by pineal gland which is decreases production as people age.  There are also some factors that decrease production of melatonin namely, alcohol, tobacco and some medication such as steroids, non-steroidal anti-inflammatory drugs, calcium channel blockers, fluoxetine, and benzodiazepines.

Dosage: It may be dosed as 0.3 mg – 5 mg during the day or at night, depending on the desired effect. The dose of greater than 1 mg may improve sleep efficiency but have not shown the capacity to offer quality sleep restoration.

3.Doxylamine is also anti-histamine drug which induces sleep by blocking the histamine and muscarinic receptors. It acts in the same manner as of the diphenhydramine. The usual dose of doxylamine is 25mg per night.

What can we do to have a good night sleep?

Photo Courtesy of  Roman Bonnefoy

• Go to bed before you feel tired.
• Avoid serious discussion before bed time. It is very hard to switch off when something bothers you. I am sure most of you will agree with me on this.
• Don’t stay up late doing things around the house.
• Put away food. Eating late at night can cause confusion on our digestive system preventing us to sleep.
• Avoid drinking coffee or tea. Try some chamomile herbal drink which is best known on its soothing and calming properties.
• Keep away from sleeping pills as well as alcohol. They will just worsen your morning by feeling tired. This will also prevents you from experiencing the stages of sleep.
• Avoid activities that will increase brainwaves like television and computer before bedtime.
• Put away electrical equipment in your bedroom, unplug them if possible. Electromagnetic activity would impede with sleep. 

Stages of Sleep

How many hours of sleep do we need?

Sleep requirements vary from one person to another and it change throughout the life cycle. Here’s a list to remind as the normal range of sleep base on age:

• Up to 18 hours is a significant amount of sleep for newborns.
• Adolescents require a total of 9.5 hours of sleep.
• 7 to 8 hours of sleep is needed by adults to restore their energy. But it is reducing as we age.

Through the use of Polysomnography, the main tool to distinguish sleep physiology, the essential five stages of sleep were identified. It is subdivided into REM (Rapid eye movement) sleep and Non-REM sleep. Each stage is a sequence into a deeper sleep. Stages 1 to 4 are under the Non-REM sleep. In aging, Stage 3 and 4, known as deep, restorative sleep, are diminished causing them to have a poor quality of sleep. REM sleep consists of stage 5 in which most dreaming happens. It is said that if you wake up while in REM sleep, you may clearly describe your dreams. Between six and seven hours is the minimum hour our body needs in order to experience these stages.  Sleep fewer than six hours a night will have an effect on our cognitive performance. 

Types of Contact Lenses

Nowadays, you can easily buy contact lenses for aesthetic purposes. But originally, contact lenses are use only for people who want to improve their vision apart from using spectacles. There are different types of contact lenses for the latter reason. It is important to choose one that will give you comfort and not impair your vision more than usual.

1.       Hard contact lenses are made of polymethylmethacrylate (PMMA). PMMA is hydrophobic by nature causing limited permeability of oxygen. For this reason, this type of lenses is hardly use by people.

2.       Rigid gas-permeable (RGP) lenses have the features of hard contact lenses but oxygen is more permeable in this type. It delivers more oxygen to the cornea giving more comfort to the user. It is available in daily wear and extended wear versions. A surface active agent and enzymatic products are used to clean this type of lenses. It also needs to soak for 4 hours in a conditioning solution before using again.

3.       Soft lenses are comfortable and easier to remove compare to other contact lenses. The visual improvement with the use of these lenses is not significantly noted as that of the hard lenses or the rigid gas-permeable (RGP) lenses. This type of lenses should not be used when instilling topical ophthalmic products aside from rewetting solution.

Note: This topic shares a part in a comprehensive review for pharmacy in preparation for foreign pharmacy qualifying examination.

Oral Care

Knowing the differences from one product to other can help us deal with our customers in a pharmacy. Among these products are the dentifrices that are available in wide varieties. This topic also shares a part in a comprehensive review for pharmacy in preparation for foreign pharmacy qualifying examination.

Dentifrices are goods that boost the removal of stains and dental plaque by the toothbrush.  These products are available in the market in different forms such as paste, gargle solution or gums.

1.       Toothpaste. We all know that it aids in reducing mouth odours, decreasing the chances of dental caries and most of all enhancing the personal appearance. It has many ingredients such as abrasives, surfactants, humectants, suspending agents, pyrophosphates, flavouring agents, and fluoride, which help attain its purpose.

2.       Mouthwashes. These products can be a cosmetic mouthwashes or anti-plaque rinses. They can also be used for enhancing the consumption of fluoride. Mouthwashes may contain astringents, demulcents, flavours, fluoride, germicidal agents, and surfactants.

3.       Cosmetic whitening agents.10% carbamide peroxide and hydrogen peroxide are the most common ingredients that can be found in this kind of dentifrices. It is the one responsible for whitening the teeth. It is a white crystal which releases hydrogen when having a reaction with water. This, in return, liberates the free oxides. Products like Proxigel and Simply White contain carbamide peroxide while Crest Whitestrips have hydrogen peroxide.

4.       Anti-plaque agents consist of Triclosan, essential oils namely eucalyptol and thymol, metal salts such as stannous and zinc, and plant extracts (sanguinarine), helps prevent gingivitis, tartar, cavities and plaque. Colgate Total is an example of which.

5.       Anti-calculous dentifrices are products composing of zinc citrate, zinc chloride and 33% of pyrophosphate. It prevents calculus formation.

6.       Desensitizing agents are products that reduce the pain in sensitive teeth caused by cold, heat, sweets, touch, or acids. These agents should not be use permanently unless instructed by a dentist. Examples of these agents are Colgate Sensitive, Sensodyne, Crest Sensitivity and Aquafresh Sensitive.

7.       Dental gums may contain baking soda as mild abrasive cleaner and in neutralizing the acid. Some have calcium to aid in remineralize the teeth and prevention of cavities. These products also contain a sweetener such as xylitol which is likely to cause cavities compare to sorbitol. Dental gums are recommended for people who are unable to brush after lunch but it is not a substitute for good oral hygiene. Products available in this form are trident Advantage, Dental Care, Advance Breath Care, Aquafresh Whitening and many more.

8.       Disclosing Agents help in envisioning where dental plaque has formed. It is use occasionally with the dentist’s supervision. It should not be swallowed. Rinsing the mouth is advisable after use.

FDA Philippines Change of Pharmacist

Food and Drug Administration (FDA) require any pharmacy settings to update them whether there is an event of changing or adding a Pharmacist. Pharmacy setting can be drugstore, hospital, distributor, manufacturer and other establishment that is registered in FDA and being supervised by Pharmacist.  

Here are the requirements:

1. Fully accomplished and notarized Notice of Change/Additional Pharmacist form.
2. 2 pieces 2 x 2 Colored ID Picture
3. Board Certificate of the new Pharmacist
4. Valid PRC ID of the new Pharmacist
5. Valid Professional Tax Registration (PTR)
6. Certificate of Attendance on a FDA accredited seminar on Licensing of Drug Establishment and Outlets 
7. Duly noted resignation letter of outgoing Pharmacist
8. Resignation letter of incoming Pharmacist signed by previous employer

Note: Submit photocopies of items 3 to 6 but bring the original documents for verification. Also secure a copy of item 1 and have it signed by the receiving officer at FDA for your own record. For further questions, please call FDA.

Disclaimer: 

The information and reference materials contained here are intended solely for the general information of the reader and NOT intended to either replace the official source nor the advice of the doctor. The owner of this site disclaims any responsibility for the decisions you make based on this information. If you have any health-related questions, persistent health condition or before taking any medication, please consult your health care provider. 

PinoyPharmacist.com do not claim ownership for any PDF files linked in this site. They are shared for the purpose of helping the governing bodies in disseminating information, news, updates, and important announcements. 

Poison Classification for Philippines

Every country has different ways of classifying drugs. Here’s how we do it in Philippines:

Non-Rx

Non-prescription medicine/over-the-counter medicine (OTC) which is supplied without need for prescription.

Rx

Prescription medicine which is supplied on prescription only.

DD,Rx

Dangerous Drug as listed in the Comprehensive dangerous Drugs Act of 2002 which is supplied only on Special Department of Health (DOH) Prescription Form (Yellow Form/DDB Form 172) by a licensed PDEA prescribing physician.

EDD,Rx

Medicines containing any amount of prohibited or regulated drugs which are supplied on ordinary prescription forms with S-2 license number by a licensed PDEA prescribing physician.

Presciption only Medicines

If you are a Pinoy Pharmacist who happened to be on duty by the time a customer walks in the store and ask for a medicine which needs a prescription, will you dispense it to the customer or not?

Some will dispense the medication asked for, even if without prescription. But we all know that it is not proper to hand over a drug to a customer without the correct prescription. Have we forgotten the rules? We, among other health professionals, should know this. Medicines have many beneficial effects but they also have side effects and even toxic effects. Remember that what matters most is the health of the person, not the pharmacy’s sales.

What can you tell the customers in this scenario? Simply tell them that you cannot give them what they need until they provide you with a valid prescription. I’m sure they will argue with you but be firm with your decision. Anyway, it is not your decision, it is the rule. Explain to them the disadvantages of taking the medicine without proper diagnosis.  

What if they tell you, they left it at home promise to bring the prescription back just give them their medicines first? Come on, do you believe that? That is a very lame excuse that we should not consider. If you allow it the first time, they will do it again.

If they ask for your manager, let them talk to your manager but make sure you and your manager are in the same page. I remember a familiar case way back when I was working in a popular pharmacy. An angry customer asked for the manager because the pharmacy assistant did not dispense the medicine he needed. So the manager went out and talked to the customer. Guess what the manager did? Oh yes, he dispensed the medicine. He was not even a pharmacist. I bet, he was just scared of the customer and wanted to get out of the scene immediately.

What I am trying to point is whether you are the pharmacy owner, the pharmacist or the pharmacy assistant, stick to the rule together. Prescription only medicines need the prescription.

What is your stand on this? Do you have a similar experience as mine?

How to Prevent Backache?

Most back pain may go away itself eventually, but it may recur. With all the discomfort and difficulty of having back pain, you simply do not like it to return. That is why, prevention is important to make sure that the problem will not start or happen again.

Here are few tips in preventing backache:

• Avoid drooping when sitting or standing. Always maintain good posture.
• Make your leg muscles stronger. Remember that leg muscles help in maintaining good posture and mobility.
• Warm up before doing any activity especially before exercises. This will avoid the risk of injury.
• Consider yoga and Qigong as exercises. This is advisable to strengthen and stretch the muscles and later improve posture.
• Reduce stress. Stress will just increases tension in muscles.
• Make sure your work surfaces at home are at a cosy height.
• 30 minutes of walking, cycling, or swimming is good for people who have suffered back pain in the past.
• While sitting, you need to move around to help your muscles relax.
• Use comfy, low-heeled shoes that will give you good balance and flexibility. This will ensure alignment of your spine and body.
• To avoid stressing your shoulder, switch one side to the other as often as possible.
• Make sure you have plenty of calcium, Vitamin D, and phosphorus in your diet. These sustain new bone growth.
• Drink plenty of water. Dehydration can be a cause of backache.
• Do not panic if you have back pain but remember to visit your doctor to resolve the issue.

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

Do you suffer from OCD?

Photo Courtesy of Lars Klintwall Malmqvist

It’s an ordinary day; you are going out for work. The usual scenario is you go around the house to check if every window, door or any point of entry are close. On your way out of the house, you have this unsettled feeling that the back door is open so you will return back in to check again, then you find out that it is locked. “Better be sure than sorry”, you say to yourself. But as you start your car engine, you still have this feeling that you might forget to close the window. Again, go back into the house to check the same things. Finally, you are driving your car, but a sudden thought came up, “Did I lock the main door?”  Head back home and check again. You did lock every door and window but you keep on checking and rechecking things over and over again.

If this annoying situation sounds so familiar to you, maybe you are struggling with OCD, obsessive-compulsive disorder. According to psychologists and psychiatrists, OCD is an anxiety disorders that varies from one person to another.

·         Compulsive Checking

People, who suffer with this kind of OCD, repeatedly check things like doors, windows, household appliances, locks and other things. They fear of catastrophe may arise if they will not checked, rechecked, and checked again.

·         Compulsive Ordering and Symmetry Obsessions

In this kind of OCD, people have the feeling of arranging things again and again until they are satisfied that everything is properly place where it should be. They often get irritated if objects they arranged are moved or even touched. They can be considered perfectionists.

·         Compulsive Washing and Cleaning

People with this kind of OCD, constantly clean and wash themselves and their home to alleviate their worries of contamination from dirt and germs. They fear of being harmed with foreign substances.

·         Primarily Obsessional OCD (pure obsessions)

Unwanted violent and sexually inappropriate thoughts and images polluted the minds of the people with this kind of OCD. They need great efforts to control these unwanted thoughts. In order for them to counteract their anxiety, they keep on thinking repetitively such counting, praying or repeating certain words.

·         Scrupulosity

This is a religious form of OCD in which the sufferers worry much of their moral purity. They keep on praying and extremely confessing for they are afraid that they might have violated religious rules.

·         Health-related OCD

People, who are always troubled of becoming ill causing them to visit the doctors frequently and keep on checking their bodies for any signs of disease, are people who suffered from this kind of OCD.

·         Hoarding

Hoarding is a kind of OCD in which the person collects insignificant things and having a hard time of disposing them. These items are in fact worthless and considered to be junk like newspapers, soft drink cans and bottles, plastics and the like.

Eligibility Assessment (Australian Pharmacy Examining Council,APEC)

Any Pinoy Pharmacist who intend to take APEC Pharmacy Examination must undergo initial assessment. It is conducted to check the applicant’s qualifications and credentials whether he/she is eligible to take the Knowledge Assessment of Pharmaceutical Sciences (KAPS).

I.                     Fill up the Application Form for the Initial Assessment. 

“An APC eligibility assessment is not an application to sit the KAPS.” There is a separate application for KAPS which can only be done after you have been assessed successfully.

II.        Required Documents:

These documents must be submitted along with the application form.

1.       Certified Copy of the applicant’s ID (passport or identity card)

2.       Certified copy of secondary education indicating subjects of study. 

3.       Certified copy of pharmacy qualification papers (Diploma)

4.       Certified official transcript of record showing subjects, hours and examination results and where applicable, details of practical and clinical education.

5.       Evidence of professional work experience as a pharmacist from graduation to the present, and two written letters of reference from employers or, if self employed, two references from professional colleagues, relating to your professional competence as a pharmacist.

If applicable the following documents must be provided:

1.    Certified copy of evidence of original and current registration or Licence to Practice (Pharmacy Board Certificate, PRC ID or you can request a certification from PRC)

 2.       Certified copy of certificate of internship (Hopefully, you retained a copy for yourself since we submitted these documents to PRC when we applied for Licensure Examination)

3.       Certified copy of evidence of resident status in Australia (if the applicant resides in Australia)

4.       Certified copy of evidence of any change of name (eg marriage certificate, deed poll)

5.       Certified copy of translation in English of any documents originally issued in a language other than English (the translated document must accompany a certified copy of the document in the original language)

Persons who are qualified to certify your documents:

1.       Justices of the Peace

2.       Official Notary Officers or an authorised staff

3.       Member of an Australian Embassy or Consulate

Note: Always present both the originals and copies to the person who will certify your documents.

Make sure that all copies are certified separately and have the following details:

 • Words "certified true copy of the original

• Signature of the certifying officer

• Name and address or provider/registration number (where appropriate) of the certifying officer clearly printed below the signature.  The APC must be able to contact the certifying person with these details.

Accomplished Application Form, supporting documents and assessment fee should be sent to:

Postal Address (normal mail):
          Australian Pharmacy Council Ltd.

                PO Box 269

                CIVIC SQUARE ACT 2608

                AUSTRALIA

      Street Address (for courier parcel only):
                Australian Pharmacy Council Ltd.

                Suite 3, Level 2, Ethos House

                28-36 Ainslie Place

                Canberra City ACT 2601

                AUSTRALIA

III. Initial Assessment Fee is $600 (Australian dollars)               

It is made payable to Australian Pharmacy Council Ltd. Payment can be made by overseas bank cheque or bank draft payable on an Australian Bank.

This eligibility assessment will take at least six weeks after the APC received your documents.  Before submitting your documents, ensure that they are complete to avoid delay in your assessment. For more details about the Initial Assessment, visit the Australian Pharmacy Council Website.

A Typical Day of a Pharmacist

Pharmacists in general, dispense prescription drugs to patients. They offer information about drugs and be of assistance to patients in understanding instructions their doctors or other health practitioners provided. They keep an eye on their patients' health and improvement to make sure their medications are working effectively and safely.

Career Path/Advancement of Pharmacists:

Community Pharmacists who have gained experiences and secure required capital can run their own independent pharmacies. While those in chain drugstores have chances of being promoted to supervisors or branch managers. Afterwards, greater opportunity like district, regional managers or executive positions in head office may be offered.

Hospital Pharmacists also followed a same path. One may be promoted to supervisor or chief pharmacist.

Industrial Pharmacist may move forward in other areas such as research, quality control, marketing or sales.

Typical Day of Pharmacist

• compounding and dispensing of prescribed drugs
• give opinion to physicians and other health practitioners on the selection, dosages, interactions, and side effects of medications
• observe the health and improvement of patients in response/reaction to drug treatment
• give advice to patients and answer any questions or queries about prescription drugs
• offer information and make recommendations concerning over-the-counter (OTC) drugs
• logging data into the computer or official record books

Other duties and responsibilities of Pharmacist:

• answer incoming physician or patient calls
• assist patients in managing their health conditions high blood pressure, smoking cessation, asthma, diabetes and other conditions
• recommend patients on medical equipments they may need in monitoring their health conditions, as well as helping them in using those equipments.
• give advice regarding stress management, exercise, or diet 

Tips on becoming a competent Pharmacist:

• Set your goals.
• Choose a practice that you will master.
• Focus on your duties and responsibilities.
• Continuously enhance your knowledge with your chosen field of practice.
• Practice with love and sense of purpose.

Pharmacist’s life is challenging yet rewarding. Enjoy being one.