A view of pharmacy and health from a very remote pharmacist
From the category archives:
Following on from the report from the TGA investigation into an apparent cluster of side effects due to Pneumovax 23 the Northern Territory have released their updated adult vaccination protocol for Pneumovax 23.
There has been one change to the guidelines. There is no change to the Indigenous schedule.
NON-Indigenous adults over 65yrs do not receive a first or second revaccination of Pneumovax
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The Therapeutic Goods Administration (TGA) has completed their investigation into the cluster of severe local injection site reactions in March 2011 that continued into April 2011.
Advice was then given to not administer the second adult dose of Pneumovax 23.
The investigation has now completed. The TGA considers that the increased reports of local reactions was not batch related but due to two factors. (Pneumovax 23 does have known high rates of local reactions after a repeat dose.)
The TGA has now advised that revaccination:
Note this now differs from the current Australian Immunisation Handbook (9th edition 2008).
A discussion I had today with the acting in-charge at Communicable Disease Control Directorate, Department of Health, Western Australia indicates the schedule will most likely remain unchanged for Indigenous Australians.
Until this is put to us in writing (Medical Cordinator CDC WA is on leave at present) continue to withhold the second Pneumovax 23 ADULT dose.
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THE NIGHT BEFORE CHRISTMAS – A DILEMMA AT RGH
Twas the night before Christmas, and it would seem
No drugs were dispensed by the pharmacy team?
The tablets did not make the usual run
And capsules, injections, of these there were none!
Untreated people were restive in beds
Delirious patients had quite muddled heads…
Cardiac failure without diuretics
The pain of arthritis was rather pathetic
When out in the car park there was such a clatter
We saw a solution for pharmacy matters
The news was quite welcomed by clinical teams
The doctors, the nurses, and others it seemed
The dilemma that looked that it might have no ending
Was now to be fixed by “physician attending”
Although he was bearded and wore no white coat
Doc Santa had tablets in a large, baggy tote
That jolly physician, so lively and quick,
Red-suited, and dapper, decidedly slick
He was somewhat rotund, with twinkling eye
But no-one begrudged him for his BMI
“Now Lasix! Now Zoton! Now Prozac and Valium!
On, Keflex! On, Plavix! On Astrix and Nexium!
To the top of the counter! And answer the call!
Now dash away! Dash away! Dash away all!”
Like subsidised treatments, the tablets did fly,
Ointments and eye-drops, all fit to apply
Out from the pharmacy, medicines flew,
They sat in the sleigh with the good doctor too.
Then on to the wards, where patients did wait,
Some were reduced to a terrible state
Who would have thought it would be such an issue?
Without medicines the treatment just could not continue
As he got the wards, Doc Santa surveyed
An absence of tablets so terribly grave
This can’t go on, he said with a grin
And reached into his sack to the capsules within
His eyes-how they twinkled! His dimples – how wry!
He got straight to work in the blink of an eye
And into the drug rooms the good Doc dispensed
Injections and lotions, from pharmacy sent
The nurses were happy, the doctors ecstatic
Rescued from problems that seemed quite traumatic
For now all the medicines were ready at hand
And the hospital’s prospects, decidedly grand
So in each bed patients quietly lay
Hoping for discharge before Christmas day
The good doc delivered the drugs that they needed
And all of their ailments could now be treated
And as he completed his medical run
His work was completed, deliveries done
He picked up his sack and returned to his sleigh
“Good bye and God Bless – I’m on my way”
He sprang to his sleigh, to his team gave a shout,
“We have more things to do, more drugs to get out”
As he left RGH, and the sleigh took to flight
He cried “Happy Xmas to all, & to all a good-night!”
Download the Christmas Edition 2011 RGH E-Bulletin
Acknowledgment – The E-Bulletin is made possible by the hard work and diligent contributions of the staff and the Patients Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. Their efforts are much appreciated.
FOR FURTHER INFORMATION – CONTACT THE PHARMACY DEPARTMENT ON 82751763 or email: chris.alderman@rgh.sa.gov.au
Information in this E-Bulletin is derived from critical analysis of available evidence – individual clinical circumstances should be considered when making treatment decisions. You are welcome to forward this e-bulletin by email to others you might feel would be interested, or to print the E-Bulletin for wider distribution. Reproduction of this material is permissible for purposes of individual study or research.
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Alcohol has the potential to interact with many medications, but the clinical significance of these interactions is often queried. Pharmacokinetic interactions between alcohol and drugs occur mainly in the liver where both are metabolised.
Pharmacodynamic interactions generally result in enhanced effects in the central nervous system (CNS) including sedation and decreased motor skills. Assessment of alcohol-drug interactions is confounded because acute alcohol intake may inhibit drug metabolism whereas chronic alcohol intake can induce enzymes. Studies often focus on the effects of chronic heavy drinking with little evidence for advice around concomitant moderate alcohol consumption.
The table below highlights some key interactions where avoiding alcohol may be prudent (click to enlarge)
Obviously, increased risk of sedation and possibly also other CNS suppression effects is expected with a variety of medications if taken concurrently with alcohol: these include antidepressants, antipsychotics, antihistamines, antiepileptics, opioids and other sedatives. Patients need to be counselled regarding this and should be warned about the risk of decreased motor skills. Caution is also advisable with vasodilators, which if taken with alcohol may lead to increased orthostatic hypotension.
Increased risk of gastric irritation may occur with NSAIDs and prednisolone, and liver damage with methotrexate and isoniazid. Drugs increasing gastric emptying such as erythromycin and H2 antagonists, result in increased alcohol absorption in the small intestine with increased blood alcohol levels.
Alcohol consumption has variable effects on drugs such as phenytoin and oral anticoagulants. Chronic use can result in significantly reduced drug concentrations. Conversely binge drinking inhibits warfarin metabolism resulting in increased risk of bleeding. Consumption of 1-2 standard drinks per day is generally considered to be safe.
Download: Alcohol and medications
Acknowledgment – This E-Bulletin is based on work by Dr Rose Allin, DATIS, RGH.
FOR FURTHER INFORMATION – CONTACT THE PHARMACY DEPARTMENT ON 82751763 or email: chris.alderman@rgh.sa.gov.au
Information in this E-Bulletin is derived from critical analysis of available evidence – individual clinical circumstances should be considered when making treatment decisions. You are welcome to forward this E-bulletin by email to others you might feel would be interested, or to print the E-Bulletin for wider distribution. Reproduction of this material is permissible for purposes of individual study or research.
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