Capitolo 10° PROFEZIA La manciata di giorni, notti, ore e minuti di fine d’anno passarono ovattati senza fare rumore; poi, allo stesso modo, in alleanza col silenzio, arrivò il mattino del trentun dicembre: il giorno di Profezia. Un giorno importante che una volta in scena viziò il silenzio e prese a fare cigolare il passaggio delle ore e dei minuti togliendo l'ovatta ai rumori e r
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Bulletin03-05May always seems to be a busy time in the Pharmacy world soI thought I would take this opportunity to update you on some of the events that are occurring as we all patiently await the Congratulations to the Dalhousie Pharmacy class of 2005 on their convocation. This is the first class with 90 graduates due to the expanded enrollment. The College of Pharmacy has recently unveiled a plaque to thank all of the people and groups that contributed to the Capital campaign to enlarge the skills lab. This was a key step to move to the expanded class size. PANS was duly acknowledged thanks to the $100,000 donation that your Association contributed.
In April, the NS Department of Health and the Department of Education jointly launched a Health Literacy Awareness Initiative. It has been acknowledged that literacy can be a barrier to health care. Please stay tuned for further details from the committee working A multi disciplinary conference on “Safety in Health Care” was recently held by the various health regulatory bodies in our province. This is another area that will continue to be at the forefront of Pharmacy practice. A key area of concern involving Pharmacy is the need for more universal seamless care as patients return to their communities from a hospital setting. This continues to be a focus of your Pharmacy Practice Com- We appreciate your comments. Please respond to: A few notes about some of the other Pharmacy Associations and their events.
The PEI Pharmacy Association is celebrating their 100th anniversary this year. The NB Pharmacy Association of Nova Scotia 1470 Dresden Row Association just completed a successful AGM and conference under the watch of their new Executive Director Paul Blanchard. Paul has just completed his first year in this Phone: (902) 422-9583 Fax: (902) 422-2619 E-mail: [email protected] position. The Pharmacy Association of Newfoundland and Labrador (PANL) which is the advocacy body for Pharmacy in that province has recently been en- acted as a separate body from the Regulatory Authority. This marks their first official year as an association.
CPhA is holding their annual conference in Quebec City at the end of May.
There will again be strong representation from Nova Scotia at this years As for our own Association, I am sure that you will all join me in congratulat- ing your Executive Director, Pat King on the receipt of two awards.
Pat received the “Richard Merrett Special Appreciation Award” from the
Canadian Society of Hospital Pharmacy, NS Branch last weekend.
Pat is also being recognized by the Canadian Foundation for Pharmacy with “The Pillar of Pharmacy Award”. The Foundation established “The
Pillar of Pharmacy Award” in 1997 to honour outstanding individuals in
Canada from these disciplines. This distinguished award is given to an individual who has given many years of service excellence and commitment The recognition of your Executive Director speaks to the strength of our association.
This is due to the involvement of you, the members of this association.
different types of skin cancers so appropriate referrals can be made. Skin cancer caught in early stages is curable. Ifcaught late, it can be fatal. There are three types of skin With Sun Awareness Week (May 30 – June 5) upon us, it’s a cancer. Basal cell carcinoma is the most common type which good time to start thinking about sun safety. Nova Scotia has usually develops as a single small blister-like bump or nodule one of the highest rates of melanoma in the country and on the face, ears, head, neck, hands and sometimes the pharmacists can play an important role in educating the public torso. Squamous cell carcinoma is the second most common about how to avoid excessive sun exposure and prevent skin type of skin cancer. It may develop on sun-damaged areas and occurs most often on the rims of ears, face, lips, mouth Risk factors for skin cancer include light-coloured skin, eyes or back of hands. This form of cancer may present in one of and hair, as well as a history of several blistering burns as a two ways. It may appear as a lesion that is firm to the touch child. People with a family history of skin cancer and those who and forms a central crust that develops into an ulceration with have spent long periods of time in the sun including work, play surrounding redness and inflammation. Alternatively, it may and exercise are also at increased risk.2 appear as red, pink or brown scaly patches. When the scaleis removed from the inflamed lesion, it reforms.4,5 Here’s a summary of the most recent sun safety guidelinesfrom the Canadian Cancer Society: The deadliest and rarest form of skin cancer is melanoma.4,5 • Keep children < 1 year of age out of direct sunlight.2 This type of cancer can develop anywhere on the body, but is • Reduce exposure to the sun during peak hours between 11 most commonly found on the back or the back of the calf.5 It am and 4 pm when a person’s shadow appears shorter than usually starts from a flat brown spot that looks like a mole or they are. Choose sunglasses with medium to dark lenses freckle.4,6 Patients should be warned to watch for moles with • SLIP! on clothes to cover arms and legs. The clothing
A – Asymmetrical – lesion is not round should be tightly woven, loose fitting and lightweight.2 B – Border – ragged, notched or blurred • SLAP! on a wide brimmed hat because most skin cancers
occur on the face or neck. Ensure that the brim is wider than D – Diameter – larger than a pencil eraser (> 6 mm) 4 a baseball hat to offer optimum protection.2 Patients should also look for changes in the surface of moles • SLOP! on a sunscreen with at least SPF 15. Apply the
including scaling, oozing, bleeding or increasing thickness.4 If product 20 minutes before sun exposure to allow enough a mole becomes itchy, tender or painful, referral is required.4 time for the chemicals to be absorbed. Reapply the product To view photos of the different types of skin cancers, visit the liberally every two hours and after swimming or sweating.2 Atlas of Dermatology website at http://www.meddean.luc.edu/ Use lip balm with SPF 15 and reapply when needed.3 lumen/MedEd/medicine/dermatology/melton/atlas.htm.
SPF 15 sunscreen blocks 93% of the sun’s rays.
Products with SPF 30 and higher block 97% of the sun’s Keep in mind that many medications, foods and herbal products may increase the risk of damage when skin is People at risk of skin cancer should use a sunscreen exposed to the sun. Adverse events such as phototoxicity, photosensitivity or photoallergy may occur. Although not all- • Avoid the use of tanning beds as they do not provide “a safe inclusive, the following chart summarizes some of the agents that may add to the damage caused by sun exposure.7,8,9 • A tan is a sign of skin damage or injury and no tan is safe.2 Pharmacist should consider warning patients about the Since pharmacists are often the first point of contact for possibility of an increased risk of sunburn and suggest a patients, it is important to be aware of the warning signs for the sunscreen for patients using these agents.
Antibiotics--------------------------------azithromycin, quinolones, sulfonamides, tetracyclines (least likely with doxycycline and minocycline)Antidepressants------------------------ most TCAs, sertraline, trazodone, venlafaxineAntihistamines-------------------------- astemizole, cetirizine, cyproheptadine, diphenhydramine, hydroxyzine, loratadineAntiparasitics----------------------------chloroquine, mefloquine, pyrvinium pamoate, quinineAntipsychotics-------------------------- haloperidol, phenothiazines, risperidoneCardiovascular medications-------- ACE inhibitors, amiodarone, CCBs (including diltiazem, nifedipine), HMG CoA reductase inhibitors (including lovastatin, simvastatin), losartan, quinidine, sotalol Chemotherapy-------------------------- dacarbazine, fluorouracil, methotrexate, procarbazine, vinblastineDiuretics---------------------------------- acetazolamide, amiloride, furosemide, metolazone, thiazidesHerbal/Alternative medications---- chlorella, chlorophyll, coriander, Dong Quai, gotu kola, shiitake mushroom, St. John’s Wort, Queen Anne’s LaceHypoglycemics------------------------- chlorpropamide, gliclazide, glyburide, tolbutamideNSAIDs----------------------------------- most medications in the class (including diclofenac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, Topical agents-------------------------- anise, benzocaine, benzoyl peroxide, coal tar, chrysanthemum, dyes (acridine orange, acriflavin, fluorescein, methylene blue, neutral red, rose bengal), essential oils (bergamot, cedar, citron, lavender, lemon, lime, neroli,petitgrain, rosemary, sandalwood), hydrocortisone, PABA, pyrimethamine, tretinoin Miscellaneous agents---------------- acetretin, alprazolam, carbamazepine, oral contraceptives, gabapentin, gold compounds, isotretinoin, methoxsalen, phenytoin, seleguline, sulfasalazine, trioxsalen, zinc pyrithione ACE = Angiotensin-converting enzyme, CCB = Calcium channel blocker, HMG CoA = Hydroxymethyl glutaryl coenzyme A,NSAID = Non-steroidal anti-inflammatory drug, PABA = para-aminobenzoic acid, TCA = Tricyclic antidepressant Make a commitment during Sun Awareness Week to speak with your patients about sun exposure and the risk of skin For further information, please contact Dr. Jane Gillis at 494- cancer. Remind patients to check moles and freckles regularly to help track changes.2 Patients should be advised to see theirdoctor or dermatologist if they notice any changes in their All qualified candidates are encouraged to apply; however, moles or freckles.2 Pharmacist should also advise their Canadians and permanent residents will be given priority.
patients to see the doctor right away if they notice a sore that Dalhousie University is an Employment Equity/Affirmative doesn’t heal or a new growth on their skin.2 Watch for a Action Employer. The University encourages applications from patient handout on this topic that will be posted in the public qualified Aboriginal peoples, persons with a disability, racially Prepared at the request of PANS on May 20, 2005 by: L. Nicky Corkum, BSc Biol, BSc Pharm Drug Information Pharmacist IWK Health Centre Recently PANS received news that a new type of Nurse Practitioner has been released in the Nova Scotia health marketplace called Speciality Nurse Practitioners (SNP’s). A number of these specialists have been licensed throughCollaborative Practice Agreements in which their collaborativepractice physician, who is a specialist, allows the SNP toperform certain medical responsibilities and prescribemedications above and beyond the normal list of drugs that nurse practitioners can prescribe. Cardiology, kidney, liver,etc., are a number of the disease areas in which SpecialityNurse Practitioners are being licensed.
The College of Pharmacy is seeking skills lab instructors forthe second year (60% FTE) and fourth year (40% FTE) of our The problem, however, is that these Speciality Nurse Practitioners are writing prescriptions and these prescriptionsare leaving the institution and ending up in a community The second year reinforces and expands upon the skills pharmacy. What happens next is that the pharmacist must learned in first year pharmacy (communication skills, resolve the identification of who the SNP is, (Only a web-based pharmacy computer skills, calculations, drug information list exists) what it is the SNP can specifically write, (again no retrieval, prescription processing and compounding). Hospital definitive list). And the ultimate problem is that none of the pharmacy and IV ad mixtures are introduced in this course.
prescriptions that Speciality Nurse Practitioners write, that are The students are also introduced to pharmaceutical care with outside the normal nurse practitioner schedule of drugs, are an emphasis on patient assessment, identification of drug paid for by private or government insurers. That means then related problems and appropriate treatment options, OTC and that when a Cardiovascular SNP writes some cardiovascular Rx counselling and patient monitoring and follow-up. The products, well within their right to do so, and when the script subject material for skills lab parallels the second year arrives at the community pharmacy the pharmacy will have to problem-based learned curriculum. The second year skills lab charge the customer cash because no insurance or government program will pay for these products. However, had The fourth year further develops skills required by a practicing these same products been prescribed by a specialist, or even pharmacist and expands upon skills learned in Skills Lab I – the patient’s family physician, they would have been paid for.
III. Although subject material parallels the fourth year The pharmacist can call the patient’s physician or specialist and problem-based learned curriculum, the cases are more get them to sign off on the drugs, but this is time consuming complex and often deal with disease states learned in and a waste of the pharmacist’s valuable time.
previous years. The lab also involves working in small groups When PANS recognized what this situation was like we wrote and interaction through role play and standardized patients to the coordinator for speciality nurse practitioners and DOH help students with the practical application of knowledge requesting that SNP’s cease prescribing in the community. The needed to meet patient specific needs. Students are expected result of the letter is that SNP’s no longer prescribe into the to utilize and further develop problem solving skills and critical community; and since the letter a series of meetings have been appraisal skills throughout the lab. The fourth year skills lab set up to see how these problems and others might be The instructor is responsible for updating/developing coursematerial, lecturing, arranging guest lecturers, studentassessment and overseeing the lab demonstrators.
Skills lab instructor appointments are members of theDalhousie Faculty Association and appointments are for thefull calendar year.
A baccalaureate degree in Pharmacy is required and teachingand work experience in the area of pharmacy practice is an
One-on-One Implementing Inclusion A conversation between Exelon Corp. and Nextions on effecting top-down change How do the concepts of diversity and inclusion truly affect the way companies do business today? To answer this question, we turned to Nicole M. Durham, director of Diversity and Inclusion at nd Arin N. Reeves, Ph.D, pre consulting firm specializing in leadership and inc