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Freshers Edition

Sept/Oct 2011

Keep Calm and Get That MPharm

Kingston University Pharmacy Students Association

Current News | Interviews | Reviews | Kingston School of Pharmacy Info

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Editor s Letter

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Hello! Im pleased to welcome you to the Kingston University Pharmacy Students Associations very first publication , The Pestle & Mortar! We hope you enjoy and can relate to the content included in this first issue . This publication aims to encourage you to read outside your studies and engage and challenge your thoughts or ideas about the world of pharmacy today. The Pestle & Mortar also aims to awaken or fuel your passion for pharmacy through our variety of articles and features from expression of opinions which can create an interesting debate , to interviews with people working in the pharmacy world . It s the editorial boards hope that we always meet your needs, as a pharmacy student and reassure you that there is more to the pharmacy degree than just keeping your head in the books! So keep calm and get that MPharm! Thank you.

Abi Ogunrinde
Editor in Chief

Staff Profiles

Contents

3
Shilan Ghafoor
Co-Editor

Current news

Uzma Mehmood
Managing Editor

Maliha Bhatti
Art Director

Kalpesh Patel
Journalist

Dawar Qhoraish
Journalist

4 5 6 7 8

rPs ConferenCe 2011 review interview

PharmaCist

Community

with a

Brands vs GeneriCs: let the Battle


CommenCe

survival Guide

mCPharmaCy

September 2011

Current news
by Shilan Ghafoor

In late August, the discovery of the anti-psychotic drug, Seroquel XL in packs of Nurofen Plus tablets sent shockwaves throughout the pharmaceutical world. At first this discovery could not be explained however, it soon came to light that this could be a case of deliberate sabotage and a police investigation was subsequently launched. What prompted this was the fact that these drugs are manufactured by two different companies at two separate sites. Nurofen Plus is made by Reckitt Benckiser while Serequel XL is by AstraZeneca. Simple logistics prevented accidental contamination. Reckitt Benckiser have also suggested that consolidation can account for this mishap. Consolidation is a process whereby medicines which are returned to pharmacies or wholesalers are repackaged again for sale. The widespread media attention quickly led to more cases of rogue packets being identified. This time a pharmacy in Northern Ireland checking their Nurofen Plus boxes found the epilepsy drug Neurotonin. The MHRA issued a Class 1 drug alert to healthcare professionals, the most critical drug alert1. while Reckitt Benckiser issued an immediate nationwide recall of all Nurofen Plus packs with an estimated 250,000 packs being asked to be returned.
2.
Wicks, N. (2011). Hit Or Miss? Reckitt Benckiser Recalls Nurofen Plus Over Sabotage Fears. Available: http://cached. imagescaler.hbpl.co.uk/resize/scaleWidth/393/?sURL=http://offlinehbpl.hbpl.co.uk/News/WRP/2045765C-C379-CCAA3E7ECA78DC895ECA.jpg. Last accessed 6th September 2011.

Nurofen Plus is an over the counter pain killer consisting of Ibuprofen and Codeine. It is available in pack sizes of 12, 16, 24 and 32 although only the 32 pack size seems to have been affected. Four specific batches of these packs were found to contain Seroquel XL, which is available on prescription only and is given in the treatment of CNS conditions including schizophrenia. Though only one pack was found to contain Neurotonin, commonly prescribed for epilepsy and neuropathic pain. So far only two people are known to have taken Seroquel in place of Nurofen Plus but neither have had any adverse effects. The Royal Pharmaceutical Societys Neal Patel stated: For a healthy adult a single dose of Seroquel is unlikely to cause major problem. However, for patients taking other medicines or those with other medical conditions or if you suspect you may have accidentally taken Seroquel and feel unwell, seek advice from your pharmacist or doctor as soon as possible. Nevertheless the case is being investigated by the police while the company has halted production of Nurofen Plus until the investigation is over.
1. MHRA. (2011). Drugs Alerts. Available: http://www.mhra.gov.uk/Safetyinformation/Safetywarningsalertsandrecalls/DrugAlerts/index.htm. Last accessed 5th September 2011 2. Vimeo. (2011). BBC News 24 - Nurofen Plus. Available: http://vimeo. com/28397879. Last accessed 1st September 2011

Review
by Abi Ogunrinde
The opening keynote of the conference was given by Marc DuBois, Executive Director of the international humanitarian medical aid organisation, Mdecins Sans Frontires (MSF). MSF provides essential healthcare to the most vulnerable populations in danger in more than 60 countries or to those that do not have access to healthcare. Mr DuBois delivered a fantastic and inspiring presentation on teamwork in challenging and extreme environments. MSF gained its reputation by acknowledging that there is a problem and not walking from it which was especially recognised by the Nobel committee. In order to sustain their reputation, teamwork was essential with healthcare professionals. Mr DuBois described a framework of no hierarchy but overlaps of teams, which placed pharmacists are at the heart of this aid organisation. We work in a challenging environment, and to overcome any challenge requires teamwork, he said. As a profession and professional, pharmacists can help contribute to the clinical outcomes of a patient, work against the problems of counterfeit medicines and improve the good manufacture practice and quality control of drugs formulated and delivered while working in extreme environments for MSF. The key message and in relation to the theme of the conference is teamwork which is vital in any sector. Mr DuBois concluded, Teamwork can be used to overcome all the challenging obstacles before you. This is why teamwork is so important. Thereafter the opening keynote, delegates had to attend one of the four scheduled parallel sessions so I chose to attend the session on Supporting the future of pharmacy through education and professionalism. This session was very engaging and applied very much to me as a pharmacy student. New research on professionalism and pharmacy education was focused on during the session. Defining professionalism (and its elements) in early career pharmacists was a study conducted by Rebecca Elvey and a group of students from the University of Manchester where they used focus groups and individual interviews to investigate the concept of professionalism. Three sub elements of professionalism were identified to be ethical values and conduct, the tangible element of professionalism and the soft elements of professionalism; and were described by Ms Elvey presenting the study in the session. Though pharmacology lecturer commented on the ethical values and conduct explored and the fact that pharmacy undergraduates need to be taught when to break the rules professionally, think on their own and be original in their thinking because new pharmacists are just put in a field where theres so many rules and regulations. It was found also that aspects of the soft elements of professionalism need to be more focused on, especially on pharmacy students.

Following the partnership created between the BPSA and the Royal Pharmaceutical Society (RPS), free joint membership for students has been established. They have been working together to provide benefits for students to gain much more during their time at university such as access to local practice forums and discount on the RPSs products and services. Therefore, as a new RPS member, I wanted to begin to reap these benefits. So I gathered up fifty-five pounds to attend one day out of this years two day RPS Annual Conference. This years conference was based on Ensuring effective teamworking and collaboration with patients and professionals held at Goldsmiths, University of London. I was , expecting to have an insight into the pharmacy profession today and meet and learn from pharmacists, pre-registration trainees and other pharmacy students. But in the end, I felt I had gained more than what I expected.

is a win:win situation. Therefore, influence is established but is not manipulation. It was interesting to see how this session struck a chord with everyone personally and professionally. A female pharmacist commented that the pharmacy profession needs to sell itself more. She mentioned that recently she was told that shes invaluable as a pharmacist, but why? This may be because of our influence as a proAnother study looked at during the session on the fession and professionals, it needs to be improved. impact of the General Pharmaceutical Council (GPhC) Code of conduct for pharmacy students and Towards the end of the conference that day, there fitness-to-practise procedures on MPharm students. was a fascinating panel session regarding The It was conducted by Gareth Kitson and a group of Medicines (Pharmacies) (Responsible Pharmacist) students from the University of Bath, where eighteen Regulation 2008 and the changes on supervision in schools of pharmacies participated. It was found that pharmacy. It is a complex subject as a uniform rule female students were more likely to read the Genfor supervision cannot apply to all sectors in phareral Pharmaceutical Council Code of conduct than macy. Though the RPS have devised a principle male students. 69% of participants in the study had based approach agreed by the chair boards consistread the conduct before agreeing but it was revealed ing of five principles (for further details, visit http:// in a focus group that participants felt that it was a www.rpharms.com/current-campaigns--england/ means to an end; to be an MPharm student and consupervision.asp). The debate was brought to the tinue with their studies they had to sign it. But study conference with a panel of experts on the topic analso revealed that there was no clarity on the Code of swering questions and expressing their own or comconduct as a student and as a professional. In addimunal views. The panellists were Martin Astbury, tion, participants felt that they were not aware of the President of the Royal Pharmaceutical Society; fitness to practice procedures and would only know Mark Koziol, Director of Pharmacists Defence Asonce they had done something wrong. Do you agree? sociation; Fin McCaul, Chair of Independent PharThe General Pharmaceutical Council were aware of macy Federation; Rob Darracott, Chief Exective the study conducted however, Mr Kitson concluded of Pharmacy Voice and Peter H. Ellis, Executive that more guidance is needed on the code of conduct. Managing Director of PharmaTrust UK. Although a final conclusion was not met, the main points that Research done by Zoe Lim and Claire Anderson were stressed during the debate was that we should from University of Nottingham on expanding the make the care of your patient your first concern teaching capacity in schools of pharmacies found which underlined most points raised; supervision it can be done best by importing practising pharmais a way of ensuring and increasing patient/public cists. However, some practising pharmacists may care and safety. Mr Koziol believes clinical checks feel theyll perish if they enter academia while and supply of medicines should not be focused on others see it as a means of continuing professional so much but more on patient care and how patients development. Though one pharmacist in academia are taking their medicines. Mr McCaul commented during the session commented saying that there that prescriptions checked and bagged should be is a tradition of teaching seen in Medicine but not given, P medicines should be dispensed by trained seen in Pharmacy. Why is that? Perhaps this tradiand competent staff but where questions are asked, tion should be implemented in the pharmacy culture the pharmacist is needed and to be contacted for an and in that way, the teaching capacity in schools of intervention. While Mr Astbury agreed with Mr Mcpharmacies and quality of teaching may increase. Caul and added that supervision is needed to facilitate getting the pharmacist in the front of shop and After lunch, I attend another parallel session out of increase the professional and patient relationship. another four parallel sessions scheduled on How to get people to want you on their team (Building susMary Tully, Conference Chair 2011, ended her weltainable influence). It was an excellent interactive session presented by Neil Poynter, Director of Mc3 come speech saying she hopes the delegates are to Ltd on how to help participants achieve influence on leave the conference feeling energized and ready others. In order to have influence, we must have good to face the challenges and I did. I felt an increased selling skills, be capable and have intellect. There excitement for the pharmacy profession. However, are four types of selling commoditive, technical, the challenges I may face might be in our school consultative and partnership. We must be interested, of pharmacy or in on a placement. Though the RPS listen to the problem being faced and solve it and seemed to have vibrant goals and a clearer vision on therefore be sellers who are consultative and can what to achieve as professional leadership body for form partnership thus, being a problem solver; which the pharmacy profession since the split between the RPS and the GPhC a year ago, which is promising.
This involved approachability, listening to the patient and treating them with courtesy, speaking in a confident manner and using the right language when speaking to patients. What can our school of pharmacy do to help in this problem?
For more information visit: Royal Pharmaceutical Society - http://www.rpharms.com/home/home.asp British Pharmaceutical Students Association - http://www.bpsa.co.uk

a Community PharmaCist
It is estimated that over 1.8 million people visit a pharmacy in England on an average day. They are a common fixture in our high streets, supermarkets and polyclinics and provide many different healthcare services to the general public. In this issue of The Pestle & Mortar, we explore the benefits and challenges of a community pharmacists day to day work. Husain Master is the manager of an independent pharmacy; in this interview we take a look at community pharmacy through his perspective.

an

interview

with...

Interview by Uzma Mehmood


What do you enjoy most about being a community pharmacist? There are many things I enjoy about my job. First and foremost is the daily interaction I have with other healthcare professionals. More importantly, I enjoy building relationships with patients. I like being at the forefront of the pharmacy and interacting with customers who visit the pharmacy for all sorts of reasons.

husain master
improve a patients understanding of their condition and medicines, resulting in better compliance and better outcomes for the patient. I also liaise with other healthcare professionals such as GPs to improve patient care. What is the most rewarding part of being a community pharmacist? The most rewarding part of being a community pharmacist is being able to provide a high quality service to customers. It is even more rewarding when this is appreciated and highly valued by the patients.

What made you want to become a pharmacist working in a community setting as oppose to working in a hospital or industrial setting? This was a personal choice. I had training in both community and hospital pharmacy but enjoyed being in a community setting more. This was because I felt I had more patient interaction than I would have done in a hospital setting.

Do you ever feel frustrated that a large proportion of the general public do not use their local pharmacy as a resource for questions on their medication? I thought community pharmacists only dispensed medicines. I dont feel frustrated, however a lot more can be done to What else can they do? promote pharmacy and enhance the knowledge of patients on Conventionally, the role of a pharmacist may have been seen as what pharmacies can offer. It is a duty of all pharmacists to the person who counts the pills behind the counter. The role of a ensure this gap in knowledge is addressed. However, patients pharmacist is moving away from this as we are now getting more are gaining more and more understanding on what pharmainvolved in delivering healthcare services to the local population. cies can offer and hence come to the pharmacy first with their Services range from Diabetes and Cholesterol testing to carrying healthcare needs. out Medicines Use Reviews (MURs). We can also carry out Vascular Risk Assessments and treat minor ailments. How do you keep up to date with developments within your

Where do you see community pharmacy in five years time? With the introduction of many new services, pharmacies are becoming more like clinics on the high street rather then a traditional medicine store. The NHS is a changing environment at the moment and this will provide great opportunities and challenges for pharmacists to expand and develop their role to get more involved in the primary care of patients. The role of a pharmacist will be in par with other healthcare professionals in terms of diagnostics and treatment. In essence we will become clinicians rather then dispensers.

industry? CPD (Continuing Professional Development) is a vital method of keeping up to date. Other ways include being involved with different committees such as your Royal Pharmaceutical Society Local Practice Forums.

What advice would you offer pharmacy students? Work hard but enjoy yourself. Before you graduate try and get some work experience in different sectors of pharmacy and see what suits you best.

Finally, how can students get more involved in the changDescribe the day to day role of a community pharmacist ing landscape of pharmacy? My day to day job varies as no one day is the same. It ranges Become members of the Royal Pharmaceutical Society and from dispensing medication to patients to providing advice on mialso attend meetings held by your Local Practice Forums. nor ailments and carrying out services such as MURs. MURs help

Brands Vs Generics
Let the BattLe CommenCe
by Kalpesh Patel & Uzma Mehmood
The inevitable question most pharmacists working in the community face, whats better branded or generic? Ever noticed a customer walking into a Pharmacy and insisting to buy a branded product such as Nurofen whilst claiming Ibuprofen tablets just do not work. Have you ever felt like screaming, Its the same thing!? The truth is generic medicines are the same as their brand named counterparts. The MHRA and GMP clearly state that when a drug is approved and licensed, it has undergone rigorous testing procedures. Testing is done to ensure that the drugs have the same active ingredients, strength, dosage form and bioequivalence throughout. Most brand and generics even have the same side effects. Although generic drugs have the same active ingredients as their branded equivalents, there can be variability in the inactive materials used. However, it is the job of healthcare professionals i.e. you the future pharmacist, to remain informed on current issues so that you are able to identify when it is necessary to suggest only certain types of drugs, whether it be generic or branded.
Have you ever noticed the difference in price between branded and generic medicines? Take for example Piriteze allergy tablets, Im sure you may have taken them over the summer if you have hay fever. The average cost of a pack of 30 Piriteze allergy tablets is about 8.00, buying the generic equivalent Ceterizine Hydrochloride will only set you back about 3.00, thats a fraction of the price even though both medicines contain the same active ingredient and work in the same way. Howvever, it does seem like an excellent marketing strategy - put a fancy name and shiny box to something and patients will always seem to fall for it, without even noticing that the same medicine is available without all the shiny bravado and for a fraction of the price.
Patients also normally worry about the safety of the drugs if they are cheaper. They dont realise that the reason branded drugs are more expensive is because the manufacturers have had the expense of developing and marketing the new drug. The drug company can apply for a patent which means that the company that has developed the drug has the exclusive right to sell the drug.

However, when the patent expires, other companies take the same concept and apply for permission to make and sell the generic version of the drug. Other companies can afford to sell the same drug as a generic product for cheaper because there are no start-up costs for developing the drug. Some patients also believe that generic medicines take longer to work as oppose to branded medicines. This is also another myth; most generic medicines take the same amount of time to work than their branded counterparts. Luckily for us as pharmacy students, we get to learn all different aspects of medicines and their uses and can therefore advice patients on the best products based on their specific needs. Our principles and goal always stand at making the care of our patients the first concern even if that means were making a smaller profit by advising a cheaper product.

Survival Guide: First Semester 2011


1st Year

Time should be spent at home on reactions and mechanisms as you go along as it will make you very prepared for the mid University is different very from college. The MPharm degree module and final exams. requires focus and is not one you can treat lightly. There is not PY2040: Professional Practice III much of a honeymoon period as youll find in the first year New parts of the MEP such as Controlled Drugs and Veteriof other courses. However, enjoy the university atmosphere nary prescriptions will be covered. At the end of workshops, though be motivated to learn as well. Topics are covered briefly there will be some sort of assessment so assure you read the in lectures and although workshops cover some topics in more relevant topics before you attend. Again, you must get into the detail, most learning will be done in self-directed study. If you mood of continuous revision. do have a query about a topic, best to email the appropriate lec- More care is needed when screening prescriptions in practiturer and ask a specific question. Its also best to have two lab cals because more legal and clinical requirements and factors coats a clean white one exclusively for Professional Practice need to be taken into consideration. practicals and another for other modules such as Pharmaceutical & Biological Chemistry. 3rd Year

PY1010: Cell Biology & Introductory Physiology The tutorial groups are very useful for the final exam so do attempt to attend each one. In addition, each tutorial will have an assessment. Spend time and effort on essay assignment set because essay writing will be assessed in future modules, so it is best to make a good start. PY1020: Pharmaceutical & Biological Chemistry I Ensure your maths skills are up to standard as some may find it difficult dealing with maths. Workshops are excellent to learn more about the calculations involved and to practice. PY1030: Pharmaceutics & Microbiology I For some of you, there will be many new concepts not learnt before in the Microbiology material therefore, background reading will be required. Maths skills are required here so make sure you ask for help in the workshops if required. PY1040: Professional Practice I This is the module about the pharmacy profession. In this module and in all future pharmacy practice modules, you must not get use to using your calculator in this module but this will be explained in your calculation workshops. The calculations covered will reappear in future modules, so it is important you can successfully complete them at a reasonable pace. Do not become frustrated if you do find calculations without a calculator difficult practice makes perfect. Ensure you use your time wisely in practicals as this will be initial preparation for your dispensing exam at the end of the year
2nd Year So youve passed the first year including the dreaded dispensing exam! Congratulations! But there is a quite jump from first year to second year. There are fewer workshops so even more background reading is required. Mid module tests are more frequent so all the revising cannot all be left few weeks before final exam so you must get use to continuous revision.

Youve survived the Law & Ethics paper! Well done on successfully passing into third year! However, there is quite another big jump from second year to third year. This year is where your time management and organisation skills are really tested. Be prepared to get a little more cosy with your classmates as this year will be filled with many group work assignments!

PY3020: Professional Practice V More calculations are to be covered mainly during selfdirected study whilst at this stage, your pace at completing calculations should have increased. In practicals, the screening prescription sheets to complete have increased in length. Prescriptions given must be dispensed, labelled, checked and your paperwork is handed in to be assessed where marks awarded contribute towards your coursework grade. Workshops will mainly be based on Responding to Symptoms and there will be some sort of assessment given, such as assessed role play therefore, its best to be continuously revising and prepare for the next topic to be covered in the following workshops. PY3030: Pharmaceutical Technology & Pharmacokinetics Not as much practicals in this module compared to other similar modules. Be prepared to stay awake in lectures as they are later in the day! PY3040: Systems Pharmacology II Attend all lectures and practicals as vital information on assessments and practical assignments will be given. Plus a lot of information from the lecturer(s) can be gained which will not be found in books. PY3060: Clinical Pharmacy Read! Read! Read! Discuss concepts with friends and lecturers for further understanding or to consolidate your understanding. There is a lot of information to assimilate from this module but there are only a few books available to aid you whilst studying this module.
4th Year Phew! Three years out of four completed already now youre on your way to getting that MPharm! Fail to prepare and prepare to fail! Plan, be organised, focus and believe! Surely, all your experiences and skills youve gained throughout the past three years of your MPharm degree will provide you with a steady platform to excel this year let alone this semester. Fourth year should not about all work and no play you must be able to work hard and play hardyoure almost there, its just the beginning!

PY2010: Introductory Pharmacology There is essay assignment and it sound obvious but make sure you address the title correctly as well as spending time and effort on your piece. PY2020: Formulations and Medicines I You will learn many new topics on pharmaceutical technology so you will need to keep up. Aultons Pharmaceutics: The Design and Manufacture of Medicines is a useful book to read further understanding and reading. Workshops are useful for more information and good chance to ask any queries. PY2030: Pharmaceutical & Biological Chemistry III There is less help in practicals so ensure you spend more time reading the instructions before your practical sessions.

Luck! Good

c
by Dawar Qhoraish

Pharmacy
Featured
in the

tomorrows PharmaCist

Having worked in a community pharmacy for six months now, I have noticed first-hand the impatience of some patients when requesting their medicines as though the pharmacy is a fast food restaurant. One group of people are those who have come into a pharmacy for the first time. The prescription is handed to the pharmacist who, along with the dispenser, is doing several things at once in the dispensary and the patient is advised of a rough waiting time and to shop around or come back in a few minutes or so. Nevertheless, most of these patients would wait right behind the prescription-handling counter and would not even sit down even when there is no one in the pharmacy at the time.

surgeries. Most of the time, patients comes in at the correct time and their medicines are ready for collection. But on the few occasions that it is not ready or the prescription is not back from the surgery yet, it is a different story. The pharmacy has to investigate if and when the prescription was requested.

Sometimes, after looking through the patient medication record system, we discover that they had come in too early and were not due for their repeat prescription for another week. This could be because they have lost a few tablets, they have taken more medicines than they should or, even worse, they might have been sharing medicines with someone else in the family. Perhaps some just show up at the pharmacy early because they think they can and it is convenient for Five to ten minutes later, depending on how long they them to pick up their medicines at that time. have their car parking ticket valid, they will ask about Sometimes patients would say that they have no their prescription. If it is not ready they will either tablets left and expect an emergency supply as though continue waiting at same spot or say that they will they were asking for extra fries. One patient even sent take their prescription elsewhere because they will get a parking fine if it is not done this instant. I often his daughter for an emergency supply to our pharmathink that they could have looked around the shop or cy because he had run out of his diabetic medicine 10 put some more money in the meter when the waiting days ago and was supposed to telephone the pharmacy time was quoted. Since when has it become the phar- and request more through the prescription collection service but was too busy. macys responsibility to ensure we get prescriptions done so that a patient doesnt have to put more money A pharmacist is responsible for dispensing the correct into a parking meter or get a fine? medicine so time is required to achieve this. Just how However, they think that if they stand at the counter, much public education is required to make people untheir medicines will be dispensed quicker. If only they derstand that we do not deliberately give long waiting times for fun and that we are here to dispense their understood the clinical checks and correct endorsemedicines accurately and safely? ments that need to be undertaken for each prescription. It is extremely frustrating when some patients do We look t not understand or appreciate the process of dispensfeed o rece forwa iv r bac k q ing yo d ing a prescription safely. ues ur t Another type of patient that makes our job challenging are those on the repeat prescription service, where the pharmacy collects their prescriptions from GP

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