Pharm.D in India: What is known and What is unknown ?

Doctor of Pharmacy (Pharm.D) in India has created a huge hike on young pharmacists, expecting the future is much better than the other branches of pharmacy. Pharm.D's syllabus is we framed with lot of debates and observations from the developed world to provide a competent clinical pharmacist for the better health care in India. See the syllabus the other health care professionals were excited to see the practicality of this course in their work place. But, theoretically Pharm.D has made a huge impact on the developed nations and developing nations to adopt the India Pharm.D syllabus a standard one to practice in their own countries. To the same, the Indian Pharm.D has many pitfalls in practicality, which is hard to answer the route cause. For instance, a competent clinical pharmacist needed more practical training which need much focus on patient care by training them in the wards and engaging them in all the activities that can make them to learn how to implement the clinical pharmacy and collaborative work with other health professionals. Due to lack of competitive faculties the scope of bed-side teaching was negligible. Its fact, when Pharm.D students enter into the wards, they see the nursing staff training their nurses, Doctors training their medicos but Pharm.D students were relaying on the medical doctors to provide some support as the faculties never likely to participate in the bed-side teaching and working with the health professionals in the wards.

Increasing number of colleges increased the demand of Pharm.D admission, but there is none to answer the practicality of their roles and jobs. Disparities in training and unsuccessful competencies with poor health care acceptance kept the Pharm.D's into dilemma. Furthermore, it also made a lot of confusion among the student minds and unable to fulfill their dreams. For instance, course such as  Pharmacoepidemiology and clinical research were elaborative in syllabus, but faculties unable to engage them in any activities such visiting clinical research sites, engaging them in some pharmacovigilance activities. Furthermore, the organizations well focusing on conferences for showoff and unnecessary hikes over the Pharm.D without know the practical barriers faced by the students. For instance, there are many pharmacy organizations inviting the international delegates to participate in the national and international conferences, but unable to engage the Indian Pharm.D's to get trained in overseas.

Now the number of Pharm.D's increasing and coming out with any vision. This is because of lack of planning and support from the Pharmacy board. This situation is especially burning in southern states where the number of colleges are more than that of other parts of India. All colleges promising to give admission but unable to secure them in jobs. The student associations such as "IPSF", and "IPA-SF" etc., are focusing on conferences and international fame rather to supporting the local Pharm.D students. The silence answers from the pharmacy leaders increasing the tensions in the student mind. There is much more needed to work at ground level, focusing on providing standard practical training rather basic theoretical knowledge, providing a scope and hope on the Pharm.D's for securing the jobs is crucial.

In conclusion, Pharm.D's are currently in great frustration and needed support from all phases for the future of clinical pharmacy in India. Further, clinical pharmacy is a practice of patient care through pharmaceutical care. If the theoretical knowledge can fulfill the dream then we are in world of delusion.
by
Dr.Akshaya Srikanth, Pharm.D
Pharm.D India

Trigeminal Neuralgia: The suicide disease

Trigeminal Neuralgia is a type of facial pain / headache causing sharp, shooting pain on one side of the face. It is one of the most painful diseases known to mankind. It is also called ‘suicide disease’, because of the severity of the pain.

Symptoms

People suffering from trigeminal neuralgia usually have a sharp, shooting, electric shock like pain on one side of the face / head. Trigeminal nerves are basically a set of 3 nerves that provide sensation to either side of the face. Trigeminal pain can affect different parts of the face. Initially the sharp pain is occasional and very short lasting. Gradually the pain becomes more permanent. It is more common in elderly people, over the age of 50 years. It is slightly more common in women.

Triggers Trigeminal Pain Attacks

Trigeminal neuralgia pain can be triggered by trivial things like cold air, touch, speaking, shaving, brushing teeth and chewing food. Pain is usually felt in the cheeks, lips, nose, ears, eyes, teeth, jaw, scalp or the entire side of the face. It almost always affects only one side of the face. Unlike migraine headache, the trigeminal pain does not change from one side of the face to the other. It is very common to find trigeminal neuralgia sufferers refusing to talk /open their mouth. They may cover that part of the face to avoid touch or air contact. Frequently they end up with dentists, thinking it is a dental problem.

How is trigeminal neuralgia diagnosed?

If trigeminal neuralgia is suspected, it is advisable to consult with a neuro physician or pain physician. After having the clinical history and performing a neurological examination, the physician may order a MRI or CT of the brain. Once diagnosis is confirmed, appropriate treatment is started.

How is trigeminal neuralgia treated?

Initial treatment for trigeminal neuralgia includes medications like carbamazepine (tegretol), oxcarbazepine, gabapentin, pregabalin, baclofen, etc. Typically, the medication is started at low doses and adjusted according the effect. With medications, mild cases of trigeminal neuralgia pain can be controlled. Taking long term medications can cause some side effects.

What are the advanced treatment options for trigeminal neuralgia?

If oral medications are not providing adequate satisfactory pain relief or if there are medication related side effects, other advanced options are available. Radiofrequency ablation of the trigeminal ganglion is newer modality of treatment available for trigeminal neuralgia sufferers. Radiofrequency thermal ablation of trigeminal ganglion, performed under x-ray guidance, provides safe, long term relief from trigeminal neuralgia pain.

It is a day care procedure performed under IV sedation. Once RF ablation is performed, patient can stop taking usual oral medications. Percutaneous pain interventional procedures like radiofrequency ablation of trigeminal ganglion are repeatable at a later date, if required. Trigeminal pain sufferers above 50 years of age are also good candidates for radiofrequency ablations. Older techniques like glycerol injections and balloon compression have been replaced by RF ablations now. Majority of insurance companies including the government schemes approve RF ablation for trigeminal neuralgia sufferers.

What is the role for surgery in trigeminal neuralgia?

Surgeries are reserved for patients, not responding to oral medications and conservative management. It may be suitable for trigeminal neuralgia due to secondary causes like tumours or trigeminal neuralgia in younger patients.Surgeries called microvascular decompression are offered by neurosurgeons for trigeminal neuralgia. Microvascular decompression surgeries have more risk involved and are costly. If performed successfully, these neuro surgeries can provide long term pain relief. Thanks to the advent of all the above mentioned treatments, trigeminal neuralgia sufferers don’t have to suffer in pain anymore.

by

Dr.Akshaya Srikanth B

2 of 3 Smokers Will Die Early If They Don’t Quit

Two-thirds of smokers will die early from their habit if they don’t quit, a new study suggests.

The findings indicate that it’s never too late to quit smoking, one expert said.

Researchers analyzed data from more than 200,000 people taking part in a study conducted by the Sax Institute in Australia. The study is a long-term investigation of healthy aging.

“We knew smoking was bad, but we now have direct independent evidence that confirms the disturbing findings that have been emerging internationally,” Emily Banks, scientific director of the Sax study and a researcher at the Australian National University, said in an institute news release.

“Even with the very low rates of smoking that we have in Australia, we found that smokers have around threefold the risk of premature death of those who have never smoked. We also found smokers will die an estimated 10 years earlier than nonsmokers,” she added.

Compared with not smoking, having just 10 cigarettes a day doubles the risk of dying early. And smoking a pack a day increases the risk four- to fivefold, according to the study published Feb. 24 in the journal BMC Medicine.

It was long thought that smoking-related diseases would kill about half of smokers early, but newer research has put the figure as high as 67 percent. 

My Suggestion: “It’s never too late to quit, no matter what your age or how much you smoke,”

by Dr.Akshaya Srikanth B, Pharm.D, BCPS.

Cola Raises Cancer Risk Due to Its Caramel Coloring

Research has found that 4-methylimidazole (4-Mel), the chemical that gives cola its

appealing caramel color is a potential carcinogen.

There aren't any federal regulations that restrict use of 4-Mel, but according to the report, more than half of Americans between age 6 to 64 drink enough soda on a regular basis to elevate their cancer risk.

Researchers from the Consumer Reports and the Center for a Livable Future at Johns Hopkins Bloomberg School of Public Health, tested 110 samples of cola and other soft drink beverages.

All of the samples, except for the clear beverages, contained 3.4 to 352.5 micrograms of 4-Mel per 12-ounce bottle or can. While there aren't federal regulations on how much of the chemical manufacturers can put in beverages, California does require companies to include a cancer warning label if the drink contains more than 29 micrograms in a 12-ounce bottle or can. The average person age 6 to 64 drank as much as two and a half cans of cola per day. Approximately one-third of children between ages 3 and 5 drank two-thirds of a can each day. People between age 16 and 44 were the most frequent cola drinkers, consuming as many as three cans per day.

Through this analysis, the researchers concluded that within the next 70 years, there could be at as many as 5,000 incidences of cancer directly related to cola consumption. But cracking down on the soft drink industry won't completely eliminate the chemical from the American diet. Unfortunately, dark-colored carbonated beverages are not the only source of 4-Mel. 

The chemical is also used in soy and barbecue sauce, pancake syrup and some soups. The study is published in PLOS One.

Read more: Cola Raises Cancer Risk Due to Its Caramel Coloring
by 
Dr.Akshaya Srikanth Bhagavathula, PharmD. BCPS.

A New One-Pill-a-Day Treatment for HIV has been approved

As expected, there’s a new single pill regimen for HIV, this one containing abacavir (ABC)/lamivudine (3TC)/dolutegravir (DTG), and it’s called Triumeq. 

The most important study for this combination was the SINGLE study, which showed that ABC/3TC + DTG (given as two pills) was superior to TDF/FTC/EFV (given as one), the difference based primarily on tolerability advantage of the former. It was a novel double-blind study, as all three drugs were different in each treatment arm.

Another benefit DTG-based regimens — whether given with ABC/3TC or TDF/FTC as separate pills — is that to date, no treatment-naive patient with virologic failure has developed resistance to DTG. I suspect it will happen one of these days, but the data thus far suggest at the very least DTG resistance will be a rare event.

Needless to say, but will say it anyway for emphasis, all patients starting this regimen will need to be tested for HLA-B*5701 and found to be negative. Wonder if pharmacies will enforce this, or whether it will be left up to the prescribers. Here’s the landmark study that proved this testing essentially excludes severe hypersensitivity to ABC, quite an amazing story in pharmacogenomics.

An unresolved question is whether ABC is associated with an increased risk of cardiovascular disease. This FDA meta analysis of randomized clinical trials didn’t think so, but around half of the observational studies did, including the updated DAD study. NA-ACCORD data will be of great interest, whenever they appear.

As of Sunday, August 24, the price of ABC/3TC/DTG is not known (at least to me) — and it could be a real game changer, since both ABC and 3TC are already generic. Says Ben Young over on TheBody: “If ViiV Healthcare manages to set the price of Triumeq in accordance with the generic status of abacavir and lamivudine, the cost should be substantially lower than the price of the other single-tablet regimens that contain all on-patent components.” Yep.

I suspect people will call it “Trii” (rhymes with “Cy”, as in “Cy Young”) for a while, just like they called TDF/FTC/EVG/COBI “Quad”.

So what are some upcoming single-tablet regimens? Tenofovir alafenamide (TAF) with FTC/EVG/COBI. TAF/FTC/DRV/COBI. DTG/rilpivirine. And inevitably, generic TDF/3TC/EFV, which is widely available globally.

Regardless, sure beats the old days.

Know more how to improve adherence to HIV patients: MEDICATION ADHERENCE COUNSELING FOR HIV PATIENTS BY PHARMACIST

by
Dr.Akshaya Srikanth, PharmD.

HERBAL MEDICINE - WORTH HEALING

The herbalist had 23 wives and raised more than 200 children

According to the official records, herbalist Li Ching-Yuen was born in China in 1677 (although he himself claimed that he was born in 1736). Throughout his long life, he constantly practiced herbalism and martial arts. In 1930, the New York Times newspaper printed an article in which they published official Chinese government documents that were uncovered. These documents, dating back to 1827, contained official congratulations on Li Ching-Yuen's 150th birthday. Later documents, dating back to 1877, contained official congratulations on his 200th birthday.

How did he do that?

Li Ching-Yuen expressed his longevity formula in one sentence: "Retain a calm heart, sit like a turtle, walk swiftly like a pigeon, and sleep like a dog".

Let's add a few more interesting historical facts to this story. Chinese army general Yang Sen invited Li to visit him, and offered him an opportunity to teach Chinese soldiers martial arts. The general could not believe how youthful his guest was, even though he had reached an age of 250 years old.

Li Ching-Yuen died on the 6th of May in 1933. He told his students that he had completed all his tasks in this lifetime, and he was now ready to come home.

Is this a true story? No one knows the truth, but if you read this story using your heart and not a limited rational mind, then you can understand the subtle meaning of it and learn a lot more.

It is possible to find other interesting stories about Western health prodigies and Eastern Yogis who lived for over 100 years. Not only did they survive for this long, they also thrived—youthful, active, and full of enthusiasm. What could we learn from them?

Holistic medicine is all that we need

These days, even modern medicine agrees: 70% of all illnesses materialise because of negative thoughts or emotional stress. Illnesses attributed to this cause are called “psychosomatic,” and they are the biggest headache of the whole mainstream healthcare system.

Sometimes several days of elevated stress is all that is needed to open up a gastric ulcer. Sometimes several years of it is all it takes to develop diabetes or heart disease, not to mention poor general health, lowered productivity, and lack of happiness. Doctors and scientists unanimously agree that our thoughts directly affect the activity of our organs and the state of our bodies in general. Ancient medicine is classified as holistic, because it takes care not only of the physical body, but also of the psyche, as well as one's personal lifestyle. This method allows one to remove the cause of the illness, rather than merely treating the symptoms, therefore stopping it from reappearing. Modern medicine, on the other hand, deals with the consequences of the illness—bodily ailments. This is why the illness often comes back, since the cause of the illness is not actually being treated.

This is where one of the biggest secrets to health reveals itself—our thoughts can heal us. There are multiple recorded stories that discuss people who were severely ill and healed themselves with the power of thought, despite doctors losing all hope. One of such impressive story tells us about Morris Goodman, who, in 1981, was involved in a plane crash and was supposed to die due to irreversible spine damage and a punctured diaphragm. The man's life was supported by a breathing ventilator, and the only movement he could do was blinking. However, this man was aware of the power of thought, and in just a few days successfully regenerated his own diaphragm and could breathe independently. He also consciously regenerated his damaged spinal cord and started to move all of his limbs. Doctors could not understand the situation at all because this just “could not be happening.” After a few months, however, Morris Goodman began to walk again, and eventually fully recovered. This is only one of many cases that are happening all around us. Thoughts cannot only make the body ill, but can also help it recover from incurable diseases.

Causes of hard to cure diseases from a different angle

The ancient ayurvedic health sciences not only prove the existence of psychosomatic illnesses, but also present a list of specific illnesses caused by specific character traits. What else could the thoughts be dependent on if not on the character?

Here are a few examples that could explain the causes of disease you or your loved ones may be suffering from:

1. Jealousy - causes oncological diseases, weakens the immune system.

2. Vengefulness - causes insomnia and throat diseases.

3. Inability to find a solution to a situation - causes lung diseases.

4. Lacking moral principals - causes chronic diseases, infections, and skin diseases.

5. Being too categorical or unwavering in beliefs - causes diabetes, migraines, and inflammations.

6. Lying - causes alcoholism, fungal infections, and weakens the immune system.

7. Aggressiveness - causes gastric ulcers, acid reflux, and warts.

8. Reticence - causes schizophrenia and kidney diseases.

9. Cruelty - causes epilepsy, asthma, and anemia.

10. Seeking conflicts - causes thyroid enlargement.

11. Apathy - causes diabetes.

12. Inconsistency or being fickle - causes infertility.

13. Being rude or insulting - causes diabetes and heart diseases.

14. Anxiety - causes digestive system disorders, heart, and skin diseases.

15. Greed - causes oncological diseases, obesity, and heart diseases.

How can we know this is truth? Many great things in this world can only be tested by experience and not by thinking about them. Ayurveda is an ancient science that still works today and is used by many great people.

An interesting fact is that it is enough to cure your character, and the relevant diseases go away permanently. This is especially important to know for those who suffer from diseases such as diabetes and cancer, for which modern medicine does not have a cure yet.

Three ways to live healthfully and truly feel good. It will involve working on yourself—however, this investment will pay off greatly in the long run. Here are three methods, tested throughout three millenniums:

1. Start monitoring your thoughts. Spend five minutes every evening writing down how you felt that day. Remember the situations you encountered and emotions you felt. What negative character traits does that uncover? What do you plan to do tomorrow to start improving yourself and to change those particular character traits? It is very important to write everything down.

2. Try to think more about things that make you happy. This is the miracle of positive thinking. When you concentrate on the things that you like, it's as if you move to a different frequency of vibrations, and the body starts to heal itself. Even better, there will be a greater number of good things in your life, because everything you think about becomes reality, including the problems that bother you. Concentrate on things you enjoy and watch how everything begins to change.

3. Try out meditation. During meditation, the body and mind rest and heal themselves. You can read more about meditation in the article “How To Own A New Ferrari And Be As Smart As Einstein, Just By Calmly Sitting On Your Couch”.

Illness is simply our body's signal about an incorrect (or, rather, non-beneficial) lifestyle. Firstly it manifests as anxiety, fear, and negative thoughts. Only then, if no effort is made to work on oneself, the body sends a more powerful signal to get your attention and make you think about what you are doing wrong, in the form of physical symptoms.

Leave only the useful and meaningful things in your life. Because everything that is useful to you is always useful to others.

by

Dr.Akshaya Srikanth, 

Pharm.D India

Understanding Issues and Challenges Faced by Many Patients

Now we see how putting the focus on the patient instead of the product has changed the communication. Even in his body language, the pharmacist now shows empathy and active listening, looking at the patient this time instead of at the medicine bottle.

Cultural competence is increasingly important as the diversity of our society increases. A background awareness of the issues facing newcomers to Indians also helps facilitate communication and achieve the healthcare goal. The pharmacist was patient and helpful with the language gap, and sought understanding instead of assuming. The pharmacist was also sensitive to the financial challenges and to the challenges in healthcare access and navigation that can affect Indians.

The key features of cultural competence for organizations include: 

1.Valuing diversity 

2.Conducting cultural self-assessment 

3.Managing the dynamics of difference 

4.Acquiring and institutionalizing cultural knowledge 

5.Adapting to diversity in defining policies and values

When communication barriers arise, whether due to cultural differences or another cause, active listening will help close the gap. Briefly stated, active listening means focusing on what the patient is saying, and then stating it back to them in your own words to allow them to confirm your understanding. Showing empathy in your choice of phrasing will help the patient feel that you have understood both the information – and how they are feeling. 

Embarrassment can often come into play in discussing health issues with patients in the pharmacy. In our next scenario, we see that this is sometimes why the question a patient asks is not the question they really want to know.
Yours 
Dr.B.Akshaya Srikanth
Pharm.D India

It's Time to Quit

One would think that a diagnosis of cancer is all a smoker needs in order to be motivated to quit. Unfortunately, in many cases this logic would be wrong. Although smoking is responsible for one-third of all cancer deaths, one-half to four-fifths of cancer patients who smoke continue to do so after diagnosis.

In a recent study, cancer patients who smoke confront even more barriers to quitting than other smokers. “I think what surprised me when I did the review,” Duffy said, “was the multitude of issues that cancer patients face, and that there are so many variables affecting why they don't get treatment, and if they do get treatment, why they may not respond. Nicotine addiction, health issues, emotional issues, psychological issues and system level issues are all in the way.” Cancer patients who are unmarried, uninsured, or depressed are particularly likely not to quit. 

Unfortunately, cancer patients who smoke often do not get the push they need from their physicians: most oncologists provide no smoking interventions other than advising patients to quit. Oncology nurses, however, may be better positioned to help patients stop smoking. As Duffy et al point out, oncology nurses are skilled educators who have access to patients and considerably more time available than oncologists to offer psycho-social interventions. Additionally, a systematic review of clinical trials found that high-intensity interventions provided by nurses who are directly involved in patient care significantly increases the likelihood of a patient quitting. 

Targeting education on tobacco use to a cancer patient's immediate situation is more effective than providing general information about the health hazards of smoking. Everyone knows that smoking is bad for health, but many are unaware that smoking reduces the effectiveness of cancer treatment, increases the risk of cancer recurrence and secondary cancer, and shortens survival.

Hospitalization is an ideal time to provide smoking cessation intervention because patients may be more motivated while undergoing treatment, are monitored and less liable to skip intervention sessions, and may have temporarily quit because of hospital smoking policy. Intervention programs that begin in the hospital and follow patients for at least a month after discharge have been shown to improve rates of smoking cessation 1 year later. In-hospital stop-smoking programs may be particularly effective in surgical patients. 

Community-based programs have also shown some success in helping people who want to quit smoking. Many states have  1-800-QUIT-NOW helplines, which have been shown to significantlyimprove smoking cessation rates in a real-world setting for periods up to a year, and the American Cancer Society offers a web-based Guide to Quitting Smoking.

Duffy et al offer specific advice to providers to help patients stop smoking. The key educational moment for cancer patients is immediately after their diagnosis. Many patients may assume that because they have cancer, there is little point to their quitting. Teaching them about the improved treatment outcomes, especially improved survival, that they may achieve if they quit smoking can help provide the motivation they lack. Patients with little confidence of success in quitting, and patients who are overconfident that they can quit on their own, should be referred to smoking cessation programs. Interventions should focus on identifying smoking triggers, preparing for high-risk situations, managing withdrawal and quitting-related stress, and setting a quit date. All patients should be evaluated for drug therapy, including nicotine replacement, bupropion, and varenicline, although each drug has contraindications to consider. Regular follow-up, either with the patient's provider or through a telephone helpline, is essential. If possible, the patient's family should be part of the process, and encouraged to quit if they too smoke.

Source:CA 
by
Dr. Akshaya Srikanth
Pharm.D India

Pharmacist Action on Awarness, Prevention and Counselling for HIV/AIDS

A pharmacist is a crucial and a focal point in the community. Practically everyone in the population comes in contact with him at some point of time, i.e. whenever any medicine or baby product is required. The outreach of this person is tremendous. We at this point of time are still facing the problem of lack of knowledge/ information on this issue with the general population. This is compounded by the fact that the information is laden with misconceptions on the subject. Pharmacists deal with people from all sections of society and largely those who are ignorant on the issue of HIV/AIDS and therefore they can be a powerful medium for spreading the message on awareness, prevention and counseling. 

Role of Pharmacist:

1. A center for exposing people to HIV/AIDS information through the display of Information Education and Communicating Posters (IECP) material as well as by keeping leaflets on the counter for the people to pick up for themselves.
2. When a syringe is sold, information on the safe use of a new needle and disposable syringe could be disseminated to the customer along with the information to destroy the same, to avoid recycling.
3. With every sale of a condom, educate the person on its correct use, as people mostly feel that they know how to use it but are not aware of the correct way along with the basics such as not reusing the condom, not to apply a lubricant, checking the expiry date as well as disposal of the same after use.
4. Condoms should not be hidden under the shelf; rather they should be kept prominently for people to get used to seeing them in the open. When the media can openly display advertisements of condoms, why can’t a pharmacy display the same? May be this will help people break mindsets and barriers for the same.
5. Information could be given when a drug related to STD is sold. Here a message for the complete course of medication along with treatment for spouse could be given. Further, the benefit of using a condom could be emphasised for the prevention of STDs.
6. The pharmacist, besides giving information and clearing doubts of those people who seek clarification on the disseminated information on a product related in some way to HIV/AIDS and its related issues, can also serve as a focal person for providing information on care of those infected as well as on how to take care of the affected family.
7. Living in the community, the pharmacist could initiate a social support group for those infected, reducing stigma related to the infection. Further, he/she could also be a trainer for people in the community for home-based care (hospice), which reduces the financial burden on the family.
8. The pharmacist is in a position to emphasise the availability of balanced and cheap nutrition, as drugs by themselves can’t help a person regain strength. It has been observed that people are generally unaware of nutrition facts. A poster regarding the same too could be displayed for people to read and understand.
9. People have faith in the pharmacist as he/she dispenses drugs for various ailments. This way we are targeting not just HIV/AIDS but all other infections, which often precipitate the onset of major illnesses. In such instances, documentation of any STD or HIV case should also be done. People generally go to the pharmacists, describe the symptoms and ask for the appropriate drug.
10. Once noted the case could be forwarded to the appropriate agency for further follow up. It should be so planned that the person comes back to the drug store every 3/5 days. This will help in seeing the progress of the person and could also be an avenue for counseling regarding the infection. Education input at this point could help reduce the number of recurring cases, new infection and increase of condom use, preventing spread as well as population control. 

All these will help in developing positive attitudes towards the people infected as well as affected. It should not be misunderstood that the pharmacist has to do each and every activity stated above. In a day, may be just one of the many may require his input. And some days may be all or a few. He/she should judge the situation and then provide the necessary input. 

Source: FIP-HIV/AIDS Care
by
Dr.Akshaya Srikanth,
Pharm.D

India

POST MARKETING SURVEILLANCE IN INDIA

Regular monitoring of clinical data of both old and newly approved drugs is considered necessary to ensure  their safety and efficacy as three phase clinical trials  cover only a few thousands of subjects. Adverse drug reactions of some of the new drugs will be only known when they are launched in the market and lakhs of people start using them. Post marketing surveillance and regular monitoring ADRs of drugs is, therefore, critical for the health authorities to decide their safety. Known also as phase IV study, the post marketing surveillance is considered helpful for  the pharmaceutical companies to improve the potential of the marketed product. This phase helps the pharma companies in finding data for newer indications and new markets for which the drug product had not been initially approved by the drug authorities. The need to have regular post marketing surveillance was found extremely important in the wake of recall of quite a few drugs from the market in recent years. Some of the high profile drugs like rosiglitazone, nimesulide, cisapride and phenylpropanolamine were withdrawn from the world markets after years of granting marketing approvals. That would mean that millions of patients had taken those unsafe drugs for years without knowing the harm these drugs might have been caused to them.

In India the decision to recall unsafe drugs from the market is taken usually after the US or European regulatory authorities take such a step. This is mainly because of the fact that post marketing studies are not undertaken by most of the pharmaceutical companies in India. Although submission of post  marketing surveillance data is mandatory on the pharmaceutical companies , most of the companies do not care to submit such reports to the DCGI. The Parliamentary standing committee on health & family welfare has taken serious note of this deficiency in enforcement of this rule by the office of the DCGI. In its investigation, the committee found that in the case of most of the approved drugs, the pharmaceutical companies were not submitting Periodic Safety Update Reports (PSURs) listing side effects, fatalities, injuries etc. These reports are expected to be submitted once every six months in the first two years and then annually in the following two years. The Committee asked the health ministry to direct CDSCO to send out a warning to all manufacturers of new drugs to comply with mandatory rules on PSURs or face suspension of marketing approval. Pharmacovigilance or ADR monitoring of the drugs by CDSCO has also been rather weak for several years and it has come into existence only from 2010. Even after launching of the pharmacovigilance programme two years ago, it has not made  much progress as yet . In the first phase of the programme, the target was to set up 40 ADR centres, but just 22 were set up. Although 60 more centres were planned last year at an investment of Rs.60 crore, only 40 more added subsequently. In an atmosphere of poor compliance in submission of PSURs by pharmaceutical companies, strengthening of the network of pharmacovigilance centres is the only option left to the government to track the drug safety in the country.

Source: PB

by

AKSHAYA SRIKANTH

Pharm.D Resident

Hyderabad, India

What You Need To Know About CHOLESTEROL

How diet and lifestyle modifications help reduce it

Cholesterol is a waxy, fat-like substance that is present in every cell in our body. Cholesterol is a component of cell membranes and furnishes the molecules for the synthesis of pro vitamin D, adrenocortical hormones like different type steroids, sex hormones, and bile salts. Our body cannot function normally without this lipid compound.

What is the cause of high cholesterol?

These include diet and family history. Obesity or diseases such as diabetes, gall bladder stones, nephrotic syndrome and cirrhosis can also contribute to a high cholesterol level.

There are two major types of cholesterol. When we talk about total cholesterol, we have LDL cholesterol, which is the bad cholesterol. One way to remember that is “L” is for lousy; we want it lower. And then we have the good cholesterol, which is the HDL cholesterol. “H” is for healthy; we want it higher. Another consideration in managing cholesterol is triglycerides, which are another form of fat found in the blood.

How to reduce cholesterol in the Indian diet

If any of your family members are been diagnosed with high cholesterol and has been advised to follow a diet low in cholesterol and saturated fats. Now comes the challenge for the lady of the house – to serve healthy and tasty foods. This is as hard a task as changing the eating habits acquired over the past years.

It is a wrong notion that the more oil you use in cooking, the tastier the food. If you can follow the tips given below, your meals can be satisfying and healthy too! And believe me it is worth the change. It is also time to change the habits of everyone in the house and teach the younger generation about eating healthy.

Foods to restrict/avoid

Rich pastries, doughnuts, croissant, deep fried snacks and sweets, cream, butter, ghee, mayonnaise, shrimps, liver, sausages, hamburgers, red meats, full cream milk and yogurt, kheer, condensed milk, evaporated milk, all full fat cheeses, fast foods, coconut oil, palm oil,

Restrict use of coconut milk, dessicated or fresh coconut.

Foods allowed

All kinds of vegetables, in any amount.

All kinds of lentils. They contain good amount of protein but no saturated fat.

Whole eggs – 3 times a week and one at a time.

Choose chicken (skinned), and all kinds of fish prepared in any way but not deep fried..

Fat free milk and yogurt and low fat cheeses

Fruits – at least 3 in a day. Eat any citrus fruit when you feel the need for a sweet.

Use sesame, mustard, olive, sunflower, soyabean, oil in cooking.

Not more than 2 cups coffee per day.

How to cut down fat and cholesterol in the cooking:

First of all change the daily menu and opt for foods that need lesser oil, lesser coconut products and no frying.

Use oats to thicken soups as they do in the MiddleEast.

Instead of cream or coconut milk, use ground paste of nuts or skim milk. Or even a little low fat paneer ground to a paste makes the dish both tasty and healthy.

If you insist on using eggs, use one whole egg and the other only the egg white. Even in baking you may do so without affecting the texture of the baked product.

You can cut down on 30 % of the given fat in a recipe and still get a good tasty dish.

De-skin poultry and remove all visible fat before cooking. If you need to cook red meat, then cook in sufficient water, chill and skim the fat layer that forms on top. Then continue with the preparation.

Most importantly, exercise - Half hour of walking 3 times per week.

Triglycerides are also important. They are also contained in the plaque buildup that leads to heart disease and they’re very strongly related with the development of heart disease. According to the most recent guidelines of the National Cholesterol Education Program (NCEP), a desirable total cholesterol level is one that is below 200.

Total cholesterol levels between 200 and 239 are considered borderline high, and levels above 240 are considered high. The goal is to have LDL cholesterol levels less than 100mg/dL. For HDL cholesterol, the higher the better, greater than 40 mg/dL for men and 50mg/dL for women and triglyceride levels should be less than 150 mg/dL.

The first step is understanding where the cholesterol comes from. Cholesterol comes from two sources. There is the cholesterol that you eat in food and there is also the cholesterol in your body. Our liver produces enough cholesterol for our body. So, when we think about methods to lower cholesterol, we have to think about reducing it in the diet, and, in some situations, we need to reduce the amount that our body makes.

There are many dietary steps an individual can take to manage their cholesterol. These include limiting fat from the diet, particularly saturated fats and trans fats, limiting cholesterol-rich foods, and boosting fiber. But results from dietary changes can be mixed. And many people can control their cholesterol by changing their lifestyle.

Increasing physical activity, maintaining a healthy weight and quitting smoking are all changes that can help someone lead a heart-healthy lifestyle. And physicians agree that a heart-healthy lifestyle benefits everyone.

Butter, cheese, cream, prawns, egg yolk, kidney, liver, red meat, brain, biscuits, cakes, chocolates and pastries.

Which are the foods to be taken even with high cholesterol levels?

Egg white, fish, all unsaturated vegetables oils, skim milk, all vegetables, all fruits, whole meal bread, oats, cereals and pulses.

Egg yolk contains cholesterol but egg white contains mainly protein. Egg yolk contains 1.33gm of cholesterol per 100 gm. The egg yolk is a source of vitamin A, B vitamins, calcium, phosphorous, lecithin and iron. Iron of yolk is easily digested and assimilated in the body. Egg white is made up of protein known as egg albumin, which is of high biological value. Egg white is also a good source of riboflavin. Egg yolk is best avoided by heart patients.

Does any food help to reduce the high cholesterol levels?

Turmeric, cinnamon and fenugreek, onions, garlic and Bengal gram dhal are believed to lower serum cholesterol levels but this is controversial. Oats, wheat bran, flax seed, citrus fruits and beans are great for cleaning out cholesterol.

Source: NCEP

by

AKSHAYA SRIKANTH

Pharm.D Resident

Hyderabad, India

HEART DRUGS DEATHS: A NEGLIGENCE OF PHARMACIST ROLE IN PAKISTAN

Heart Drugs Deaths: A result of negligence of Pharmacist role in Pakistan.

The deaths of heart patients in Pakistan have exposed the defects in the health system of Pakistan; following are the main reasons for defective Health system.

Negligence of Health system by Federal Government and Parliament.

In past General Zia used to provide moral guidelines to Pakistani nation, once he advised Pakistani nation not to use Ghee as that was dangerous for health of people.

While present president Zardari never have spoken any single words about such subjects while he himself is suffering from heart disease while Zia himself was not suffering from Heart Disease. Infact Zardari and Parliament removed the subject of health from the federal subjects, while even United nations have not done such thing although that is not a government but maintain this subject in the form of very efficient system of WHO (*World health organization).

It is obvious from eighteen amendments that present parliamentarians including opposition have made such decisions without thoroughly examining the issue and made blind decisions, therefore Pakistani nation is paying price of their mistakes.

At present there are very strict regulations for import of drugs in USA, CANADA EU countries, but in Pakistan due to eighteen amendment Drugs act 1976 have become totally irrelevant. All drugs which are used in heart disease are imported from China and India and no drug is manufactured in Pakistan, Local Pharma Industry just formulate and convert the imported drugs into finished dosage form, and due to ambiguity created by eighteen amendments by foolish parliamentarians, Health system due is running without any inspection and monitoring system. Moreover Federal Government have not taken any step for manufacturing of Pharmaceuticals in Pakistan, infact only genuine manufacturing facility of Penicillin Plant in Mianwali established in 1960 have also been destroyed and Pakistani nation is forced to import low quality drugs from Garage based Pharmaceutical Industry in China and India.

Negligence of Role of Pharmacist in Pakistan:

Role of Pharmacist is very important in USA,CANDA,EU and in other parts of world, but in Pakistan to grasp the whole budget the doctors have made their monopoly in hospitals and do not understand the importance of Pharmacist in the hospital whose main responsibility is to understand the use of drugs, their interactions and side effects, as kingdom of drugs is now so much broad it is not simply possible for physicians to master this field, therefore it is their responsibility and duty to demand and take the professional help from Pharmacist in discharging their duties.

From this accident it is clear that When you will appoint non pharmacist and will try to make pharmaceuticals by workers without supervision of pharmacist then you will have to face such music always. Violation of Good manufacturing practices and using non professional and non Pharmacist staff results in such type of accidents, therefore running of Pharmaceuticals Industry by non professional and non pharmacist persons should be discouraged at present MOST OF THE PHARMACEUTICALS OWNERS are businessman such as distributors,and shop keepers, no one can expect care and quality from such peoples, Medicines should not be a business for money making, Therefore Pharmacist should be provided facilities and financial support and loans for running and owning the Pharmaceutical Industries, because only they are educated and qualified for this job.

Moreover importing Drugs from India and China garage based pharmaceuticals is not only harmful for the economy but also dangerous for the health and safety of the nation and measures should be taken to improve growth of Local Pharmaceuticals as well as to promote exports of Pharmaceuticals.Only when we will hand over Pharmaceuticals business to Pharmacist then only we can compete with India or China, otherwise we will continue to kill our peoples.

Laws and regulations about Health should be made by health professional and not by political personalities like Raza Rabani,Ishaq Dar or Zardari or Nawaz Shareef.

Pharmacists and other health professionals and physicians should work to augment and improve their roles for service of humanity and not just for money making.

Akshaya Srikanth, 

Pharm.D Intern

India

How To Find Your Dream Career

Before we begin let’s just agree on one thing. There are no quick answers to how to find your dream career. Finding your dream career is a process. How lengthy this process is depends on how sincere you are with yourself. It also depends on how much you are willing to sacrifice in pursuit of your dream career.
1. The Toughest Part - Know What You Want
The toughest part about finding your dream career isn’t about finding the dream career. It is about finding yourself. Do you know what you want? This is the first question you need to ask yourself. It is a seemingly easy question many answer by mentioning what they DON’T WANT instead of what they WANT. But that is not the answer that will ensure you to find your dream job.
Knowing what you don’t want does not mean you easily arrive at what you want.Unfortunately, the process of elimination does not work in finding your dream career. You can go through a thousand “don’t wants” and still not hit it. How to find your dream career? Start by knowing what you want!
2. Know Your Values
If you feel a little lost with finding what you want, start by knowing your values. Ask yourself, what do you really value? Time? That’s a common answer I get and a good one too. We all want more time for ourselves and family. So, if you value time then you know the dream career you are looking for must offer more time. Is that all? List a set of values you treasure. Then things will begin to fall in place. You have defined what it is that will fit in these criteria.
3. Know How Much You Are Willing To Sacrifice
Do you have the knowledge and skill set that fit the needs of your dream career? If you do not, how much are you willing to sacrifice in order to add those skill set in your repertoire? How to find your dream career is easy. How much you are willing to sacrifice in order to achieve it is tough to answer.
4. Do It For The Right Reasons
The trigger to how to find your dream career should never be money. It should not be because you are currently unhappy with your salary and hence you want a dream career that pays you an enormous amount of money. Money should never be the motivation. Make passion a motivation but never money.
5. The Easiest Part
If you know what you want, what you value and you do it for the right reasons – then this is the easy part. Here are your “3 Steps Guide to How To Find Your Dream Career” so to speak.
Do Your Research
Find out about the industry. Do you have friends in the industry? Find out what are the expectations, the knowledge and skills needed. The Internet is also the perfect place to start. You can read books focused on your dream career or check out sites offering career advice on certain industries. For example, the site - Job Application and Interview Advice is a compelling site written to help people Snag A Job every day. It covers all aspects of how to snag a job including job applications forms, resumes, cover letters and interview questions and answers.
Network With People In The Industry
Get to know people in the industry so you get a feel of what it is like upfront. This also sets you up for potential short-term work when the opportunity arises for some hands on experience before you make that leap. I have personally allowed friends based on recommendations to visit us after office hours. This allows them to see what it is like in our industry and to speak in depth with staff from various departments in order to understand our line.
Create A Plan To Pursue Your Dream Career
Now that you know how to find your dream career, create a plan to achieve it. How do you plan to add new skill sets? How do you plan to apply for the job? When would be able to get practical training, if that’s a requirement? Develop a plan and act upon it!
I hope it will motivate you all.
Thanks for reading
AKSHAYA SRIKANTH
Pharm.D aspirant

Pursuing Career Success the Right Tools are Important for Your Career Success

Life in the working world is very different from school or college. There are no clear rules so to speak. But there are guidelines and principles you can follow to increase your chances of career success.

Based on our real life experiences, we want to provide you with guidelines, advice and tips to help you ease into the working world. In the hope this will help you achieve career success.

This is our toolbox, tools we have used in the course of our own pursuit of a successful career. The tips, techniques and advice are geared for you to be a success with bosses, colleagues, clients and foes.

While we can share our experiences with you, YOU need to belief that you are in charge of your own destiny. Everything starts and ends with you. You are the one in control, no one else. We do not have magic formulas here you can learn in a night and be on your way to greatness. But what we know is this - the advice, tips and techniques here are used by ourselves. We aim to guide you towards a successful career, work and life.

We have collected them for you to freely use in pursuing career success. You are your own career builder; we are the supplier of the tools. You need to decide which tools to use, which suits you best and then put them into action.

There are three things we ask of you:

1. Bring Enthusiasm. Unless you are interested to improve yourself and attain success, no amount of reading can help you.

2. Take Action. Internalize the relevant materials. Then decide to take action. Nothing happens until you act upon that change you desire.

3. Be Patient. Nothing happens overnight. Success like many things in life takes time. Drop by drop an empty bucket is soon filled with water. Small steps at a time. Pursuing career success is a marathon. Not a sprint.

As you peek around you will see things in a different perspective, so you can enjoy and feel more satisfied pursuing career success. Well, come on in and let’s get started!

Hope you enjoy reading..

Thanking you
Akshaya Srikanth,
Pharm.D Internee

11 things you must know

Here are 11 things you must know to protect you and your patient health:

What is this medication called?

Why am I taking this medication?

Is this medication intended to replace any of your other medications?

What is the proper way to use this medication?

How much should I take?

How often should I take it?

When is the best time of day to take it?

What should I do if I forget to take a dose?

How do I safely store the medication, and how long is it good for?

What side effects can this medication cause, and how should I deal with them?

When should I seek emergency medical attention for a side effect?

How long should I continue taking this medication?

How can I safely stop the medication? (For some medications, you'll need to gradually reduce your dose to prevent withdrawal symptoms - ask your pharmacist whether yours is one of them.)

Will this medication interact with any of my other medications, foods, alcohol, or alternative medical treatments (such as herbals or homeopathy)?

Knowing the answers to these questions could save patient life. If you or your patient aren't sure of the answers, ask your pharmacist or doctor!

by
Akshaya Srikanth

THINK LIKE A GENIUS

“Even if you’re not a genius, you can use the same strategies as Aristotle and Einstein to harness the power of your creative mind and better manage your future.”

The following eight strategies encourage you to think productively, rather than reproductively, in order to arrive at solutions to problems. “These strategies are common to the thinking styles of creative geniuses in science, art, and industry throughout history.”

1. Look at problems in many different ways, and find new perspectives that no one else has taken (or no one else has publicized!)
Leonardo da Vinci believed that, to gain knowledge about the form of a problem, you begin by learning how to restructure it in many different ways. He felt that the first way he looked at a problem was too biased. Often, the problem itself is reconstructed and becomes a new one.

2. Visualize!
When Einstein thought through a problem, he always found it necessary to formulate his subject in as many different ways as possible, including using diagrams. He visualized solutions, and believed that words and numbers as such did not play a significant role in his thinking process.

3. Produce! A distinguishing characteristic of genius is productivity.
Thomas Edison held 1,093 patents. He guaranteed productivity by giving himself and his assistants idea quotas. In a study of 2,036 scientists throughout history, Dean Keith Simonton of the University of California at Davis found that the most respected scientists produced not only great works, but also many “bad” ones. They weren’t afraid to fail, or to produce mediocre in order to arrive at excellence.

4. Make novel combinations. Combine, and recombine, ideas, images, and thoughts into different combinations no matter how incongruent or unusual.
The laws of heredity on which the modern science of genetics is based came from the Austrian monk Grego Mendel, who combined mathematics and biology to create a new science.

5. Form relationships; make connections between dissimilar subjects.
Da Vinci forced a relationship between the sound of a bell and a stone hitting water. This enabled him to make the connection that sound travels in waves. Samuel Morse invented relay stations for telegraphic signals when observing relay stations for horses.

6. Think in opposites.
Physicist Niels Bohr believed, that if you held opposites together, then you suspend your thought, and your mind moves to a new level. His ability to imagine light as both a particle and a wave led to his conception of the principle of complementarity. Suspending thought (logic) may allow your mind to create a new form.

7. Think metaphorically.
Aristotle considered metaphor a sign of genius, and believed that the individual who had the capacity to perceive resemblances between two separate areas of existence and link them together was a person of special gifts.

8. Prepare yourself for chance.
Whenever we attempt to do something and fail, we end up doing something else. That is the first principle of creative accident. Failure can be productive only if we do not focus on it as an unproductive result. Instead: analyze the process, its components, and how you can change them, to arrive at other results. Do not ask the question “Why have I failed?”, but rather “What have I done?”