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Damn.. it is hard to prevent getting a cold when you work in a community setting. I hate to say, the bug is back. Everyone is down with a cold. Sadly, I caught it too. Every pharmacy I went to, the dispensers are coughing and sniffing away.

It is time to boost up the immune sytem with plenty of fruits and vegetables, and fluids!! For those who are susceptible to colds, don’t forget to get your flu jab too!! 

Last night, my throat started itching and felt abit scratchy.I got abit worried and started drinking lots!! And this morning I lost my voice, my throat was swollen, I couldn’t swallow my saliva. Wanted to take ibuprofen, but I cant even swallow any food! Ugh. With my job, I can’t work if I can’t talk! Just hope it’ll get better.

Being an extremist, I had about 4Litres of water today, to flush and clear all the toxins in my body!! Going to do that for the next couple of days!! I hope I will be ok by tomorrow, because I want to meet up with some friends during the weekend!

Today, I was working in my pre-reg store, due to the weather, it was rather slow.

So I managed to spare some time to listen to the sales rep from Chiesi, promoting the relatively new Fostair inhalers.

Well.. this pink inhaler has been available for awhile now, but I guess not many doctors are prescribing it yet. So the company is trying very hard to sell their product through pharmacies, hoping we pharmacist can influence patients and doctors of the benefits of Fostair compared to Symbicort and Seretide inhalers (the combination inhalers).

At first I was just entertaining the sales rep, after listening to her presentation, I actually gave it a thought, and had a go at reading the leaflets to see whats so great about fostair.

Well here are some information gathered :-

• It is the first and only metered-dose inhaler combining beclomethasone and formoterol
• Comparable efficacy to symbicort and seretides
• Fast onset of bronchodilation within 1-3 minutes, and is the only formoterol containing combination in MDI
• It is now licensed to be used with aerochamber plus spacer
• Fostair is cheaper then Seretide and Symbicort (the latter being most expensive)
• Only combination inhaler that has extra fine particles , delivers 31% medication to lungs compared to 10-20%  for non-extra fine MDI (similar to QVAR)
• It is a solution formulation, it delivers uniform dose from the 1st to the final actuation, so patient doesn’t have to shake before use.

The only disadvantages are it needs to be kept in the fridge before use, once removed from fridge shelf life is 5 months, which is still pretty long considering each inhaler provides approx 1 month supply if BD dosing. Also it is not like Symbicort – SMART trial, where it is licensed to be used as a reliever as well as a preventor, Fostair is not licensed to be used as a reliever, but it does open up the airways faster, due to the extra fine particles.

I rarely see it on prescriptions, as it is still fairly new. Licensed to be used with aerochamber plus spacer only recently granted. But so far, for those who has been on Fostair has given positive feedback. I guess, it would be an alternative to think about when doing MUR, if a patient doesn’t get on with symbicort or seretide, or still dont get maximal benefit, then perhaps Fostair would be an alternative before stepping up to step 4 or 5. Also it is much cheaper than symbicort, one more thing as well, with symbicort(turbohaler), patients need to breathe in harder to get the drug into the lungs. The in-check dial device is a useful tool to determine whether the type of inhalers are suitable for the patient.

Have you ever experienced a food allergy?? Why this topic?? Recently I went back home, and had my favourite Teo Chew braised duck, and thought about the allergy I had 14 years ago. I will never forget this, because it was so bad. The duck was so good, that my family and I went there every week for about 2 months, and then I got the allergy, only me in the entire family.

I had a rash – nettle like rash (wheal) all over my body for a month! Yes ONE whole month! I was off school for several weeks. I can still remember vividly how distressed I was especially when I woke up in the morning, that is when the rash is the worst. I know I went to the GP, took some med, but it didn’t work. Then I went to the GP again, it failed again.

 Finally I went to a skin specialist; they gave me 3 different regimens, asking me to try Regimen A 1^st, if it doesn’t work, go on to B, then finally C. But the meds were so good, I didn’t even have to try B, slowly the rash went away after a few days! Now, I wish I can remember what meds they were. Could it be just antihistamine?? Hmm..

Have you had a similar or worst allergy in the past? Feel free to share.

I was looking through my emails earlier today, and saw a newsletter on Sativex. Have you ever dispensed this in your pharmacy?? I have only seen a prescription for it once, and I can barely remember now. But I think it is good to learn if you do not know much about it by now.

Some facts : -

- Oromucosal mouth spray for MS patients for neuropathic pain, spasticity, overactive bladder, pain due to cancer
- 1^st cannabis based med licensed in the UK (June)
- Only specialist should prescribe (neurologist) as add on for MS spasticity when other regular med provides  inadequate relief
- Dose – gradual increase, maximum 12 sprays per day, 15 min gap between sprays
- Interactions with drugs that causes drowsiness
- Not for use in under 18
- Those travelling with sativex require doctor’s letter
- Currently a Schedule 1 drug, might be reschedule to schedule 4 later – homeoffice allow doctors to prescribe and pharmacist to dispense
- Can be on nhs or private rx
- No legal requirement to record in CD reg currently (I have seen it being recorded in CD reg)
- Store in fridge prior opening, once open it is ok.

4×5.5ml is the old and unlicensed pack size, current pack size is 3x10ml, need to confirm with prescriber accordingly

Went back to my pre-reg store today, nothing exciting happened .

There were not many queries for me today because the counter staff was quite good. But I had a boy showing me several round scaly patch on his body, above the chest and at the back near the shoulders. There were several round patches, individual ones, not joined together, but I could easily see 5 or more. They were the size of 5 penny or smaller. But they all got very obvious  edge, and its scaly not smooth, not itchy either. Well, one thing for sure it wasnt on the scalp or the groin area, so I gave him canestan 1%. I think is is ring worm. However, I have not seen many individual ones, it just made me wonder if it could be something else. Definately not pox too. I hope I was right, i know the antifungal cream wouldnt harm him. But I have also told the mom if the cream doesn’t help, go to the doctor.

Another query was from a staff, she is on warfarin, anti-hypertensive, glaucoma meds, and wanted travel sickness tablets. I know most of them will not be suitable ie the hyoscine hydrobromide or cinnarizine, due to the antimuscarinic effects. Bnf did say cautious with hypertension, angle closure glaucoma etc. Besides the motion sickness band, I would refer. What would you do?