peace of mind with medication™
the newsletter of Manrex Pty ltd – weBsterCare • issue no. 104 • feBruary 2008 • weBsterCare 2008
Q&a with Gerard StevenS part 3
More answers to questions
What is happening in the rest of
Benefits Scheme. The problem
is that it is designed for simply
My job often takes me to
dispensing medication into
conferences and meetings in
the original packs. However,
foreign parts. From what I can see,
the Australian government has
here in Australia we have the most
commissioned a trial to identify
complete medication management who in the community will benefit systems. It's about the
most from DAAs. So
software and the visual
they can work out who
appeal and impact of
will be funded in the
Gerard Stevens saying hello there,
what we have. I look
future. Webster-pak is
Australia Day is big in the Stevens
carefully at packaging
the most recognisable
family. Matt and Tan have come up
concepts and pharmacy services
of all the DAAs. This funding is
with one huge Australia Day party
overseas to see if there is anything
designed to encourage pharmacists
to celebrate. Oz flags, balloons,
better. So far the answer is no. Even to provide this service.
streamers, BBQ aprons, tea towels
in the US they mostly use unit dose. Many thousands of patients
and just about every true blue
If they had Unit Dose 7 it would
are admitted to hospital every
song played all day. Talk about
save them a lot of aggravation.
year after an adverse effect from
Australians all, let us rejoice.
I keep telling them, and at last
medication errors. Much of this
Webster-pak has been on TV and
they are showing interest. I point
could be avoided if medications
radio and in the papers. It is all to do
out that it's Webstercare—it takes
were taken the way they are
with the new government funding
the guesswork out of taking
prescribed. Statistics can tell us
arrangements for a trial of dose
how many people go to hospital.
administration aids. We like it.
What's happening in Australia?
But there are many more who
New Year Note: Jessica the dog does
Here we have one of the most
do not end up in hospital after a
not like fireworks and wants them
cost-effective government funded
medication misadventure. These
banned. She doesn't care how good
medication supply systems in
can never be counted, but their
the harbour bridge looks. She is
the world—the Pharmaceutical
problems are just as great.
getting up a petition among other
dogs in the area. Many people say
she is barking mad but Jessica says,
Words of Wisdom
just you wait.
I've just finished reading Ken
Some people are wise and some are otherwise.
Follett's 1,000 page epic, ‘World
The nicest thing about the future is that it always starts tomorrow.
without End', the sequel to ‘Pillars of
I didn't say it was your fault, I said I was blaming you.
the Earth'. I can't believe I read it all.
No more for now, Mr. Follet, this fan
Times have not become more violent—they have just become
is sequelled out.
Keep on Webstering.
Life is like a dogsled team. If you're not the lead dog, the scenery never changes.
manrex pty ltd – WeBSterCare • aBn 29 974 510 173 • 17-19 mOOre Street, leICHHardt nSW 2040
tel: (02) 9563 4900 • Fax: (02) 9563 4955 • Free Call: 1800 244 358 • emaIl: [email protected]
did You Know?
thiS month — dYSphaGia
manrex continuinG education SerieS
by Paul Hannan
Dysphagia is difficulty in swallowing.
contribute to swallowing disorders
their medication. Some medications
About 50% of aged care home residents
can cause xerostomia or a dry
have identifiable signs and symptoms
mouth, including anticholinergics,
of dysphagia. While swallowing
• Stroke or cerebrovascular
angiotensin-converting enzyme (ACE)
impairment increases with age, ageing
inhibitors and many short- and long-
alone does not cause dysphagia. In
• Parkinson's disease
acting antihistamines. The dryness
older people healthy swallowing
• Chronic reflux oesophagitis or
of the mouth can lead to a feeling of
occurs more slowly, while remaining
gastro-oesophageal reflux disease
coordinated and effective.
• Neuromuscular disorders such as
If swallowing disorders are
Huntington's or multiple sclerosis
The act of swallowing occurs in three
unrecognised or untreated, residents
phases. In the first phase, food or
may become malnourished and
liquid is contained in the mouth by
• Motor neuron disease
dehydrated. Choking, aspiration and
the tongue and palate. The tongue
• Sjogren's syndrome (due to
sometimes complete obstruction may
moves the food around in the mouth
decrease in salivary flow)
occur. Aspiration is the accidental
for chewing. This phase is the only one
• Myasthenia gravis
sucking in of food particles or fluids
under voluntary control.
• Post-radiation therapy
into the lungs. Aspiration pneumonia
The second phase of swallowing begins
• Medication with anticholinergic
(infection of the lungs due to
when the brain makes the decision
effects eg tricyclic antidepressants,
aspiration) has a high mortality rate of
to swallow. At this point a complex
series of reflexes begin. The food is
• Phenothiazides eg Mellerill®,
thrust from the mouth into the throat.
Largactil®, Stelazine® (may cause
At the same time, a muscular valve
Eating while in an upright position
at the bottom of the pharynx opens,
• Olanzapine (Zyprexa®)
helps prevent choking and aspiration
allowing food to enter the oesophagus,
• Poor dentition
of food. Residents should remain
and other muscles close the airway to
Difficulty swallowing liquids is usually
sitting upright or standing for 15 to 20
prevent food from entering the airways. associated with poor muscular control
minutes after eating a meal.
This second phase of swallowing takes
before the swallow. This is common
Many people with dysphagia have
less than half a second.
in people with neurological diseases
difficulty swallowing thin liquids
The third phase of swallowing begins
such as Parkinson's and MS.
such as water, tea, coffee and juices.
when food enters the oesophagus.
Patients with Alzheimer's disease may
Thin liquids splash into the pharynx
The oesophagus, which is about
not be able to swallow fluids or food
before the swallowing mechanism
nine inches long, is a muscular tube
when they reach the final stages of
is triggered, increasing the risk of
that produces waves of coordinated
aspiration. Thickening thin fluids
contractions. As the oesophagus
Strokes commonly lead to dysphagia
is not always recommended for all
contracts, a muscular valve at the end
and patients may benefit from
residents—check with a speech
of the oesophagus opens and food is
rehabilitation to retrain swallowing
pathologist. If the swallowing problem
propelled into the stomach. The third
is due to lack of saliva, sucking
phase of swallowing takes six to eight
popsicles, ice chips or lemon ice or
seconds to complete.
drinking lemon-flavoured water may
The whole process involves over 40
Some medications are a high risk for
increase saliva production, which
pairs of muscles.
causing oesophageal injury, leading to
increases swallowing frequency. Reflux oesophagitis should be treated
Signs and symptoms
dysphagia. These include:• Bisphosphonates eg alendronate
with proton pump inhibitors such as
A variety of symptoms indicate that
Zoton®, Somac®, Nexium® or Losec®
a resident has a swallowing disorder:
or domperidone (Motilium®).
Drooling—Food leakage from mouth—
• Potassium chloride (Slow K®,
Food retention in mouth—Coughing or
choking during or just after eating—or
drinking—Change in voice or speech,
Dysphagia is an unpleasant,
frightening and potentially life-
congestion or secretions after a meal—
• Quinidine (Kinidin Durules®)
threatening condition which
Refusal or reluctance to have food
• Tetracyclines eg doxycycline
affects a large number of aged care
placed in mouth.
residents. Recognition and proper
Residents presenting with these
• Clindamycin (Dalacin C®)
assessment is essential. A complete
symptoms should have an assessment
• Ferrous sulphate
evaluation of dysphagia should
by a speech therapist.
(Ferrogradumet®, FGF®, Fefol®,
include a medication review and
may result in the elimination of
Residents should be encouraged to
medications or changes in dosage.
Conditions and medications that may
drink sufficient water when they take
Medical news from all over
The Multi Dose advantageWebster-pak is the most widely recognised multi dose system in Australia. Originally created for community/home care it soon spread into residential aged care. Since then we have developed the system to keep it in line with your changing needs and technological advances. How does it help?• All medications for one
week in one pack.
• All medications for one
The use of statins commonly
dosage time in a single
prescribed to reduce cholesterol
has been shown to reduce
the risk of death from either
• You can always see
chronic airways limitation or
what pills have been
used and what is left.
data was obtained from Health
Maintenance organisations in the
• Widely recognised, so
USA. Regular statin use was based
very little orientation
on at least 90 days of treatment.
needed for staff.
A simple test that can be given
• Fully accountable system.
by any physician predicts with 87% accuracy a person's risk of
• Resident photo on
developing dementia within
pack—right there at the
six years. The test is a 14-point index combining medical history,
cognitive testing and physical examination. Risk factors for developing dementia are, an age of 70 or older, low physical
also the flexi-pak
functioning on everyday tasks,
coronary bypass surgery and a body mass index of less than 18.
Designed for residents who
People who score 0 to 3 on the test
need medications when going
have a 6% chance of developing dementia within six years. A score
out for the day.
of 4 to 6 indicates a 25% chance.
• The Flexi-pak
People with a score of 7 or higher have a 54% chance of developing
dementia within six years.
There is a higher occurrence
of congestive heart failure
patient to tear off a day or a
in rural Australia compared
to metropolitan areas. The
percentage of rural patients
• Each compartment is
over 60 with CHF was 16.1%.
labelled with the patient's
It was 12.4% in metropolitan
areas. This may be because
name, day, dosage time
there are less specialist
referral and echocardiograms.
The use of recommended
• The Flexi-pak folder
pharmacotherapies was also
helps keep everything
lower in rural compared to
Life in the aged care home business gets more complicated every day.
At Webstercare we are dedicated to making your life as simple as we can.
And what could be simpler than picking up the phone and calling
1800 244 358 to find out about our medication management reports?
Webstercare's reports provide detailed information that will help you with
all your decision-making for a resident's medication review.
A new funding instrument to determine the level of funding from
the government, ACFI, arrives on the 20th March 2008. Many of
our reports provide information to help you deal with that. They
Superwoman, Wonder Woman,
provide documentation for accreditation requirements and ACFI
Julia Gillard—they all tremble in
implementation. An example is use of psychotropics and diagnoses. Your
the aura of the Webster woman of
pharmacy can provide the reports.
every year, Zoe Diplos. Approach
her presence with your Webster-
Ask your pharmacist or ask us. We will welcome your phone call. A
problems and get your tlc, your
summary booklet of the latest reports will be delivered to your door. Just
brow soothed and a mountain of
call Webstercare on 1800 244 358.
Zoe says: Are you no longer as
young as you were? Why not be
proud and say, yes, I'm a senior
• I'm the life of the party—even if
it lasts until 8 p.m.
• I'm very good at opening
childproof caps—with a
• I'm usually interested in going
home before I get to where I am
• I'm awake for hours before my
body allows me to get up.
• I'm smiling all the time because I
can't hear a thing you're saying.
• I'm very good at telling stories—
over and over and over and over.
• I know everything I can't find
is in a safe, secure place—
• I'm sure they are making adults
much younger these days.
Take two after meals with water
And most important of all:
• If you're only as old as you feel,
Credit card companies keep writing to me to offer me credit.
how could I be alive at 150?
For that, I am deeply indebted.
Scientists have located the gene that causes obesity. His name is Gene Harris and he invented Krispy Kreme doughnuts.
My father taught me a valuable lesson, don't trust anybody. He didn't tell
Gerard Stevens and Paul Hannan
me—he robbed me.
saying hello to another year and goodbye for this edition. Signing off
Business conventions are important because they demonstrate how many
with one of the wisest sayings we
people a company can operate without.
have heard in a long time:
I have always wanted to be the last man on earth, just to see if all those women
When life hands you lemons, ask for
were lying to me.
tequila and salt.
manrex, webStercare, webSterSYStem, unit doSe 7, webSter-paK and flexi-paK are reGiStered trade marKS of manrex p/l webStercare.
0022-3565/08/3251-1–9$20.00THE JOURNAL OF PHARMACOLOGY AND EXPERIMENTAL THERAPEUTICS Copyright © 2008 by The American Society for Pharmacology and Experimental Therapeutics JPET 325:1–9, 2008 Printed in U.S.A. Perspectives in Pharmacology Exploiting Complexity and the Robustness of NetworkArchitecture for Drug Discovery Marc K. Hellerstein Department of Nutritional Sciences, University of California, Berkeley, California; Division of Endocrinology and Metabolism,Department of Medicine, University of California, San Francisco, California; and KineMed, Inc, Emeryville, California
SOGC CLINICAL PRACTICE GUIDELINES SOGC CLINICAL PRACTICE 155 (Replaces guideline No 147), February 2005 Guidelines for Vaginal Birth After PreviousCaesarean Birth This guideline has been prepared and reviewed by the Clinical 1. Provided there are no contraindications, a woman with 1 previous Practice Obstetrics Committee and approved by the Executive