Associate Professor Therese Kairuz

Liquid preparations of omeprazole are compounded extemporaneously for patients who cannot tolerate or have difficulty with tablets or capsules, such as those with a nasogastric tube or jejunal or feeding tube, those with a swallowing disorder, and young children and the elderly. Recommendations for preparation of a liquid from the enteric-coated pellets of omeprazole capsules are available in the literature. The pellets are dissolved in a sodium bicarbonate solution; shaking is recommended to aid dissolution. Apparently some pharmacists crush the pellets to speed up the compounding process. The aim of this study was to investigate the chemical stability of omeprazole in extemporaneously compounded liquids prepared by the grinding and shaking methods. A high-performance liquid chromatographic method was developed for evaluation of chemical stability. Samples were stored at 2°C (refrigerated conditions) or 25°C/60% relative humidity and assayed for drug concentration at 0, 1, 2, 4, and 8 weeks. The method of preparation affected the chemical stability of omeprazole when stored at 25°C/60% relative humidity; it was stable for 4 weeks if prepared by the shaking method, but for only 1 week if prepared by the grinding method. For both methods, the suspension was stable for 8 weeks if stored under refrigerated conditions. It is recommended that the shaking method be employed for extemporaneously compounded omeprazole suspensions, and that the prepared suspension be stored in the refrigerator.

The aim of this article is to present information related to pharmacy practice and education in two countries, South Africa and New Zealand, where there is currently a small migration of pharmacists from the former to the latter. The pharmacy profession in both countries is under the statutory regulation of a pharmacy council, and a society is responsible for professional aspects. The councils also play an important role in undergraduate pharmacy education, and tertiary institutions are responsible for the curricula. Externships and indigenous health programmes are important elements of education at both institutions cited in this article (Nelson Mandela Metropolitan University and The University of Auckland). Compulsory community service for pharmacists has been introduced in South Africa, while New Zealand is pioneering Continued Professional Development linked to competency and annual pharmacist registration. The information presented in this article may stimulate discussion and collaboration between members of the pharmacy profession across geographical borders. © 2009 FIP.

Aim: To formulate a stable and palatable paediatric phenobarbitone 10 mg/mL oral liquid and compare its physicochemical stability to the existing formulation compounded in some New Zealand hospitals. Method: Formulations were compounded from pharmaceutical standard ingredients according to good manufacturing practices and stored in glass bottles at different storage conditions. The physical stability of the formulations was determined by pH, appearance, viscosity and microbial studies; chemical stability was assessed using high performance liquid chromatography. Results: The new formulation and the existing hospital formulation remained physically stable for 28 days in terms of pH, appearance, viscosity and microbial stability. The phenobarbitone sodium concentration remained within an acceptable range (above 95% of the original concentration) after 28 days of storage at different conditions. The viscosity of the new formulation facilitated in masking phenobarbitone sodium's bitter taste, thus improving palatability. The palatability of the new formulation was superior to the hospital formulation. Conclusion: A palatable paediatric phenobarbitone oral liquid formulation with improved rheological properties was developed.

The reader has been introduced to the concept of qualitative research and its role in pharmacy practice research. Guidelines contributing to conducting quality research have been presented, including the need for an ethical approach to a study. In part 2, "Useful tools for data collection and analysis", the use of focus groups and face-to-face interviews will be discussed as examples of data collection methods and suggestions on how to analyse data will be presented.

Objective: To gather information on devices used to administer liquid medicines, dosing intervals for antibiotic administration, and parents' perceptions of the advice received from pharmacists about prescription medicines, for children up to the age of six years. Setting: Six schools from different socio-economic areas were selected within the Auckland area of New Zealand. To facilitate distribution and collection of questionnaires, the headmaster or a teacher was known to the researchers. Method: An anonymous questionnaire was distributed to year 1 and 2 students (aged five and six years) to take home for completion by a parent or primary caregiver. Respondents were asked to refer to their youngest child and/or to the last time they had given medicines or received a prescription for a child. Key findings: A total of 299 completed questionnaires were received (48.2%); 60 questionnaires had not been distributed by school teachers in error, and the overall return rate was thus adjusted to 53.4%. The device used most frequently to administer medicines to younger children up to the age of three years was an oral medicine syringe, while nearly one-third of children aged three to six years received medicine in a 'teaspoon'. Almost half the respondents (48.8%) indicated they would be most likely to forget the midday dose of antibiotics, and dosing deviated from recommended intervals. Most respondents had received advice from a pharmacist on how to take the medicine, and had understood instructions and had the opportunity to ask questions. Conclusion: This study highlights areas that pharmacists can include when advising parents and guardians about children's medicines, such as ideal dosing intervals of antibiotics and the use of accurate dosing devices. © 2007 The Authors.

Objective: The skill to compound non-sterile products is one of the seven competencies required of entry-level pharmacists for registration with the New Zealand Pharmacy Council. The need for extemporaneous compounding skills has been questioned in other countries, as it is argued that the skill is not often required in modern pharmacy settings. The aim of the current study was to determine the scope and frequency of extemporaneous compounding in New Zealand hospitals Method: Retrospective data were collected from eight large hospitals where extemporaneous compounded is regularly undertaken, for the period June 1, 2004 to December 31, 2004. Data were retrieved from compounding logbooks and batch sheets in hospital dispensaries. Data were collected from the north and south islands of the country. There are 32 hospitals of various sizes in New Zealand but extemporaneous compounding is not undertaken at all of them due to staff shortages or lack of demand. Key findings: There were 2015 products compounded over the seven-month period, with an average of 251.9 per month. Suspensions were the most frequently compounded oral dosage form. Omeprazole suspension was the most frequently compounded extemporaneous product. Nearly one-third of the compounded products were for beta-blockers. Creams, ointments and non-oral solutions were the most common topical compounded products. Conclusion: Pharmacists perform a broad range of extemporaneous compounding, and the skill of compounding is thus an essential competency for all hospital pharmacists. © 2007 The Authors.

OBJECTIVE - To validate an acid-base titration method, adopted from the British Pharmacopoeia, for analysis of ursodeoxycholic acid (UA) in extemporaneously compounded formulations. METHODS - Two different extemporaneously compounded formulations containing UA 15mg/ml, prepared from both pure drug and Actigall capsules were compared. A series of titrations was carried out to validate the titration method, as per International Conference on Harmonisation (ICH) guidelines. The titration method was used to analyse the stability of the UA suspensions stored for six weeks under ICH accelerated stability conditions. RESULTS - The titration method was found to be specific and accurate. Differences between the initial drug concentration of the two suspensions and the concentration after six weeks at accelerated stability conditions were statistically insignificant, indicating stability of the formulations. CONCLUSION - A simple acid-base titration method adopted from the British Pharmacopoeia has been validated to determine UA content in extemporaneously compounded suspensions, and can be recommended for quality assurance testing in hospital pharmacy.

Background: Pseudoephedrine is the precursor of choice for the illicit manufacture of methamphetamine, much of which is obtained through purchases of pseudoephedrine products from community pharmacies. Aim: To investigate issues surrounding data collection by community pharmacists in New Zealand on purchasers of pseudoephedrine products and its provision to police. Method: Questionnaires were mailed to a random sample of 50% of community pharmacies in New Zealand, with a second mailing to non-responders. Results: There was a response rate of 63%. 95% of pharmacists limited the quantity of pseudoephedrine products sold on each occasion. 45% asked for identification from all purchasers. Requesting/collecting identification resulted in various problems such as dealing with aggressive customers, and requiring time to attend court cases as a result of data provided to police. A major issue identified was the lack of feedback from police on information that had been provided. Nonetheless, there was support amongst pharmacists to continue to collect this information. Conclusion: Although there were a number of problems encountered by pharmacists, many of these can be overcome.

Objective: To explore perceptions of pharmacy graduates and preceptors regarding a new undergraduate pharmacy degree. Method: Data from focus groups and interviews with pharmacy graduates and preceptors were qualitatively analysed by thematic coding. Results: Participants identified strengths such as clinical knowledge and research skills; areas needing improvement were communications and calculations. Other areas identified by both graduates and preceptors included organization and management skills, longer externship experiential learning and extemporaneous compounding. It was suggested that extending the duration of the externship experience would facilitate the shift into the workplace and consolidate undergraduate learning. The internship programme was considered essential for personal development and for putting theory into practice. Conclusion: Both preceptors and graduates were satisfied with the undergraduate program. The knowledge, skills and attitudes displayed by graduates were considered to be adequate, providing a firm foundation for future practice.

Aim: To determine the extent and nature of extemporaneous compounding of liquid preparations in a sample of New Zealand hospitals. Methods: Retrospective data were collected from eight hospitals known to provide compounding services during the period 1 June 2004 to 31 December 2004; including dosage form, volume, and quantity prepared. Data were collected on site from compounding logbooks and batch sheets. Demographic patient data was limited to age and was only collected from pharmacy departments where this information was readily available. Off-label use was analysed where appropriate data were available. Results: 2015 products were compounded over the 7-month period; an average of 251.9 per month. More oral dosage forms, were compounded (n=152) compared to topical dosage forms (n=100); 74 drugs required extemporaneous preparation for oral use. There were 16 drugs used in an off-label manner on 144 occasions for paediatric patients. Most off-label drugs were reformulated as suspensions; omeprazole suspension was compounded at all of the hospitals. Off-label use of four drugs (sotalol, labetalol, diazoxide, and clonidine) was analysed for different paediatric age groups. Conclusions: Suspensions are the most frequently compounded dosage form and omeprazole is the drug that is most frequently reformulated. Off-label medicines form a small but integral role in the supply of medicinal products. © NZMA.

Objective: Benzodiazepines are primarily indicated for the treatment of anxiety states and as hypnotics. Their inappropriate use often relates to duration and manner of use. Few studies have attempted to assess the prevalence of benzodiazepine prescribing in South Africa. The primary aim of the study was to examine the prevalence of sedative/hypnotic prescribing according to patient age and sex in a primary care setting. Setting: South African private healthcare patients. Method: An exposure cohort drug utilisation study was conducted. Prescription data were obtained from a South African private medical aid administrator. Descriptive statistics were used in the data analysis. Key findings: Prescription records (n = 27 080) of 8084 patients in 2004 who were prescribed one or more benzodiazepines were retrospectively analysed. The average age of patients receiving benzodiazepines was 43.17 years (standard deviation (SD) 14.42 years). Benzodiazepine prescribing was more common in females (55.64% of patients were female). There was an increase in prescriptions per patient with increasing age, peaking at an older age among females. Diazepam (13.36%), zopiclone (13.19%) and oxazepam (12.03%) were the most frequently prescribed active ingredients. The majority of benzodiazepine hypnotics were prescribed in quantities of up to 14 units (tablets or capsules), while the benzodiazepine-related drugs zolpidem and zopiclone were prescribed in quantities of up to 30 units. Anxiolytics were often prescribed in quantities of 20 to 30 units. Conclusion: Anxiolytics were prescribed in greater quantities than hypnotics. An increase in anxiolytic/hypnotic prescriptions and quantities of tablets/capsules occurred with increasing age. The trends and differences that were detected in the prescribing of benzodiazepines warrant further investigation in larger patient populations, especially with respect to the choice of agent, duration of treatment and patient age. © 2007 The Authors.

Suitable dosage forms are not always available for specific patient populations and must be extemporaneously compounded. Extemporaneous preparation is the manipulation of drugs and excipients for a particular patient using traditional compounding techniques; these are referred to as 'off-label' and 'unlicensed' medicines. Off-label use can include altered doses, dosage forms or indications for use. Registered medicines are produced to internationally recognized standards of Good Manufacturing Practices. Within the pharmaceutical manufacturing industry, quality, safety and efficacy are enforced by regulatory legislations. In contrast, the responsibility for acceptable standards for the compounding of 'off-label' medicines falls on the prescriber, pharmacist or hospital nurse. Studies have been conducted by researchers from Australia and throughout Europe, highlighting the frequency of off-label use for paediatrics, with one study reporting that most extemporaneous preparations (29.6%) were for drugs required to treat metabolic diseases. Risks include compounding errors, adverse reactions to ingredients and excipients, and non-validated stability of the product. Sterile compounded products, including products for ophthalmic and palliative care, carry additional risks in these vulnerable patients. This paper provides an overview of off-label medicines highlighting biopharmaceutical, quality, safety and efficacy issues important to medical and allied health professionals. © 2007 Bentham Science Publishers Ltd.

Toward the end of the 1980s, the care of terminally ill patients in New Zealand moved from state-owned hospitals into community hospice settings. As a result, responsibility for the management of medicines for patients receiving palliative care also transferred to the community hospice environment. To meet the requirements of palliative care patients and to facilitate the compounding of sterile preparations, community pharmacists began to compound certain aseptic preparations with a Still Air Box, a unique apparatus that is an alternative to the more expensive and bulky laminar airflow cabinets.

Depression may affect up to 50% of people in older age groups. The increasing numbers of patients over 65 years of age may lead to higher prevalence rates of this debilitating condition. The diagnosis of depression in older patients is complex because symptoms may present as somatic concerns or anxiety. Comorbid conditions need to be investigated, evaluated and, if necessary, treated. Prescribing antidepressants to older patients requires consideration of the pharmacokinetic parameters of the medications used in this population, as these affect drug selection, duration of treatment, and suitability when comorbidity is present. This paper provides a review of current literature and makes recommendations for the pharmacological management of depression in older patients within the New Zealand context. © NZMA.

Preparing health professionals in New Zealand requires an understanding of the principles of the Treaty of Waitangi (signed in 1840) and of the cultural needs and common illnesses of the Maori people. Inter-professional learning between pharmacy, nursing and medical students was incorporated into the undergraduate curricula at second-year level at the University of Auckland in 2002. Learning about Maori health is achieved through group work, with each mixed-discipline group of 12 students researching one health issue that is prevalent among the Maori, such as diabetes. Maori cultural advisors play a key role in conducting sessions of Te Reo, where they teach simple conversational Maori greetings and traditional songs and introduce cultural concepts. On the final day of the programme, each group presents a poster with their findings and recommendations to fellow students and assessors. Nursing students gave more positive feedback than pharmacy or medical students, and evaluation of the inter-professional programme was overwhelmingly favourable. © 2005 Taylor & Francis.

Objective: The aim of this study was to determine children's preferences for colour, flavour and dosage form design of medicines. Method: Semi-structured interviews were conducted with 25 preschool children aged between 5 and 6 years. A teddy bear was used as the 'patient', and each child was given the opportunity of 'administering' medicine to the teddy bear. Questionnaires were sent to the parents to determine the colour and flavour of the over-the-counter medicine most frequently administered to the child. Setting: The study was conducted at pre-school facilities in the Eastern Province region of Port Elizabeth, South Africa. Key findings: Children selected red as the most popular medicine colour and bubblegum as the favourite flavour. Most children preferred a liquid dosage form rather than a chewable tablet or jelly sweet. Conclusion: Children have definite preferences for colours and flavours of medicines, and children of different cultures exhibited different preferences for different dosage forms.

Depression is the most common psychiatric disorder in adolescence and modern demands upon young people contribute to the cycle of tiredness, an inability to cope, stress and ultimately, depression. The aim of this study was to elicit perceptions regarding the use of antidepressant medication among a sample of adolescents and young adults so that medical practitioners and pharmacists can understand some of the issues surrounding antidepressant use, and assist patients to adhere to treatment. The interview method was selected as most suited to the purposes of this study, and nine in-depth interviews were transcribed verbatim. Coding and condensation of emerging themes was conducted, and verified by a second analyst. Themes relating to antidepressant medication included aids and barriers to compliance, and recognising the need for medication. The role of health professionals was explored, and the support of family, partners and friends was considered important. This study gives the reader valuable insight into the use of antidepressant medication.