mucositis coding scale by cdc.gov /nchs / ppt /icd9 / att_mucosit s sept05.ppt

Cancer Treatments, Mucositis & Mouthwash

Oral mucositis (inflammation of the mucosa lining of the mouth) and mouth of ulcers is a widespread and potentially serious consequence of high-dose chemotherapy and radiotherapy.

Symptoms, which may include altered taste perception, sores, and varying degrees of pain, usually appear 4 to 5 days after chemotherapy or radiotherapy treatment initiation.

A compounding pharmacist can formulate a specialised preparation such as a mouthwash to help manage the discomfort. There are various formulations that pharmacists can use based on the experience and needs of the individual physician and patient respectively.

Mucositis, painful inflammation and ulceration of the mucous membranes lining the digestive tract, can involve both the oral tract and the gastrointestinal tract. Oral mucositis is a widespread and potentially serious consequence of certain high-dose chemotherapy and radiotherapy treatments. It is a devastating consequence of cancer treatment for patients, who then find it extremely difficult to perform simple, everyday mouth-related activities, including chewing, biting, talking, swallowing, drinking, and sipping.

Oral and gastrointestinal mucositis affects up to 100% of patients undergoing high-dose chemotherapy and blood stem-cell transplantation and 80% of patients with malignancies of the head and neck who are receiving radiotherapy. Mucositis also affects a wide range of patients receiving chemotherapy.

Causes of Mucositis

About 5% to 15% of all patients undergoing cancer treatment experience mucositis. TABLE 2 details the grades of oral mucositis as defined by the World Health Organization (WHO). In grade 3 oral mucositis, the patient is unable to eat solid food; in grade 4, the patient is also unable to consume liquids. Radiotherapy to the head and neck or to the pelvis or abdomen is associated with grade 3 oral mucositis in more than 50% of patients. Among patients undergoing head and neck radiotherapy, pain and decreased oral function may persist long after the conclusion of therapy. HIV infection may cause oral thrush.

Oral mucositis is characterized by damage to the epithelial or lining cells mouth and throat. Epithelial cells normally serve as a barrier between the inside and outside of your body and protect it from viruses.
Because of their relatively high turnover rate compared with cells in other organs, epithelial cells are particularly susceptible to the damaging effects of radiation and chemotherapy. A reduction of the saliva barrier, disruption of epithelial cells, thinning of the epithelium, and ulceration also occur. Other conditions can contribute to oral mucositis, including oral infections and trauma or irritation.

Symptoms

Cancer patients who are undergoing chemotherapy usually develop symptoms of oral mucositis 4 to 5 days after treatment is initiated. A peak is reached at around day 10, followed by slow improvement over the course of a few weeks. Radiotherapy-induced mucositis, which usually appears at the end of the second week of treatment, may last for 6 to 8 weeks.

As a result of epithelial-cell death, the lining of the mouth thins sloughs off and becomes red, inflamed, and ulcerated. Ulcers range in size from 0.5 cm to greater than 4 cm. Oral mucositis can be extremely painful; the degree of pain, often described as a burning sensation, is usually related to the extent of the tissue damage. As a result of the pain, the patient may experience trouble speaking, eating, or even opening the mouth.

Alterations in taste perception are common, especially in patients receiving radiation therapy to the neck and mouth. An altered sense of taste is a temporary condition that occurs because of effects on the taste buds located mainly in the tongue. Common complaints are that food tastes too sweet or too bitter or continually has a metallic taste. In some cases, only partial recovery of taste occurs. Severe pain and the inability to chew, swallow, or talk may ultimately lead to dehydration and malnutrition. The lack of saliva can cause tooth caries, loss of fillings, mouth ulcers, and pain, as saliva has a cleansing effect on the mouth and controls bacteria.3
Pain and loss of taste perception make it more difficult to eat, which frequently leads to weight loss. Infection of the sores or ulcerations by a virus, bacterium, or fungus can occur. About half of all patients receiving chemotherapy develop severe oral mucositis that may require modification of the patient’s cancer treatment.

Treatment

For patients undergoing chemotherapy, radiotherapy or preventive strategies should be started before the cancer treatment. These include:

  • a pretreatment dental examination
  • good oral hygiene such as cleaning the mouth every 4 hours and at bedtime
  • brushing the teeth with a gentle toothbrush two or three times daily and a non-detergent toothpaste,
  • flossing between the teeth
  • using an alcohol-free mouthwash.

If saliva dries up the patient could:

  • use artificial saliva (ask your compounding pharmacist) or
  • chew sugar-free gum

If the mucositis develops and is painful the patient could:

  • Use a special mouthwash formulated by a compounding pharmacist depending on your specific symptoms that may include an anaesthetic, an antiseptic, an antifungal, a barrier protection agent, an anti-inflammatory or an anti-viral.
  • Drink plenty of liquids – at least 3 litres per day
  • Avoid alcohol
  • Avoid citrus fruits, tomatoes, acidic foods, alcohol, and hot foods that can aggravate mucositis lesions.
  • Eat food that is soft, non-spicy, pureed, or in liquid form. Harder foods should be treated to make them soft and easy to eat.
  • Refrain from smoking.
  • Suck ice cubes. This is a simple, but often effective, method

Compounded Preparations

Your compounding pharmacist can discuss the various ingredients that can be incorporated into a mouthwash depending upon the various symptoms being managed. In addition, they can flavour a custom mouthwash according to the patient’s individual preferences.

Alternatively, the medicines may be compounded into an ice-block, paste or lollipop and can be flavoured.

Compounding Pharmacy Australia | Customised Medication

What is a Compounding Pharmacy?

Sometimes a “one-size-fits-all” approach to medication does not work for everyone. It means that patients’ needs are not met by a traditional dispensing pharmacy. We have the ability to compound products tailored to suit the needs of our customers, giving them access to the best medicine for their personal needs. 

You’re likely to visit a pharmacy when you need to pick up your prescriptions, but have you ever visited a compounding pharmacy? 

Most people don’t know the difference between a regular and compounding pharmacy. A compounding pharmacy is a speciality pharmacy that can make a medication prescribed by a doctor, for patients that cannot use a commercially manufactured medication. Often, a compounding pharmacy is used for people with allergic tendencies or for those that are very young and need a small dosage of a certain medication. 

Unlike ordinary pharmacies that sell manufactured medicines, a compounding chemist will compound (mix) and package your prescription onsite – we often say “make it up from scratch”. Compounding is the process of making a medication from raw ingredients that are either not readily available on the Australian market, currently out of stock or were not manufactured in the precise dose and/or dosage form that you have been prescribed. 

Working with your doctor, compounding allows our pharmacists to customise the strength and dosage of a medication according to your individual needs.

Compounding pharmacies will only issue medications that are obtained via a prescription from a medical doctor. This is a safe and reliable way to obtain customised medications. They are individualised for the patient and not administered as a set and predetermined dose like commercial medications.  Some compounding pharmacies undergo an extra quality assessment to provide consumers with confidence that the product has been compounded to compounding standards.  The Pharmacy Boards around Australia are currently reviewing their assessment of compounding pharmacies in an effort to improve the standards of delivery of compounded medicines.

How can someone know if compounding is the right choice for their medication or supplements?

There are many situations where compounding medicine can be helpful. Compounded medications can be great for people who cannot swallow pills, such as the elderly or young children, and need an alternative form such as a cream or liquid. Many people are allergic or sensitive to particular ingredients in mass-produced medications, and these can be removed in a compounded medication. 

A compounding pharmacy can also create custom doses for someone who needs larger or smaller doses than the ones that are mass manufactured. In addition, compounding is worth looking into for pet needs, as the medication will be compounded specifically for your animal. 

Overall, compounding is the perfect solution for anyone who cannot tolerate mass-produced medications for any reason. It may also minimise side effects because a compounding pharmacist can help a patient get the appropriate dosage needed whilst removing any ingredients that pose a problem for that patient such as lactose, colouring agents, gluten or preservatives.

There are so many prescription medications available. Why do we need compounded medications?

Some medications are only available by compounding. For people with strict dietary and allergy requirements, compounding the medicine may be the only option. Also, compounding pharmacies cater to medication that has been discontinued or is no longer being manufactured in bulk. 

 

What is involved in compounding medication? 

  • The dosage compounded is tailored exactly for the patient
  • Medication compounded can come in many forms including patches, chewable’s, suppositories, mixtures, rapid dissolve tablets,  or gels
  • The medicine can be compounded free of problem-causing ingredients like certain preservatives, alcohol or lactose that may cause an allergic reaction 
  • The medicine can be compounded in a vegan (eg. cellulose) capsule instead of an animal-sourced capsule (eg. gelatin)

Can I buy compounded medication without a prescription?

No. Compounded medication acts in the same way as traditional medication. If the active ingredient in the medication can only be prescribed by a doctor then you must obtain a prescription in order to be able to purchase the compounded medication. Most compounding pharmacies (including Fresh Therapeutics Pharmacies) require a prescription for any medicine that is compounded. 

Can I have my prescription medicine compounded if it is cheaper to have it compounded?

No. In Australia, it is illegal to compound and sell medicine that is already produced by a pharmaceutical manufacturer.  Only medicines that are not available by a commercial manufacturer and prescribed by a doctor registered in Australia can be compounded.

I want to visit a compounding pharmacy. Where do I find one?

Your GP will be your first point of contact when it comes to prescription medicines to be compounded. There are many compounding pharmacies in Sydney. Get in touch today. 

What is the difference between a pharmacy and a compounding pharmacy?

Commercially available medications are manufactured by pharmaceutical companies in mass quantities for the general population with no specific patient in mind. Compounded medications are ordered by a physician, individually prepared by a compounding pharmacist and made specifically for a person’s unique medical needs

 

How long does it take to compound my medication?

The wait time varies depending on the complexity of the prescription required for compounding. Usually, the medicine can be compounded within a day. However, if an ingredient needs to be ordered, the process can take several days so it is best to check with your Compounding Pharmacy. If you need a repeat of a compounded medicine, it will need to be compounded again, as every medicine is bespoke and created to tailor for each specific patient. 

 

As experienced compounding pharmacists, we have outlined the benefits for compounded medication.

Various Forms
Sometimes, patients may need their medication in a different dosage form. For instance, some people who have difficulty swallowing tablets or capsules may find it easier to take their medication in liquid form. Some medications can be also compounded in cream or gel forms and the medication is absorbed through the skin. As a compounding pharmacy, we can offer medicines in various forms depending on the best solution for you!

Discontinued Medications
When large manufacturers discontinue production of a certain medication, they make it hard for the patients who still need these medicines. Compounding pharmacists play an important role in providing access to discontinued medications by compounding pharmaceutical-based ingredients in order to ensure that patients get the critical care they require. Compounding pharmacies have access to the quality tested pharmaceutical ingredients and can fill the prescription using the latest research, quality control process, and techniques that help meet the individual patient needs. If you want to learn more about discontinued medication, get in touch with us.

Easy to Use
Some medications taste extremely unpleasant, making it challenging for the patients to take them as directed. A compounding pharmacist can customise the prescription from scratch with the patient’s flavour of choice. This is especially handy when dealing with patients who may refuse medication, like young children, elderly patients, or even pets.

Allergy-Friendly
We understand that each individual is unique and complex. Many of our patients have issues with allergy, sensitivity, intolerance to dyes, lactose, gluten, fructose or alcohol. These can cause unwanted reactions when taking a certain medication. In other cases, traditional manufactured medications may contain preservatives that cannot be tolerated by the patient because of sensitivities or allergies to these substances. A compounding pharmacist can make a formula without the offensive ingredients, so a patient can still get the right treatment.

Unique Services at our Compound Chemist Broadway and Bondi
When it comes to compounding, identifying our patients’ needs is our top priority.  What flavour of an oral medicine would they prefer? Can we compound the medicine in a different sized capsule? Can the medicine be safely delivered through the skin, under the tongue, through the nose or maybe through the vagina? Can we safely combine several medicines in one capsule?  What side effects are our patients dealing with? What questions might they have when they take their medicine? We often do a lot of research to source the active ingredients, determine a formula and develop the method to compound the medicine. As a compounding pharmacy, we offer patients a service they can’t receive at most other pharmacies. 

 

Compounding pharmacies are often unheard of. If you have any specific medical or allergic requirements, speak to your GP about compounding your medicine and how it can help you. Alternatively, we have trained pharmacists onsite that are more than happy to give you reputable advice. 

For your customised compounded medication, including health plans or advice about prescription medicines, get in touch with our friendly and knowledgeable compounding pharmacists today. Visit one of our stores today or call us on 02 9389 3168. 

INCONTINENCE: World Continence Week 19-25 June

IncontinenceIncontinence describes any accidental or involuntary loss of urine from the bladder (urinary incontinence) or bowel motion, faeces or wind from the bowel (faecal or bowel incontinence). It may cause distress as well as being a hygiene problem. However, incontinence can be managed and treated.

If you have experienced this problem, you are not alone. Incontinence is a widespread condition. It can range from ‘just a small leak’ to complete loss of bladder or bowel control. In fact, over 4.8 million Australians have bladder or bowel control problems for a variety of reasons.

It is likely that the true number of people affected is much higher. Many people do not tell their doctor or pharmacist about their incontinence, due to embarrassment. Some people mistakenly think that incontinence is a normal part of ageing or that it cannot be treated. If you experience bladder or bowel control problems seek help, as the symptoms will not go away on their own and may worsen over time.

World Continence Week is held on 19-25 June 2017. The week is coordinated in Australia by the Continence Foundation (CFA). CFA provide resources and information for the public, including the National Continence Helpline (Ph. 1800 33 00 66). This Helpline is a free service staffed by continence nurse advisors who can provide information, education and advice to people with incontinence or those caring for someone with incontinence.

Urinary incontinence is quite common and often associated with pregnancy, childbirth, menopause or some chronic health conditions. It can range from a small dribble when you cough or laugh, to large flows of urine. Stress and urge incontinence are common types of urinary incontinence.

People with poor bowel control or faecal incontinence have difficulty controlling their bowels. This may mean they pass faeces or stools at the wrong time or in the wrong place. They may also pass wind when they don’t mean to or experience staining of their underwear. About 1-in-20 people experience poor bowel control. It is more common as you age, but many young people also have poor bowel control. People with poor bowel control also often have poor bladder control.

Treatment depends on the type of incontinence. It is therefore important that a continence assessment is conducted by a professional so an appropriate management plan can be developed. Lifestyle changes may significantly help some types of incontinence and these include:

  • Drink about 6–8 cups of fluid each day (1.5–2 litres of water) spread evenly throughout the day, unless otherwise advised by your doctor. To avoid disruptions to your sleep, drink a little less in the evenings.
  • Reduce the number of drinks containing caffeine (e.g. tea, coffee, hot chocolate and cola) as this can increase urge incontinence.
  • Avoid constipation by maintaining a healthy balanced diet that contains plenty of fruit, vegetables and fibre.
  • Lose some weight if required, as a modest amount of weight loss can improve urinary incontinence.
  • Aim for 30 minutes of exercise most days.
  • Do pelvic floor exercises to strengthen the pelvic floor muscles.
  • Go to the toilet only when you need to, rather than ‘just in case’.
  • Go to the doctor if you think you have a urinary tract infection.

There is a range of health professionals with specialist knowledge in continence management who can assist you www.continence.org.au.

At Fresh Therapeutics we help you understand which medicines (both prescribed and over-the-counter) can affect bladder and bowel continence.

We stock the Molimed®  range of incontinence pants, pads and other aids – not all pads are the same.   We also have information about the Australian Government Continence Aids Payment Scheme (CAPS). This program provides financial assistance for eligible people who have permanent and severe incontinence to meet some of the costs of incontinence management products.

As members of the Pharmaceutical Society Self Care Program, Fresh Therapeutics Pharmacies  provide information about incontinence in the Self Care Fact Cards Bladder and urine control, Pelvic floor exercises, Fibre and bowel health, and Urinary tract infection.

Acknowledgement: Pharmaceutical Society Of Australia Health Column

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