NORLAND AVENUE PHARMACY PRESCRIPTION COMPOUNDING FOR GENERAL PRACTICE

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1 OCTOBER 2011 NORLAND AVENUE PHARMACY PRESCRIPTION COMPOUNDING N ORLANDA VENUEP HARMACY. COM We customize individual prescriptions for the specific needs of our patients. INSIDE THIS ISSUE: Smoking Cessation 2 Diaper Rash 3 PRESCRIPTION COMPOUNDING FOR GENERAL PRACTICE Diabetic Foot Ulcers Norland Avenue, Suite 105 Chambersburg, PA Phone: (717) Fax: (717) Web:

2 Page 2 SMOKING CESSATION The following review found that nicotine replacement therapy can help people who make a quit attempt to increase their chances of successfully stopping smoking - Nicotine replacement therapy for smoking cessation (Cochrane Database Syst Rev Jan 23; (1):CD000146). BACKGROUND: The aim of nicotine replacement therapy (NRT) is temporarily to replace much of the nicotine from cigarettes to reduce motivation to smoke and nicotine withdrawal symptoms, thus easing the transition from cigarette smoking to complete abstinence. OBJECTIVES: The aims of this review were:to determine the effect of NRT compared to placebo in aiding smoking cessation, and to consider whether there is a difference in effect for the different forms of NRT (chewing gum, transdermal patches, nasal spray, inhalers and tablets/lozenges) in achieving abstinence from cigarettes. To determine whether the effect is influenced by the dosage, form and timing of use of NRT; the intensity of additional advice and support offered to the smoker; or the clinical setting in which the smoker is recruited and treated. To determine whether combinations of NRT are more likely to lead to successful quitting than one type alone. To determine whether NRT is more or less likely to lead to successful quitting compared to other pharmacotherapies. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register for papers with 'nicotine' or 'NRT' in the title, abstract or keywords. Date of most recent search July Nicotine Polacrilex 4mg Flavored Lollipops #5 Place lollipop in mouth until urge to smoke ebbs. Place lollipop back into childproof container. MAIN RESULTS: We identified 132 trials; 111 with over 40,000 participants contributed to the primary comparison between any type of NRT and a placebo or non-nrt control group. The RR of abstinence for any form of NRT relative to control was 1.58 (95% confidence interval [CI]: 1.50 to 1.66). The pooled RR for each type were 1.43 (95% CI: 1.33 to 1.53, 53 trials) for nicotine gum; 1.66 (95% CI: 1.53 to 1.81, 41 trials) for nicotine patch; 1.90 (95% CI: 1.36 to 2.67, 4 trials) for nicotine inhaler; 2.00 (95% CI: 1.63 to 2.45, 6 trials) for oral tablets/lozenges; and 2.02 (95% CI: 1.49 to 3.73, 4 trials) for nicotine nasal spray. The effects were largely independent of the duration of therapy, the intensity of additional support provided or the setting in which the NRT was offered. The effect was similar in a small group of studies that aimed to assess use of NRT obtained without a prescription. In highly dependent smokers there was a significant benefit of 4 mg gum compared with 2 mg gum, but weaker evidence of a benefit from higher doses of patch. There was evidence that combining a nicotine patch with a rapid delivery form of NRT was more effective than a single type of NRT. Only one study directly compared NRT to another pharmacotherapy. In this study quit rates with nicotine patch were lower than with the antidepressant bupropion. AUTHOR S CONCLUSIONS: All of the commercially available forms of NRT (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking. NRTs increase the rate of quitting by 50-70%, regardless of setting. The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT. We have the ability to compound nicotine as a lollipop in a variety of strengths to meet the unique needs of each of your patients. This form of delivery may be preferred by patients as it allows them to simulate the hand to mouth movements associated with smoking.

3 Page 3 DIAPER RASH The following case report suggests that topical cholestyramine ointment may be a safe and efficacious treatment option for perianal irritation - Cholestyramine ointment to treat buttocks rash and anal excoriation in an infant (Ann Pharmacother Sep;30(9):954-6). OBJECTIVE: To describe a novel treatment for perianal excoriation in an infant receiving a promotility agent. CASE SUMMARY: A 2-month-old boy with reflux, and regurgitation was treated with cisapride. Shortly after cisapride therapy he developed a rash on his buttocks and anal irritation that progressed in severity despite the use of numerous topical products and extended diaper-free periods. A topical cholestyramine ointment compound was prepared and administered, resulting in complete resolution within 3 days. DISCUSSION: Cisapride can decrease the gastrointestinal transit time, which can lead to less time for bile acid reabsorption in the distal ileum. If high concentrations of bile acids are contained in the stool, they can irritate the anus and buttocks in a manner similar to the skin irritation experienced by patients with ostomies. Cholestyramine, a bile acid sequestrant, can irreversibly bind the bile when applied topically and bring relief to the patient. CONCLUSIONS: Topical cholestyramine ointment may be a safe and efficacious treatment option for perianal irritation due to bile acids. PMID: With our state of the art compounding lab and pharmaceutical experience, we have the ability to compound cholestyramine and mupirocin into one topical ointment. Cholestyramine 10% / Mupirocin 2% Topical Ointment 120gm Apply to affected area 3x day or at each diaper change The following study found that mupirocin applied topically is an excellent antifungal agent for the treatment of diaper candidosis - Perianal candidosis--a comparative study with mupirocin and nystatin (Int J Dermatol Aug;38(8):618-22). OBJECTIVE: To assess the efficacy and clinical outcome of 2% mupirocin in a polyethylene glycol base and nystatin cream as treatment regimens in diaper candidosis. DESIGN: A prospective randomized comparative study. METHODS: In vitro. The susceptibility of 20 clinical isolates of Candida albicans to 2% mupirocin, nystatin, and five additional antifungal agents was evaluated using the Nathan agar-well diffusion assay. The minimum inhibitory concentration (MIC) of mupirocin against the Candida species was determined using a tube dilution method. In vivo. Twenty patients (mean age, 12 months; range, 1 month to 4 years) with moderate to severe Monilia diaper dermatitis either had mupirocin ointment or nystatin cream applied to the infected area every 8 h or after every diaper change for a period of 7 days. Microscopic examination of skin scrapings and mycologic and microbiological cultures were performed before treatment and daily for 7 days, and progress was clinically assessed. RESULTS: In vitro. Topical mupirocin produced a greater zone of inhibition than nystatin cream, i.e. a mean of 27.2 mm (SD 1.55) compared with a mean of 17.3 mm (SD 1.08) for nystatin cream. MIC for mupirocin of 512 microg/ml in one case, 256 microg/ml in six cases, 200 microg/ml in 10 cases and 400 microg/ml in three cases were obtained for the 20 clinical isolates. C. albicans also displayed a universal sensitivity to mupirocin and nystatin. In vivo. Eradication of all Candida organisms was achieved within 2-6 days (mean, 2.6 days) in 10 patients receiving topical mupirocin therapy with rapid healing of the excoriated wounds (mean, 4.7 days). Both Gram-positive and Gram-negative bacteria were eradicated from the infected area within the trial period. Ten patients received topical nystatin cream and, in each case, Candida was successfully cleared within 5 days (mean, 2.8 days). Only three wounds were clinically healed within the trial period, however. The remaining seven wounds showed evidence of improved, but ongoing excoriated dermatitis and a heavy growth of polymicrobial organisms. CONCLUSIONS: Both agents eradicated Candida, the major difference being the marked response of the diaper dermatitis to mupirocin. Mupirocin should be applied topically 3-4 times daily or with each diaper change and is an excellent antifungal agent. PMID:

4 Page 4 DIABETIC FOOT ULCERS The following study found that application of topical tretinoin improved the healing of foot ulcers in patients with diabetes - Short-contact application of topical tretinoin improved the healing of foot ulcers in patients with diabetes (Arch Dermatol Nov;141(11):1373-7). OBJECTIVE: To determine the efficacy and safety of shortcontact administration of topical tretinoin on foot ulcers in patients with diabetes. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Outpatient clinic at a Veterans Affairs medical center. PATIENTS: Twenty-four volunteers with diabetic foot ulcers but without evidence of peripheral arterial disease or infection. INTERVENTIONS: Patients were randomized to 4 weeks of daily treatment with either topical 0.05% tretinoin solution (Retin- A) or placebo saline solution. Photographs and assessment of wound size and appearance were assessed every 2 weeks for a total of 16 weeks. MAIN OUTCOME MEASURES: The proportion of ulcers that healed in each group and the degree of change in ulcer size. RESULTS: Twenty-two patients, with a total of 24 foot ulcers, completed the study. At the end of 16 weeks, 2 (18%) of 11 ulcers in the control group and 6 (46%) of 13 ulcers in the tretinoin treatment group healed completely. Topical tretinoin therapy significantly decreased ulcer area and depth compared with placebo treatment over the 16 weeks of the study (P <.01 for surface area; P =.02 for depth). Adverse effects mainly consisted of mild pain at the ulcer site. CONCLUSIONS: Short-contact application of topical tretinoin improved the healing of foot ulcers in patients with diabetes. The tretinoin therapy was generally well tolerated, without serious local or systemic adverse effects. PMID: With our state of the art compounding lab and pharmaceutical knowledge and experience, we have the ability to compound tretinoin as a topical gel. Tretinoin 0.05% Topical Gel 60ml Apply sparingly QD

5 Prescriber Name Prescriber Address City State Zip Phone Fax Date Patient Name DOB Address City/State/Zip Phone Patient will pick up at pharmacy Please ship to patient Bill Insurance Plan: ID# All topical compound %s are per 1 ml or 1 gm unless otherwise noted Smoking Cessation [ ] Nicotine Polacrilex 4mg Flavored Lollipops Quantity #5 Directions: Place lollipop in mouth until urge to smoke ebbs. Place lollipop back into childproof container. Diaper Rash [ ] Cholestyramine 10%/Mupirocin 2% Topical Ointment Quantitiy 120gm Directions: Apply to affected area 3x day or at each diaper change Diabetic Foot Ulcers [ ] Tretinoin 0.05% Topical Gel Quantity 60ml Directions: Apply sparingly QD Directions Prescriber s Signature Refills: NR 757 Norland Avenue, Suite 105 Chambersburg, PA Phone: (717) Fax: (717)