C Conway Portfolio 2009

Weight Loss Surgery Life changing more ways than one Being overweight can cause all sorts of health problems, and the more overweight you are the more serious they can be. If you’ve tried everything to lose weight, and nothing has really worked for long, weight loss surgery could be the solution for you. Experts in weight loss surgery At your local BMI hospital, you will receive personal ongoing care and support from a team of specialists before, during and long after treatment to help you stay healthy and achieve the best possible results. Come and see us soon - and change your life for the better. Telephone: 0800 404 66 95 www.bmiweightloss.co.uk

Early detection of potential health problems through health screening can reduce sickness absence and make big savings for your business. Experts in Health Assessment Intelligent Health from BMI, the UK’s largest independent healthcare provider, offers a choice of 5 different levels of cost-effective health screening for all your employees. To find out which one would benefit your business the most, call us on 0808 101 0366 or email business@bmihealthcare.co.uk After all, a healthy team is a productive team.

Reliable protection that fits her lifestyle Look after her bones so she can enjoy the things in life that make her feel good ibandronic acid Supporting her every step of the way Prescribing information ing requirements. Pregnancy/Lactation: Do not use. Side effects: Bonviva® (ibandronic acid) 150mg tablet. See SmPC before prescribing. Indication: See SmPC for full details. Common: Dyspepsia, nausea, abdominal pain, diarrhoea, flatulence, Treatment of osteoporosis in postmenopausal women at increased risk of fracture. A reduction reflux, oesophagitis, headache, influenza-like syndrome, fatigue, myalgia, arthralgia, rash, mus- in the risk of vertebral fractures has been demonstrated, efficacy on femoral neck fractures has cle cramp, musculoskeletal pain/stiffness. Rare but potentially serious: angio-edema and hyper- not been established. Dosage and administration: 150mg once monthly, swallowed sensitivity reactions. Osteonecrosis of the jaw has been reported with IV and oral bisphospho- whole whilst sitting or standing with plain water after overnight (>6 hours) fast. Maintain fast nates. Legal Category: POM. Presentation and Basic NHS Cost: Oral - Bonviva (including other medications), do not lie down for 1 hour after administration. Contra-indi- 150mg tablet blister pack x 1 £21.45, 150mg tablet blister pack x 3 £64.35. MA Nos: cations: Hypocalcaemia, hypersensitivity to any ingredient. Precautions: Treat hypocal- EU/1/03/265/003, EU/1/03/265/004. MA Holder: Roche Registration Limited, 6 caemia and other disturbances of bone and mineral metabolism before starting Bonviva. Ensure Falcon Way, Shire Park, Welwyn Garden City AL7 1TW, United Kingdom. Bonviva is a registered adequate intake of calcium and vitamin D. Not recommended if creatinine clearance <30ml/min trade mark.Date of Preparation: September 2006. or if serum creatinine >200Ìmol/l (2.3mg/dl). Potential for oropharyngeal ulceration and Information about adverse event reporting can be found at upper GI disturbance. Follow dosing instructions especially if there is a history of prolonged www.yellowcard.gov.uk Adverse events should be reported oesophageal transit time. Caution with NSAIDs. Invasive dental procedures should be avoided in to Roche products Limited. patients receiving bisphosphonates if possible. Interactions: Metabolic interactions are consid- Please contact UK Drug Safety Centre on: 01707 367554. ered unlikely as ibandronic acid does not inhibit major hepatic P450 isoenzymes. Observe fast- Date of preparation: November 2007

Actively protects and supports bones 1 where it matters most Bonviva belle: Margaret, 56 january february march april may june july august september october november december Prescribing information Bonviva® (ibandronic acid) 150mg tablet. See SmPC before prescribing. Indication: Treatment of osteoporosis in postmenopausal women at increased risk of fracture. A reduction in the risk of vertebral fractures has been demonstrated, efficacy on femoral neck fractures has not been established. Dosage and administration: 150mg once monthly, swallowed whole whilst sitting or standing with plain water after overnight (>6 hours) fast. Bonviva gives her reassurance for her Maintain fast (including other medications), do not lie down for 1 hour after administration. Contra-indications: Hypocalcaemia, hypersensitivity to any ingredient. Precautions: Treat hypocalcaemia and other disturbances of bone and mineral metabolism before starting Bonviva. Ensure adequate intake of calcium and vitamin D. Not recommended if creatinine clearance <30ml/min or if serum creatinine >200Ìmol/l (2.3mg/dl). Potential for osteoporosis, so now all she has to worry oropharyngeal ulceration and upper GI disturbance. Follow dosing instructions especially if there is a history of prolonged oesophageal transit time. Caution with NSAIDs. Invasive dental procedures should be avoided in patients receiving bisphosphonates if possible. Interactions: Metabolic interactions are considered unlikely as ibandronic acid does not inhibit major hepatic P450 isoenzymes. Observe fasting requirements. Pregnancy/Lactation: Do not about is winning first prize for her daffs use. Side effects: See SmPC for full details. Common: Dyspepsia, nausea, abdominal pain, diarrhoea, flatulence, reflux, oesophagitis, headache, influenza-like syndrome, fatigue, myalgia, arthralgia, rash, muscle cramp, musculoskeletal pain/stiffness. Rare but potentially serious: angio-edema and hypersensitivity reactions. Osteonecrosis of the jaw has been reported with IV and oral bisphosphonates. Legal Category: POM. Presentation and Basic at the village show NHS Cost: Oral - Bonviva 150mg tablet blister pack x 1 £21.45, 150mg tablet blister pack x 3 £64.35. MA Nos: EU/1/03/265/003, EU/1/03/265/004. MA Holder: Roche Registration Limited, 6 Falcon Way, Shire Park, Welwyn Garden City AL7 1TW, United Kingdom. Bonviva is a registered trade mark. Date of Preparation: September 2006. Reference: 1. Bonviva 150mg Summary of Product Characteristics, October 2006. Information about adverse event reporting can be found at www.yellowcard.gov.uk Adverse events should be reported to Roche products Limited. Please contact UK Drug Safety Centre on: 01707 367554. Date of preparation: November 2007. ibandronic acid Providing strength from within

Gimme 5 Just one of the devastating effects of RSV is the demand it places on paediatric beds - at a local cost of over £100,000 per year. With Synagis, just five injections can help to keep RSV at arms length. It’s worth thinking about. The impact of RSV demands it

5 simple steps to preventing RSV. Just one of the devastating effects of RSV is the demand it places on paediatric beds - at a local cost of over £100,000 per year. With Synagis, just five injections can help to stamp out RSV. It’s worth thinking about. The impact of RSV demands it

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sratch Scratch beneath beneath the surface… the surface... He’s not in any trouble but his relationship with his family is strained AreAre his emerging needs beingneeds his emerging met? being met? STRATTERA*▼(ATOMOXETINE) ABBREVIATED PRESCRIBING INFORMATION Presentation Hard capsules: 10mg, 18mg, 25mg, QT or a family history of QT prolongation. Discontinue in patients with jaundice or laboratory evidence of liver injury, and do not restart. on the cardiovascular system can be potentiated. There is the potential for an increased risk of QT interval prolongation when be considered potentially related to atomoxetine. No serious safety concerns were observed during acute or long-term treatment. The 40mg, or 60mg atomoxetine. Uses Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children 6 years of age and older, Use with caution in patients with hypertension, tachycardia, or other cardiovascular disease. Pulse and blood pressure should be atomoxetine is administered with other QT prolonging drugs, (such as neuroleptics, class IA and III anti-arrhythmics, moxifloxacin, following data is from clinical trials in adults: Very common (≥10%): Appetite decreased, insomnia, dry mouth, nausea. Common (≥1- and in adolescents, as part of a comprehensive treatment programme. Treatment must be initiated by a specialist in the treatment of measured periodically while on therapy. Growth and development should be monitored during treatment with atomoxetine. erythromycin, methadone, mefloquine, tricyclic antidepressants, lithium, or cisapride) drugs that cause electrolyte imbalance (such as <10%): Early morning awakening, libido decreased, sleep disorder, dizziness, middle insomnia, sinus headache, palpitations, ADHD. In adolescents whose symptoms persist into adulthood and who have shown clear benefit from treatment, it may be appropriate Consideration should be given to dose reduction or interrupting therapy in patients who are not growing or gaining weight satisfactorily. thiazide diuretics), and drugs that inhibit CYP2D6. Caution is advised with concomitant use of medicinal drugs which are known to lower tachycardia, hot flushes, abdominal pain, constipation, dyspepsia, flatulence, dermatitis, sweating increase, difficulty in micturition, to continue treatment into adulthood. When continuing atomoxetine beyond 1 year, re-evaluation of the need for therapy is Patients requiring long-term therapy should be carefully monitored. Suicide-related behaviour (suicide attempts and suicidal ideation) the seizure threshold (such as antidepressants, neuroleptics, mefloquine, bupropion, or tramadol). Atomoxetine should be used urinary hesitation, urinary retention, dysmenorrhoea, ejaculation disorder, ejaculation failure, erectile disturbance, impotence, recommended. Initiation in adults is not appropriate. Dosage and Administration For oral use, administered as a single daily dose in has been reported in patients treated with atomoxetine. In double-blind clinical trials, suicide-related behaviours occurred at a frequency cautiously with pressor agents and drugs that affect noradrenaline. Atomoxetine did not cause clinically significant inhibition or induction menstruation irregular, orgasm abnormal, prostatitis, fatigue, lethargy, rigors, weight decreased. Uncommon (≥0.1-<1%): Peripheral the morning, with or without food. Some patients may benefit from taking it twice daily in divided doses. May be taken with or without of 0.44% in atomoxetine-treated patients, with no events in the placebo group. Hostility and emotional lability were more frequently of cytochrome P450 enzymes. Pregnancy and Lactation Should not be used during pregnancy unless the potential benefit justifies the coldness. Undesirable Effects (Post-Marketing Surveillance) Seizure, QT interval prolongation, Raynaud’s phenomenon, abnormal food and can be discontinued without dose tapering. Dosing of children/adolescents up to 70 kg body weight: Initiate at a total daily dose observed in clinical trials among children and adolescents treated with atomoxetine compared to those treated with placebo. Patients potential risk to the foetus. Due to lack of data, atomoxetine should be avoided during breast-feeding. Driving, etc Use caution when liver function tests, jaundice, hepatitis, suicide-related events, aggression, hostility, emotional lability, priapism. For full details of these of approximately 0.5mg/kg and maintain for a minimum of 7 days prior to upward dose titration according to clinical response and who are being treated for ADHD should be carefully monitored for the appearance or worsening of suicide-related behaviour, hostility, driving or operating hazardous machinery. Undesirable Effects (Clinical Trial Reporting) Children and Adolescents Mild to moderate and other side-effects, please see the Summary of Product Characteristics, which is available at http://emc.medicines.org.uk/. Legal tolerability. The recommended maintenance dose is approximately 1.2mg/kg/day. The safety of single doses over 1.8mg/kg/day and and emotional lability. Introduce with caution in patients with a history of seizure. Discontinuation of atomoxetine should be considered gastro-intestinal disturbance (abdominal pain, decreased appetite, nausea) and sedation are the most common adverse events but Category POM Marketing Authorisation Numbers 00006/0375, 00006/0376, 00006/0377, 00006/0378, 00006/0379 Basic NHS Cost total daily doses above 1.8mg/kg have not been systematically evaluated. Dosing of children/adolescents over 70 kg body weight: in any patient developing a seizure or if there is an increase in seizure frequency where no other cause is identified. As with other seldom lead to drug discontinuation as the effects are usually transient and tolerable. Some patients lose weight early in therapy. With £15.02 per pack of 7 (10mg, 18mg, 25mg, 40mg), £60.06 per pack of 28 (10mg, 18mg, 25mg, 40mg, 60mg). Date of Preparation or Initiate at a total daily dose of 40mg and maintain for a minimum of 7 days prior to upward dose titration according to clinical response psychotropic medications, the possibility of rare, serious psychiatric adverse events cannot be excluded. Interactions Should not be continued treatment, differences in growth (height and weight) are clinically insignificant. In adult and paediatric clinical trials, patients Last Review January 2007 Full Prescribing Information is Available From Eli Lilly and Company Limited Lilly House, Priestley Road and tolerability. The recommended maintenance dose is 80mg. The maximum recommended total daily dose in children and used in combination with monoamine oxidase inhibitors (MAOIs) and should not be used within 2 weeks of discontinuing therapy with experienced mild increases in heart rate and blood pressure. The following is based on data from clinical trials in child and adolescent Basingstoke, Hampshire, RG24 9NL Telephone: Basingstoke (01256) 315 999 *STRATTERA (atomoxetine) is a trademark of Eli Lilly adolescents over 70 kg and adults is 100mg. For patients with a known poor metaboliser genotype (CYP2D6 poor metabolisers), a lower a MAOI. Treatment with a MAOI should not be initiated within 2 weeks of discontinuing atomoxetine. Dose adjustment and slower patients: Very common (≥10%): Appetite decreased, abdominal pain, vomiting. Common (≥1-<10%): Influenza, anorexia (loss of and Company. starting dose and slower up titration of the dose may be considered. Special Populations Doses may need to be modified in patients titration of atomoxetine may be necessary in those patients who are also taking CYP2D6 inhibitor drugs (eg, SSRIs, quinidine, appetite), early morning awakening, irritability, mood swings, dizziness, somnolence, mydriasis, constipation, dyspepsia, nausea, with hepatic insufficiency or renal disease. Atomoxetine should not be used in children under 6 years of age. Contra-indications terbinafine). Caution is advised when combining atomoxetine with potent inhibitors of cytochrome P450 enzymes other than CYP2D6 dermatitis, pruritus, rash, fatigue, weight decreased. Uncommon (≥0.1-<1%): Suicide-related events, aggression, hostility, emotional Information about adverse event reporting can be found at www.yellowcard.gov.uk Hypersensitivity to atomoxetine or any of the excipients. Should not be used in patients with narrow angle glaucoma. Warnings and in patients who are poor CYP2D6 metabolisers. Atomoxetine should be administered with caution to patients being treated with high lability, palpitations, sinus tachycardia. In trials lasting up to ten weeks, weight loss was more pronounced in poor metabolisers. Adults Adverse events should also be reported to Eli Lilly and Company Limited (Tel. no. 0870 240 1125) Special Precautions Uncommonly, allergic reactions have been reported. Use with caution in patients with congenital or acquired long dose nebulised or systemically administered (oral or intravenous) salbutamol (or other beta2 agonists) because the action of salbutamol Adverse events reported most frequently were gastro-intestinal or genitourinary. Urinary retention or urinary hesitancy in adults should

well adjusted and coping? Well adjusted and coping? He seems to be doing OK at school, but is he really reaching his potential? Are his emerging needs Are his emerging needs being met? being met? STRATTERA*▼(ATOMOXETINE) ABBREVIATED PRESCRIBING INFORMATION Presentation Hard capsules: 10mg, 18mg, 25mg, QT or a family history of QT prolongation. Discontinue in patients with jaundice or laboratory evidence of liver injury, and do not restart. on the cardiovascular system can be potentiated. There is the potential for an increased risk of QT interval prolongation when be considered potentially related to atomoxetine. No serious safety concerns were observed during acute or long- 40mg, or 60mg atomoxetine. Uses Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children 6 years of age and older, Use with caution in patients with hypertension, tachycardia, or other cardiovascular disease. Pulse and blood pressure should be atomoxetine is administered with other QT prolonging drugs, (such as neuroleptics, class IA and III anti-arrhythmics, moxifloxacin, term treatment. The following data is from clinical trials in adults: Very common (≥10%): Appetite decreased, insomnia, dry and in adolescents, as part of a comprehensive treatment programme. Treatment must be initiated by a specialist in the treatment of measured periodically while on therapy. Growth and development should be monitored during treatment with atomoxetine. erythromycin, methadone, mefloquine, tricyclic antidepressants, lithium, or cisapride) drugs that cause electrolyte imbalance (such as mouth, nausea. Common (≥1-<10%): Early morning awakening, libido decreased, sleep disorder, dizziness, middle insomnia, ADHD. In adolescents whose symptoms persist into adulthood and who have shown clear benefit from treatment, it may be appropriate Consideration should be given to dose reduction or interrupting therapy in patients who are not growing or gaining weight satisfactorily. thiazide diuretics), and drugs that inhibit CYP2D6. Caution is advised with concomitant use of medicinal drugs which are known to lower sinus headache, palpitations, tachycardia, hot flushes, abdominal pain, constipation, dyspepsia, flatulence, dermatitis, sweating to continue treatment into adulthood. When continuing atomoxetine beyond 1 year, re-evaluation of the need for therapy is Patients requiring long-term therapy should be carefully monitored. Suicide-related behaviour (suicide attempts and suicidal ideation) the seizure threshold (such as antidepressants, neuroleptics, mefloquine, bupropion, or tramadol). Atomoxetine should be used increase, difficulty in micturition, urinary hesitation, urinary retention, dysmenorrhoea, ejaculation disorder, ejaculation failure, erectile recommended. Initiation in adults is not appropriate. Dosage and Administration For oral use, administered as a single daily dose in has been reported in patients treated with atomoxetine. In double-blind clinical trials, suicide-related behaviours occurred at a frequency cautiously with pressor agents and drugs that affect noradrenaline. Atomoxetine did not cause clinically significant inhibition or induction disturbance, impotence, menstruation irregular, orgasm abnormal, prostatitis, fatigue, lethargy, rigors, weight decreased. Uncommon the morning, with or without food. Some patients may benefit from taking it twice daily in divided doses. May be taken with or without of 0.44% in atomoxetine-treated patients, with no events in the placebo group. Hostility and emotional lability were more frequently of cytochrome P450 enzymes. Pregnancy and Lactation Should not be used during pregnancy unless the potential benefit justifies the (≥0.1-<1%): Peripheral coldness. Undesirable Effects (Post-Marketing Surveillance) Seizure, QT interval prolongation, Raynaud’s food and can be discontinued without dose tapering. Dosing of children/adolescents up to 70 kg body weight: Initiate at a total daily dose observed in clinical trials among children and adolescents treated with atomoxetine compared to those treated with placebo. Patients potential risk to the foetus. Due to lack of data, atomoxetine should be avoided during breast-feeding. Driving, etc Use caution when phenomenon, abnormal liver function tests, jaundice, hepatitis, suicide-related events, aggression, hostility, emotional lability, priapism. of approximately 0.5mg/kg and maintain for a minimum of 7 days prior to upward dose titration according to clinical response and who are being treated for ADHD should be carefully monitored for the appearance or worsening of suicide-related behaviour, hostility, driving or operating hazardous machinery. Undesirable Effects (Clinical Trial Reporting) Children and Adolescents Mild to moderate For full details of these and other side-effects, please see the Summary of Product Characteristics, which is available at tolerability. The recommended maintenance dose is approximately 1.2mg/kg/day. The safety of single doses over 1.8mg/kg/day and and emotional lability. Introduce with caution in patients with a history of seizure. Discontinuation of atomoxetine should be considered gastro-intestinal disturbance (abdominal pain, decreased appetite, nausea) and sedation are the most common adverse events but http://emc.medicines.org.uk/. Legal Category POM Marketing Authorisation Numbers 00006/0375, 00006/0376, 00006/0377, total daily doses above 1.8mg/kg have not been systematically evaluated. Dosing of children/adolescents over 70 kg body weight: in any patient developing a seizure or if there is an increase in seizure frequency where no other cause is identified. As with other seldom lead to drug discontinuation as the effects are usually transient and tolerable. Some patients lose weight early in therapy. With 00006/0378, 00006/0379 Basic NHS Cost £15.02 per pack of 7 (10mg, 18mg, 25mg, 40mg), £60.06 per pack of 28 (10mg, 18mg, Initiate at a total daily dose of 40mg and maintain for a minimum of 7 days prior to upward dose titration according to clinical response psychotropic medications, the possibility of rare, serious psychiatric adverse events cannot be excluded. Interactions Should not be continued treatment, differences in growth (height and weight) are clinically insignificant. In adult and paediatric clinical trials, patients 25mg, 40mg, 60mg). Date of Preparation or Last Review January 2007 Full Prescribing Information is Available From Eli Lilly and and tolerability. The recommended maintenance dose is 80mg. The maximum recommended total daily dose in children and used in combination with monoamine oxidase inhibitors (MAOIs) and should not be used within 2 weeks of discontinuing therapy with experienced mild increases in heart rate and blood pressure. The following is based on data from clinical trials in child and adolescent Company Limited Lilly House, Priestley Road Basingstoke, Hampshire, RG24 9NL Telephone: Basingstoke (01256) 315 999 adolescents over 70 kg and adults is 100mg. For patients with a known poor metaboliser genotype (CYP2D6 poor metabolisers), a lower a MAOI. Treatment with a MAOI should not be initiated within 2 weeks of discontinuing atomoxetine. Dose adjustment and slower patients: Very common (≥10%): Appetite decreased, abdominal pain, vomiting. Common (≥1-<10%): Influenza, anorexia (loss of *STRATTERA (atomoxetine) is a trademark of Eli Lilly and Company. starting dose and slower up titration of the dose may be considered. Special Populations Doses may need to be modified in patients titration of atomoxetine may be necessary in those patients who are also taking CYP2D6 inhibitor drugs (eg, SSRIs, quinidine, appetite), early morning awakening, irritability, mood swings, dizziness, somnolence, mydriasis, constipation, dyspepsia, nausea, with hepatic insufficiency or renal disease. Atomoxetine should not be used in children under 6 years of age. Contra-indications terbinafine). Caution is advised when combining atomoxetine with potent inhibitors of cytochrome P450 enzymes other than CYP2D6 dermatitis, pruritus, rash, fatigue, weight decreased. Uncommon (≥0.1-<1%): Suicide-related events, aggression, hostility, emotional Information about adverse event reporting can be found at www.yellowcard.gov.uk Hypersensitivity to atomoxetine or any of the excipients. Should not be used in patients with narrow angle glaucoma. Warnings and in patients who are poor CYP2D6 metabolisers. Atomoxetine should be administered with caution to patients being treated with high lability, palpitations, sinus tachycardia. In trials lasting up to ten weeks, weight loss was more pronounced in poor metabolisers. Adults Adverse events should also be reported to Eli Lilly and Company Limited (Tel. no. 0870 240 1125) Special Precautions Uncommonly, allergic reactions have been reported. Use with caution in patients with congenital or acquired long dose nebulised or systemically administered (oral or intravenous) salbutamol (or other beta2 agonists) because the action of salbutamol Adverse events reported most frequently were gastro-intestinal or genitourinary. Urinary retention or urinary hesitancy in adults should

The changing face of The changing face of ADHD in young people – ADHD in young people – are their emerging are their emerging needs being met? needs being met? Prescribing information can be found on the back cover

Primary to Secondary Functional Primary to Secondary Academic The changing nature The changing nature Psychosocial performance, school School a life-changing transition social skills, disruptive/ inappropriate Parent / sibling of ADHD of ADHD ng people relationships, behaviour difficulty forming / in you keeping friendships * This transition is a key time for personal and social development1 * Hyperactive symptoms become less * Instead, psychosocial issues have a * Young people will experience:1 • changes in emotional development of a problem …the actual symptoms of the original significant impact ‘…ADHD symptoms may decrease with • changes in personal identity • changes in cognitive capacity The added hyperactive syndrome are less problematic relative to other psychosocial outcomes in advancing age (and/or pubertal onset), but fewer symptoms may be associated with greater adolescence i.e. low self-esteem, poor school • puberty problems facing performance and poor peer relationships8 degrees of impairment than was the case in childhood’ as well as growing independence and responsibility young people Willoughby M, 200310 ‘Failure to establish appropriate behaviour, learning styles and friendships with ADHD3-9 in the first year of secondary school may have potentially serious consequences for children’s broader psychosocial development’ Thompson A, 20032 These changing symptoms cause a new Self-esteem set of problems for young Emotio people with ADHD The transition to secondary school places new Self-belief, perception of nal interaction Self-regulat pressures on young people with ADHD – an ideal with ing emotional state others s, time to re-evaluate patients and their treatment inability to expr ess their true personality

Preparation of Vidaza

Cover 1 Cover 2 Back Cover 2 Back Cover 1 Prescribe Epipen twin pack for Prescribe Epipen twin pack for your at risk patients your at risk patients Epipen Twin Pack contains 0.3mg adrenaline for adults and Epipen Twin Pack contains 0.3mg adrenaline for adults and children over 30kg in weight children over 30kg in weight Epipen Junior Twin Pack contains 0.15mg adrenaline for Epipen Junior Twin Pack contains 0.15mg adrenaline for You need the children up to 30kg in weight children up to 30kg in weight Often just one EpiPen®Auto-Injector abbreviated prescribing information. Please EpiPen®Auto-Injector abbreviated prescribing information. Please refer to the Summary of Product Characteristics before prescribing. refer to the Summary of Product Characteristics before prescribing. Presentation: EpiPen delivers a single dose of 0.3mg of adrenaline BP Presentation: EpiPen delivers a single dose of 0.3mg of adrenaline BP other half to 1:1000 (0.3ml)in a sterile solution. EpiPen Jr. delivers a single dose of children 1:1000 (0.3ml)in a sterile solution. EpiPen Jr. delivers a single dose of children 0.15mg adrenaline BP 1:2000 (0.3ml) in a sterile solution. 1.7ml of 15-30kg body weight and 0.3mg 0.15mg adrenaline BP 1:2000 (0.3ml) in a sterile solution. 1.7ml of 15-30kg body weight and 0.3mg adrenaline remains in the auto-injector after activation. Uses: (EpiPen) adrenaline for children >30kg body weight, or at the adrenaline remains in the auto-injector after activation. Uses: (EpiPen) adrenaline for children >30kg body weight, or at the Adrenaline is considered the first-line drug of choice for allergic discretionof the physician. EpiPen should only be injected into the Adrenaline is considered the first-line drug of choice for allergic discretionof the physician. EpiPen should only be injected into the is only half emergencies. Adrenaline effectively reverses the symptoms of rhinitis, anterolateral aspect of the thigh. Contra-indications: There are no emergencies. Adrenaline effectively reverses the symptoms of rhinitis, anterolateral aspect of the thigh. Contra-indications: There are no urticaria, bronchospasm and hypotension. The strong vasoconstrictor absolute contra-indications to the use of adrenaline in alife threatening urticaria, bronchospasm and hypotension. The strong vasoconstrictor absolute contra-indications to the use of adrenaline in alife threatening action of adrenaline, through its effect on alpha adrenergic receptors, situation. Warnings: Avoid the risk of inadvertent intravascular action of adrenaline, through its effect on alpha adrenergic receptors, situation. Warnings: Avoid the risk of inadvertent intravascular solve the acts quickly to counter vasodilation and increased vascular injection. DO NOT INJECT INTO THE BUTTOCKS. Accidental injection acts quickly to counter vasodilation and increased vascular injection. DO NOT INJECT INTO THE BUTTOCKS. Accidental injection permeability which can lead to loss ofintravascular fluid volume and into the hands or feet may result in loss of blood flow to the affected permeability which can lead to loss ofintravascular fluid volume and into the hands or feet may result in loss of blood flow to the affected hypotension during anaphylactic reactions. Adrenaline, through its areas. Precautions: Patients must be instructed in the proper use of hypotension during anaphylactic reactions. Adrenaline, through its areas. Precautions: Patients must be instructed in the proper use of action on beta receptors on bronchial smooth muscles, causes EpiPen. Use with extreme caution in patients with heart disease and action on beta receptors on bronchial smooth muscles, causes EpiPen. Use with extreme caution in patients with heart disease and the story relaxation which alleviates wheezing and dyspnoea. Adrenaline also those taking digitalis, mercurial diuretic or quinidine. The effects of relaxation which alleviates wheezing and dyspnoea. Adrenaline also those taking digitalis, mercurial diuretic or quinidine. The effects of alleviates pruritus,urticaria and angioedema and may be effective in adrenaline may be potentiated by tricyclic antidepressants alleviates pruritus,urticaria and angioedema and may be effective in adrenaline may be potentiated by tricyclic antidepressants relieving gastrointestinal and genitourinary symptoms associated with andmonoamine oxidase inhibitors. Adverse events: May include relieving gastrointestinal and genitourinary symptoms associated with andmonoamine oxidase inhibitors. Adverse events: May include problem anaphylaxis. Indication: EpiPen is intended for immediate self palpitations, tachycardia, sweating, nausea and vomiting, respiratory anaphylaxis. Indication: EpiPen is intended for immediate self palpitations, tachycardia, sweating, nausea and vomiting, respiratory administration in the emergency treatment of allergic anaphylactic difficultly, pallor, dizziness, nervousness and anxiety. Legal Category: administration in the emergency treatment of allergic anaphylactic difficultly, pallor, dizziness, nervousness and anxiety. Legal Category: reactions. Anaphylaxis may be caused by insect stings or bites, foods, POM. Basic NHS Cost: EpiPen and EpiPen Jr. are available as single reactions. Anaphylaxis may be caused by insect stings or bites, foods, POM. Basic NHS Cost: EpiPen and EpiPen Jr. are available as single drugs and other allergens as well asidiopathic or exercise-induced unit doses at £28.05 each. EpiPen andEpiPen Jr. are also available as drugs and other allergens as well asidiopathic or exercise-induced unit doses at £28.05 each. EpiPen andEpiPen Jr. are also available as anaphylaxis. Reactions may occur within minutes of exposure and twin packs; two single unitdoses at £56.10. Marketing Authorisation anaphylaxis. Reactions may occur within minutes of exposure and twin packs; two single unitdoses at £56.10. Marketing Authorisation consist of flushing, syncope, tachycardia, faint or unobtainable pulse Numbers: EpiPen Auto-Injector 10085/0012. EpiPen Jr. Auto- consist of flushing, syncope, tachycardia, faint or unobtainable pulse Numbers: EpiPen Auto-Injector 10085/0012. EpiPen Jr. Auto- associated with a fall in blood pressure, convulsions, vomiting, Injector10085/0013. Marketing Authorisation holder: ALK-AbellóA/S, associated with a fall in blood pressure, convulsions, vomiting, Injector10085/0013. Marketing Authorisation holder: ALK-AbellóA/S, diarrhoea and abdominal cramps, involuntary voiding, wheezing, Bøge Alle 6-8, DK-2970, Hørsholm, Denmark. Telephone:+45 4574 diarrhoea and abdominal cramps, involuntary voiding, wheezing, Bøge Alle 6-8, DK-2970, Hørsholm, Denmark. Telephone:+45 4574 dyspnoea due to laryngeal spasm, pruritus, rashes, urticaria 7445 Date of last revision: August 2005. Customer contact: ALK- dyspnoea due to laryngeal spasm, pruritus, rashes, urticaria 7445 Date of last revision: August 2005. Customer contact: ALK- orangioedema. Dosage and Administration: ADULTS: Self Abelló Ltd, 1 Tealgate, Hungerford, Berkshire,RG17 0YT, United orangioedema. Dosage and Administration: ADULTS: Self Abelló Ltd, 1 Tealgate, Hungerford, Berkshire,RG17 0YT, United administration of 0.3mg adrenaline (EpiPen) intramuscularly. Kingdom. Telephone: 01488 686016. Website: www.epipen.co.uk or administration of 0.3mg adrenaline (EpiPen) intramuscularly. Kingdom. Telephone: 01488 686016. Website: www.epipen.co.uk or CHILDREN: The appropriate dosage may be 0.15mg (EpiPen Jr.)for www.alk-abello.co.uk CHILDREN: The appropriate dosage may be 0.15mg (EpiPen Jr.)for www.alk-abello.co.uk References 2. Stark BJ, Sullivan TJ. Biphasic and protracted anaphylaxis. Information about adverse event reporting can be found at www.yellowcard.gov.uk 1. Korenblat P, Lundic MJ, Danker RE et al. A retrospective study of J Allergy Clin Immunol 1986; 78(1 Pt 1): 76-83. epinephrine administration for anaphylaxis: how many doses are 3. Lieberman P. Ann Allergy Asthma Immunol 2005; 95: 217-226. Adverse events should also be reported to ALK-Abelló Ltd. (tel: 01488 686016) needed? Allergy Asthma Proc 1999; 20(6): 383-6. 4. Lee JM. Pediatrics 2000; 106: 762-766.. Information about adverse event reporting can be found at www.yellowcard.gov.uk Adverse events should also be reported to ALK-Abelló Ltd. (tel: 01488 686016) Prescribing information can be found on the back cover Prescribing information can be found on the back cover ALK ABELLO EpiPen ® TWIN ALK ABELLO EpiPen ® TWIN PACK PACK Curing Allergy Adrenaline (Epinephrine) Auto-Injector Curing Allergy Adrenaline (Epinephrine) Auto-Injector

Inside spread 1 Inside spread 2 Hospital: Ambulance despatched One of your patients Pam was one of has just had an her doctor’s anaphylactic reaction. Delay: Delivery van blocking road at risk patients Has she got everything that So she had everything she needs? she needed Pam is allergic to nuts. She also has asthma. She’s ● Patients with: had reactions before but not as bad as this. She can feel her throat tightening and is having difficulty breathing. The answer was simple - a previous history of food induced symptoms Delay: Road closed - even mild food symptoms but concurrent asthma are Still, she knows what to do and she’s already given herself an adrenaline injection and phoned for an ambulance. find alternative route - Epipen Twin Pack particularly at risk - non-food allergies But now fifteen minutes have passed and she’s not feeling any better. The ambulance hasn’t arrived and she’s starting to feel panicky. - a history of anaphylactic reactions What Pam doesn’t know is that: She just needs some Delay: Heavy rush need Epipen Twin Pack. Carrying two auto-injectors can improve outcomes. hour traffic ● 35% of anaphylactic reactions require more than one dose to reverse symptoms1 ● the incidence of biphasic reactions may vary from 1% to as many as more time. But how? Patient has been waiting 15 minutes because of By the time the ambulance arrived, Pam had used her second Epipen and her symptoms had subsided. It had given her the extra delayed ambulance time that each at risk patient may need one day. 20% of episodes2-4 ● the ambulance is stuck in traffic

C Conway Portfolio 2009

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