Health Professionals Pharmacists Have A Responsibility Biology Essay

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As health professionals, pharmacists have a responsibility to participate in all aspects of medication management in partnerships with the consumer and/or carer. They must have a clear understanding of their responsibilities in the health care team and understand their accountability for these responsibilities and for supporting continuity in medication management. The ease with which pharmacists can access information about the medication treatment of individual consumers and the volume of information available to them varies depending on the setting in which they practice. Whatever the settings, pharmacists have a duty of care to use the information they can access to provide the best possible therapeutics advice for improving the health and wellbeing of consumer. But, in each and every case, a medicine can be defined as being a chemical substance given with the intention of preventing, diagnosing, curing, controlling or alleviating disease or otherwise enhancing the physical or mental welfare of people. It includes prescription and non-prescription medicines including complementary health care products, irrespective of the administered route (National Competency Standards Framework for Pharmacists in Australia., 2010).

Therefore, a portfolio is used to purposely compile and honestly assess ones competence according to any gaps that exist within one's own knowledge (SHPA CPD Update - April 2010., 2010). It consists of a list of objectives or outcomes to be achieved, a personal development plan which includes educational priorities including why they are priorities and how learning is achieved and how this will be demonstrated and finally and appraisal which is a formal evaluation of the evidence, including discussion of strengths and weaknesses, and plans for future professional development (Thistlethwaite, 2006).


Kyrillos Kyrillos

15 Vanny Place

Maroubra, 2035 NSW

0416 404 718

[email protected]


Graduating pharmacy student (at the end of 2012) with experience in rural and community pharmacies. Excellent interpersonal skills and communication skills. Looking for a continuation of my learning outside of the university lifestyle and professional advancement with the continuation on into my internship year and beyond.

Work Experience

Book-Keeping, 2006 till present

St. Kyrillos Medical and Dental Centre, Kingsford NSW

Keeping the books in order and processing medical and immunization forms to be sent in perfect order to the required governmental branches. Keeping the times and hours worked by the employees at the medical centre in good order to maintain a good history.


Pharmaceutical Placement, April 2011

Blooms Pharmacy, Kingsford NSW

Processed prescriptions, compounded creams and lotions, assisted in putting together Webster Paks, conducted a detailed patient history and MMR, counseled patients on various chronic and acute illnesses.

Pharmaceutical Placement, July 2011

Philopaters Pharmacy, Maroubra NSW

Processed prescriptions, compounded creams and lotions, assisted in putting together Webster Paks, conducted a detailed patient history and MMR, counseled patients on various chronic and acute illnesses.

Sanitation Manager, 2003

Johnson and Johnson Pharmacy, Kingsford NSW

Kept the shelves and products up to date and made sure that they were of a high quality of presentation.


2009 - present Charles Sturt University - Wagga Wagga Campus

B. Pharmacy

2006 - 2008 University of Technology, Sydney

Three years of a B. Medical Science course

2005 Marist College, Pagewood

Higher School Certificate

2003 Marist College, Pagewood

School Certificate


Skill Name

Last Used/Experience

Prescription Dispensing/Compounding

Currently used/2 years

Customer Relationship Management

Currently used/6 years

Inventory Control

Currently used/6 years


Currently used/6 years


Currently used/2 years

Clinical Applications

Currently used/2 years

Patient Counseling

Currently used/2 years

MS Office (Word, Excel, PowerPoint)

Currently used/13 years

Other Information

I volunteer on Wednesday nights (when I am in Sydney) to cook and provide food for and distribute it to the homeless people at St. Marys Cathedral


Castro Shehata of CasPro

Initial Reaction

Before starting my portfolio assessment, I was very confused as to how to start as there was conflicting information about how to go about it from various students, both past and present. Until I attended the actual introduction lecture, I had no idea of how to start or even start researching for it. I had to sit in front of my computer and write down all I could find out about Complementary and Alternative Medicines (CAM) from the subject outline, and the summary on Assessment item C2 available therein and accessing the Pharmaceutical Society of Australia's Competency Standards Framework. I think came about an understanding or at least a basic understanding of where to start. When that happened I knew that a large portion of the successful completion of the this assessment would be managing my time to be able to finish on time considering all my placement assessments due approximately at the same time. In addition one week before my mid-semester holidays, I had a motorcycle accident, distally fracturing my tibia, causing me to be in a lot of pain and halting the research I had planned before starting placement as I was always drowsy due to the pain medications. But I soldiered on, and hopefully this assessment will be done in time.

Fish Oil


Fish oil, also known as Omega-3 fatty acids and alpha-linoleic acid, became popular in the 19th century as ingestion of cod liver oil became popular as being a rich source of vitamin D for sun-deprived children in England. More recently though, there has been a marked interest in it as being protective of the cardiovascular system as studies were done on the Inuit people of Greenland (Oh, 2004). There was an unusually low incidence of heart disease despite their diet being high in fat. It was thus recognised that their diet was rich in omega-3 fatty acids and relatively lower in omega-3 fatty acids and saturated fatty acids compared to gender and age-matched groups living in Denmark (Kromann & Green, 1980).

The primary essential fatty acids in the human diet are omega-3 and omega-6 fatty acids. Dietary sources of omega-3 fatty acids include fish oil and certain plant and nut oils. Omega-6, on the other hand, are primary provided in the diety by palm, soybean, rapeseed and sunflower oils. Omega-9 is not considered essential because it can be produced within the body (Di Minno, et al., 2010).

Omega-3 fatty acids have long been known to play critical roles in growth but have more recently suggested as providing a wide range of health benefits including reductions in the risk of coronary heart disease and regulating cholesterol. Other studies point to action relation to cancer and certain psychological or neurological disorders such as depression and attention-deficit hyperactivity disorder (Milte, Sinn, & Howe, 2009). Due to the aforementioned health benefits, fish oil, which is rich in omega-3 fatty acids, has gained popularity as a dietary supplement.


There are varying studied results of the mechanism of action of fish oil depending on the specific effects in question. For antiarrythmic effects, EPA may block fast voltage-dependent sodium channels via specific binding, which results in prolongation of the inactivated states of these channels (Kang & Leaf, 1996). Antiasthmatic effects on the other hand, the anti-inflammatory effects of EPA were found to be more effective than DHA in human asthmatic alveolar macrophages in vitro (Mickleborough, Tecklenburg, Montgomery, & Lindley, 2009). In a study done on a population at high risk of type 2 diabetes, altering the diet to increase omega-3 fatty acids and the omega-3: omega-6 ratio was associated with a greater chance of a protective effect on glucose metabolism (Sartorelli, et al., 2010). The anti-inflammatory effects studied were on healthy subjects where intravenous fish oil inhibited the inflammatory response to endotoxin LPS, thereby reducing plasma adrenocorticotrophic hormone and TNF-alpha (Pittet, et al., 2010). There was noted an inhibition of the tumour necrosis factor and interleukin-1 production in patients with severe heart failure (Mehra, Lavie, Ventura, & Milani, 2010). Antioxidant effects were seen in humans exposed to particulate matter, supplementation with fish oil increased Cu/Zn superoxide dismutase activity and glutathione levels (Romieu, et al., 2008). In vitro, DHA decreased oxidative stress in human fibroblasts (Arab, Rossary, Flourie, Tourneur, & Steghens, 2006). A fish oil diet has been associated with a significant inhibition of platelet adhesion to collagen or fibrinogen coated surfaces (Andrioli, et al., 1999). Omega-3 fatty acids at moderate dosages may exert antithrombotic effects by increasing prostacyclin production by vessel walls as well as by direct inhibition of platelet activity (De Caterina, et al., 1990). Investigations have also noted increased fibrinolysis and vascular plasminogen activator and prothrombin fragment 1-2 (Seljeflot, et al., 1999).


Absorption: Emulsified fish oil is believed to be better absorbed in humans, where in human research a single dose of emulsified fish oil vs. capsular triglyceride fish oil resulted in enhanced absorption of EPA and DHA, based on changes in phospholipid fatty acids (Raatz, Redmon, Wimmergren, V, & M., 2009).

Distribution: Dietary intake of omega-3 fatty acids increases levels of omega-3 fatty acids in serum, plasma and leukocyte, monocyte and erythrocyte phospholipids (da Silva, et al., 2008). In patients undergoing elective cardiac surgery, supplemental fish oil resulted in a maximal increase of omega-3 fatty acids in cardiomyocyte phospholipids after 30 days of supplementation where arachidonic acid was the main fatty acid displaced (Metcalf, et al., 2007). In women at high risk of breast cancer, fish oil for six months increased omega-3 levels in breast adipose tissue (Yee, et al., 2010)

Metabolism: Human research trials have shown that DHA was retroconverted to EPA (Vidgren, et al., 1997)In fish, dietary alpha-linolenic acid led to accumulated alpha-linolenic acid in the tissues; dietary fish oil led to a large proportion of dietary EPA accumulating in the tissues (Turchini & Francis, 2009)

Recommended Dose

The U.S. Food and Drug Administration has ruled that the use of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the primary omega-3 fatty acids found in fish, as dietary supplements is safe and lawful, provided that daily intakes of EPA and DHA omega-3 fatty acids do not exceed 3g per person daily from conventional food and dietary supplement sources (Christine, December 2005).

Recommended daily intake of omega-3 fatty acids orally for healthy adults with no history of heart disease is at least eating fish two times per week (Kris-Etherton, Harris & Appel, 2003)

Various doses according to the specific ailment or disease in which the fish oil has been studied and trialled. For anxiety, 3g of n-3 fatty acids daily, that is , five capsules daily of 450mg of EPA, 100mg of DHA and 50mg of other triglyceride n-3 fatty acids for three months is recommended (Branchey & Hibbeln, 2009). For asthma, fish oil capsules containing 3.2g of EPA and 2-2.2g of DHA for 3-10 weeks may have beneficial effects in asthma (Mickelborough, Lindley, Ionescu & Fly, 2009). The effects of omega-3 fatty acids on blood pressure appear to be dose-responsive, that is, higher doses have greater effects with 3-4g of omega-3 fatty acids has been used daily for up to one year (Morris, Taylor, Stampfer, Rosner & Sacks, 1993). For cardiac arrhythmias, two or four or six capsules of fish oil containing 260mg of DHA, and 60mg of EPA per 1g capsule has been taken daily for 12 weeks has shown positive effects (Ninio, Hill, Howe, Buckley & Saint, 2008). For sufferers of chronic obstructive pulmonary disease, an omega-3 polyunsaturated fatty acid rich diet containing 0.6g of omega-3 polyunsaturated fatty acid and 0.4g of omega-6 vs. a low omega-3 diet for 24 months improved inflammatory markers in patients (Matsuyama, Mitsuyama, Watanabe, Oonakahara, Higashimoto, et al., 2005). Those affected by depression a study recommended 1.05g of ethylester-EPA daily plus 0.15g of ethyl-DHA daily in three divided doses which was taken over an eight week period (Lucas, Asselin, Merette, Poulin & Dodin, 2009).

Although there are some infant formulas that contain omega-3 fatty acids, effective doses are not clearly established. Ingestion of fresh fish should be limited in young children due to the presence of potentially harmful environmental contaminants and fish oil capsules in and of itself should only be used under direction from a qualified healthcare professional (Ask the Expert: Fish Oil Dosing., March 2006). Children under the age of 18 whom are asthma sufferers with moderately persistant asthama have the recommended dose of 300mg of EPA plus DHA daily for six weeks and were shown to have improved pulmonary function (Biltagi, Baset, Bassiouny, Kasrawi & Attia, 2009). Its use has also been indicated for illness prevention with the dosage being 200mg of EPA plus 1g of DHA provided through an ultrahigh-temperature-processed chocolate milk for five days per week for six months in children aged 9-12 - the study showed a marked reduction in illness and infection (Thienprasert, Samuhaseneetoo, Popplestone, West, Miles, et al., 2009).


Caution should be used when concurrently giving fish oil to patients with bleeding disorders or those using anticoagulants or antiplatelets. This is because there is an increased risk of bleeding particularly at doses of 3g daily or more. There have also been documented cases of increased bleeding and international normalised ratios in patients taking warfarin with fish oil (Jalili & Dehpour, 2007). Also in patients with low blood pressure, as omega-3 fatty acids have been found to cause reductions in blood pressure (Morris, Taylor, Stampfer, Rosner & Sacks, 1993). Though it has marked decrease in triglyceride levels, it has been seen to increase the LDL cholesterol (Caniato, Alvarenga & Garcia-Alcaraz, 2006). In individuals at risk for hormone imbalance or those undergoing hormone replacement therapy, for example a decreased oestrogen receptor production has been associated with fish oil supplementation (Kramer, Johnson, Doleman & Lund, 2009). In addition, those suffering from ventricular tachycardia or ventricular arrhythmia, caution should be taken as omega-3 supplementation worsens their outcome of either tachycardia or arrhythmia (Jenkins, Josse, Beyene, Dorian, Burr, et al., 2008). Vitamin A and D toxicity may occur with the taking of fish oil in large amounts (Cannell, Vieth, Willet, Zasloff, Hathcock, et al., 2008).

There were potential adverse effects in infant boys where fish oil supplementation was given to the mother during lactation and was associated with a decrease in physical activity and an increase in energy and starch intake and blood pressure (Asserhoj, Nehammer, Matthiessen, Michaelsen & Lauritzen, 2009).


Drug Interactions: In human research, increased levels of DHA in the blood were associated with a decreased risk of relapsing to substance abuse (21). Clinical evidence suggests that dietary supplementation with polyunsaturated fatty acids increases the efficacy of antiandrogen therapy in the treatment of prostate cancer (283). According to several studies done, fish oil may theoretically act synergistically with other antiarthritics. There is conflicting evidence regarding the effect of fish oil on asthma; in one study (105) it was shown that it caused a decreased use of short term bronchodilators was reported and in another (82) showed an exacerbation of asthma. Although slight increases in fasting blood glucose levels have been noted in patients with type 2 diabetes, available scientific evidence suggests that there are no statistically significant long-term effects of fish oil in patients with diabetes including no changes in HbA1c levels (65). DHA seems to have greater effects than EPA on its reductions in blood pressure with the intake of omega-3 fatty acids and therefore concurrent use with antihypertensive agents may cause additive blood pressure lowering (316).


Evidence suggests that people with low levels of EPA and DHA may have an increased risk of developing acute coronary syndrome. Supplementation with omega-3 fatty acids have positive benefits in terms of reduced cardiovascular disease mortality and total mortality (Block, Harris, Reid, Sands & Spertus, 2008).

There is also strong scientific evidence from human trials that omega-3 fatty acids from fish or fish oil supplements (EPA and DHA) significantly reduce blood triglyceride levels (Balk, Lichtenstein, Chung, Kupelnick, Chew, et al., 2006).

Multiple human trials report small reductions in blood pressure with intake of omega-3 fatty acids (Morris, Taylor, Stampfer, Rosner & Sacks, 1993); while other trials reported little to no benefit (Rasmussen, Vessby, Uusitupa, Berglund, Pedersen, et al., 2006). Benefits have been reported as additive with anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin with intravenous administration of fish oil.(Rollins, 2010) Though effects beyond three months of treatment have not been well evaluated.

In a trial in men, it was assessed that omega-3 supplementation resulted in reduced tension in patients attending an abuse clinic (Branchey & Hibbeln, 2009).

Clinical research has demonstrated benefit in patients with attention-deficit hyperactivity disorder treated with a combination product containing both omega-6 and omega-3 fatty acids (Colter, Cutler & Meckling, 2008) with polyunsaturated fatty acid supplementation (Sinn & Bryan, 2007).


I, Kyrillos Kyrillos, declare that all material presented in this Fish Oil summary is my own work, or otherwise, the material provided has been acknowledged and referenced in an appropriate manner. I am aware that Charles Sturt University takes matters of Academic Misconduct very seriously, and thus, this document complies with the requirements of this institute to be a true, individual and authentic document. I also agree for my topic to be cross referred by the plagiarism detection software TURNITIN if need arises.

Signed: Date: 05/09/2012 Name of CSU BPharm Candidate

Kyrillos Kyrillos


(Oh, 2004): refer to Appendix 1

Practical Applications of Fish Oil (Omega-3 Fatty Acids) in Primary Care

Current? No, conducted in 2004

Authentic? Yes

Sufficient? Yes

Valid? Yes, Addresses Objective 1, 3, 10, 11, 13 and 14

This article is a clinical review that set out to search the Medline and Cochrane databases using the key words "fish oil" or or "docosahexaenoic" or "eicosapentaenoic." These were combined with the keywords "cardiovascular disease," "myocardial infarction," "hypertriglyceridemia," "pregnancy," "rheumatoid arthritis," or "infants." Search was further limited to humans, clinical trials. References from key articles were also scanned for relevant sources (Oh, 2004). It is a clinical review that exhibited several figures and tables, not just plain text. It is a traditional clinical review article, which is also known as an update, and is different from systematic reviews and meta-analyses (Siwek, Gourlay, Slawson & Shaughnessy, 2002). Systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment. Updates review the medical literature almost as carefully as a systematic review but discuss the topic under question more broadly and make reasoned judgements where there is little hard evidence, based upon the expertise of the reviewer. A clinical review is on a broader topic and is usually by someone versed in the topic. It is evidence based and should fulfil a number of wider requirements (Vetter, 2003). This article provides sound evidence though it can be called biased as there is only one author. It discusses the properties, toxicity of fish oil. It enabled me to determine the applicable use of alternative therapies. The use of this article explained to me the importance of evaluating any literature that I use for my own personal advancement in knowledge of this specific topic with regards to pharmacy practice. I was thus able to conduct a literature evaluation through clinical review which assessed the validity of the information gathered for the above summary of fish oil.


Ask the Expert: Fish Oil Dosing. (March 2006). Retrieved September 2012, from

Asserhoj, M, Nehammer, S, Matthiessen, J, Michaelsen, KF, & Lauritzen, L (2009). Maternal fish oil supplementation during lactationmay adversely effect long-term blood pressure, energy intake and physical activity of 7-year-old boys.. Journal of Nutrition, 139(2), 298-304.

Balk, EM, Lichtenstein, AH, Chung, M, Kupelnick, B, Chew, P, & Lau, J (2006). Effects of omega-3 fatty acids on serum markers of cardiovascular disease risk: a systematic review. Atherosclerosis Journal, 189(1), 19-30.

Biltagi, MA, Baset, AA, Bassiouny, M, Kasrawi, MA, & Attia, M (2009). Omega-3 fatty acids, vitamin C and Zn supplementation in asthmatic children: a randomised self-controlled study. Acta Paediatrica, 98(4), 737-742.

Block, RC, Harris, WS, Reid, KJ, Sands, SA, & Spertus, JA (2008). EPA and DHA in blood cell membranes from acute coronary syndrome patients and controls.. Atherosclerosis Journal, 197(2), 821-828.

Branchey, M, & Hibbeln, JR (2009). Low plasma levels of docosahexaenoic acid are associated with an increased relapse vulnerability in substance abusers.. American Journal on Addictions, 18(1), 73-80.

Caniato, RN, Alvarenga, ME, & Garcia-Alcaraz, MA (2006). Effect of omega-3 fatty acids on the lipod profile of patients taking clozapine.. Australia and New Zealand Journal of Psychiatry, 40(8), 691-697.

Cannell, JJ, Vieth, R, Willet, W, Zasloff, M, Hathcock, JN, White, JH, , et al. (2008). Cod liver oil, vitamin A toxicity, frequent respiratory infections, and the vitamin D deficiency epidemic. Annals of Otology, Rhinology and Laryngology, 117(11), 864-870.

Christine, JL (December 2005). Letter Regarding Dietary Supplement Health Claim for Omega-3 Fatty Acids and Coronary Heart Disease. Retrieved September 2012, from

Colter, AL, Cutler, C, & Meckling, KA (2008). Fatty acid status and behavioural symptoms of attention deficit hyperactivity disorder in adolescents: a case-control study.. Nutrition Journal, 7(8),

Di Minno, MN, Tremoli, E, Tufano, A, Russolillo, A, Lupoli, R, & Di Minno, G (2010). Exploring newer cardioprotective strategies: omega-3 fatty acids in perspective. Journal of Thrombosis and Haemostasis, 4(104), 664-680.

Jalili, M, & Dehpour, AR (2007). Extremely prolonged INR associated with warfarin in combination with trazodone and omega-3 fatty acids. Archives of Medical Research, 38(8), 901-904.

Jenkins, DJ, Josse, AR, Beyene, J, Dorian, P, Burr, ML, LaBelle, R, , et al. (2008). Fish-oil supplementation in patients with implantable cardioverter defibrillators: a meta-analysis. Canadian Medical Association Journal, 178(2), 157-164.

Kramer, F, Johnson, IT, Doleman, JF, & Lund, EK (2009). A comparison of the effects of soya isoflavonoids and fish oil on cell proliferation, apoptosis and the expression of oestrogen receptors alph and beta in the mammary gland and colon of the rat. British Journal of Nutrition, 102(1), 29-36.

Kromann, N, & Green, A (1980). Epidemiological studies in the Upernavik district, Greenland. Incidence of some chronic diseases. Acta Med Scand, 208, 401-406.

Lucas, M, Asselin, G, Merette, C, Poulin, MJ, & Dodin, S (2009). Ethyl-eicosapentanoic acid for the treatment of psychological distress and depressive symptoms in middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. American Journal of Clinical Nutrition, 89(2), 641-651.

Matsuyama, W, Mitsuyama, H, Watanabe, M, Oonakahara, K, Higashimoto, I, Osame, M, , et al. (2005). Effects of omega-3 polyunsaturated fatty acids on inflammatory markers in COPD. Chest Journal, 128(6), 3817-3827.

Mickelborough, TD, Lindley, MR, Ionescu, AA, & Fly, AD (2009). Protective effect of fish oil supplementation on exercise induced bronchoconstriction in asthma. Chest Journal, 129(1), 39-49.

Milte, CM, Sinn, N, & Howe, PR (2009). Polyunsaturated fatty acid status in attention deficit hyperactivity disorder, depression, and Alzheimer's disease: towards an omega-3 index for mental health?. Nutrition Review, 67(10), 573-590.

Morris, MC, Taylor, JO, Stampfer, MJ, Rosner, B, & Sacks, FM (1993). The effect of fish oil on blood pressure in mild hypertensive subjects: a randomized crossover trial. American Journal of Clinical Nutrition, 57(1), 59-64.

Ninio, DM, Hill, AM, Howe, PR, Buckley, JD, & Saint, DA (2008). Docosahexaenoic acid-rich fish oil improves heart rate variability and heart rate responses to exercise in overweight adults. British Journal of Nutrition, 100(5), 1097-1103.

Oh, R (2004). Practical Applications of Fish Oil (Omega-3 Fatty Acids) in Primary Care. The Journal of the American Board of Family Medicine, 18(1), 28-36.

Rasmussen, BM, Vessby, B, Uusitupa, M, Berglund, L, Pedersen, E, Riccardi, G, , et al. (2006). Effects of dietary saturated, monounsaturated and n-3 fatty acids on blood pressure in healthy subjects.. American Journal of Clinical Nutrition, 83(2), 221-226.

Rollins, CJ (2010). Effect of intravenous omega-3 fatty acids on clinical symptoms of rheumatoid arthritis. Journal of Parenteral and Enteral Nutrition, 34(2), 169-170.

Sinn, N, & Bryan, J (2007). Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behaviour problems associated with child ADHD. Journal of Developmental & Behavioural Pediatrics, 28(2), 82-91.

Thienprasert, A, Samuhaseneetoo, S, Popplestone, K, West, AL, Miles, EA, & Calder, PC (2009). Fish oil n-3 polyunsaturated fatty acids selectively affect plasma cytokines and decrease illness in Thai schoolchildren: a randomised, double-blind, placebo controlled