Line

PROFESSIONALS

Bedei Compounding

 

About Compounding

COMPOUNDED MEDICATIONS are prescribed by physicians, veterinarians, and other legally-authorized prescribers  and prepared to order for a specific patient by specially-trained, licensed compounding pharmacists. For individuals with unique health needs not being successfully treated by off-the-shelf drugs, custom-compounded medications are a smarter, more effective solution. Compounding opens the door to customized treatment designed with the patient in mind and eliminates many of the side effects and complications associated with traditional prescription drugs.

THE COMPOUNDING OF MEDICATIONS is a centuries-old tradition and a foundational element of pharmacy practice. Although an estimated 30 million prescriptions are compounded every year, many patients are still unaware of this unique treatment option and its many applications and benefits. Compounding is also in growing demand for veterinary use.

PHARMACY SCHOOLS in each state are required by law to teach students the practice of compounding pharmaceuticals. Consequently, pharmacists are the only healthcare professionals with extensive knowledge of chemical compatibilities and the skill to prepare alternative dosage formulations. Compounding is currently practiced to a small degree in some pharmacies while a select few specialize exclusively in medication compounding, like BCPS. These compounding pharmacies are licensed and regulated in the 50 states and the District of Columbia by their respective state Board of Pharmacy.

BECAUSE EVERY PATIENT and every patient’s needs–are unique, custom compounding is a vitally important element of quality medical care.

Medical Conditions

Pain-related conditions that can be treated with Compounded Pain Creams

  • ARTHRITIS
  • CARPAL TUNNEL SYNDROME
  • EPICONDYLITIS
  • FAILED BACK SYNDROME (FBS)
  • FIBROMYALGIA
  • GOUT
  • MUSCLE SPASMS
  • MUSCULOSKELETAL PAIN
  • NEUROPATHIC PAIN
  • PLANTAR FASCIITIS
  • RADICULOPATHY
  • REFLEX SYMPATHETIC DYSTROPHY (RSD)
  • SHINGLES
  • TMJ DISORDERS
  • TENDINOSIS
  • TENDONITIS
  • TRIGEMINAL NEURALGIA

Conditions that Wound Care Cream can aid

WOUND CARE CREAM can be used for wounds caused by:

  • TRAUMA
  • CHEMICAL OR PHYSICAL SCALDS AND BURNS
  • PRESSURE
  • ADVERSE EFFECTS OF MEDICATIONS
  • METABOLIC DISEASES, SUCH AS DIABETES
  • SURGICAL PROCEDURES

Conditions that Compounded Scar Cream can treat

SCAR CREAM can be used on both old and new scars caused by:

  • BURNS
  • SURGICAL PROCEDURES
  • SEVERE TRAUMA

SCAR CREAM can also help prevent the following scarring disorders:

  • HYPERTROPHIC SCARRING
  • KELOIDAL SCARRING

Cosmetic conditions that can be improved with Compounded Cosmetic Cream

  • AGE SPOTS
  • BIRTH MARKS
  • FRECKLES
  • SUN DAMAGE

Compounding Medications

  • Compounded Pain Cream

    COMPOUNDED PAIN CREAM is specifically designed to target and treat the site of pain with customizable formulations, while avoiding many of the complications common to other pain treatment methods. Pain Cream provides a flexible, convenient, and effective solution for a variety of pain-related conditions.

    Targeted Relief

    PAIN CREAMS ARE DESIGNED to administer high concentrations of pain medication directly onto the site of pain for targeted relief. Furthermore, our pharmacists will work with the doctor to create a custom formulation, designed to meet a patient’s unique needs. As a result, our formulations offer the combined benefits of precise dosing, personalized treatment, and the combined effect of multiple ingredients working together for optimal pain relief.

    Fewer Risks & Side Effects

    BECAUSE OUR PAIN FORMULATIONS are applied topically, they do not circulate throughout the entire body. This provides powerful pain medication where it is needed and less where it isn’t. As a result, Pain Creams are less likely to interact with other medications being taken and cause fewer side effects than other pain medications. Finally, since Pain Cream is not absorbed throughout the entire body, the risk of dependence and addiction is virtually eliminated.

    PCCA Lipoderm®

    ALL OF OUR PAIN CREAMS are formulated using the anhydrous silicone base, PCCA Lipoderm®. Lipoderm® is the only transdermal base designed and proven to effectively deliver pain medication. Furthermore, Lipoderm® has been tested and proven to deliver up to 4 drugs simultaneously and to deliver medications more effectively and more quickly than other topical bases.

    .

    Active Ingredients in COMPOUNDED PAIN CREAM.

    • BACLOFEN
    • CYCLOBENZAPRINE
    • DICLOFENAC
    • GABAPENTIN
    • KETAMINE
    • KETOPROFEN
    • LIDOCAINE
    • TRAMADOL
  • Wound Care Cream

    WOUND CARE CREAM is custom compounded and specially designed to protect wounds and aid the body’s healing process, for quicker recovery and reduced risk of infection or other complications.

    Spira-Wash™ Gel

    ONE OF THE SECRETS behind the effectiveness of Wound Care Cream is Spira-Wash™ Gel, the base used in all of our Wound Care Formulations. Spira-Wash™ is specifically designed to aid the body’s healing process by acting as a protective barrier against the air, blocking out potentially harmful microorganisms and environmental toxins. Along with guarding against contaminants, Spira-Wash™ also creates a moist environment for the wound to heal in, which has been proven to speed healing by up to 50%. And unlike many comparable products, which protect the wound but also inhibit proper washing, Spira-Wash™ is water-washable, making cleaning and debridement of the wound as easy as possible.

    Meadowsweet Extract

    SPIRA-WASH™ GEL CONTAINS organic Meadowsweet Extract which can potentially provide antioxidant and additional healing properties. Meadowsweet Extract may also act as an anti-inflammatory and antiseptic. Research also suggests that Meadowsweet Extract possesses antimicrobial properties.

    Customization

    ALONG WITH THE NUMEROUS healing qualities found in every Wound Care Formulation we create, Wound Care Cream can also be customized at the request of your doctor. Our pharmacists will work with you and your physician to create a formulation that best suits your needs. Customized formulations can include antifungal protection, pain reduction, antimicrobial coverage (for gram-positive and gram-negative), and increased healing properties.

  • Compounded Scar Cream

    SCAR CREAM is designed to soften, smooth, flatten, lighten and dramatically improve the overall appearance of both old and new scars.

    Scarring Disorders

    SCAR CREAM, while improving the appearance of preexisting scars, can also help prevent scarring disorders, including hypertrophic and keloidal scarring. Both hypertrophic and keloidal scars are the result of excessive collagen produced in the healing process. Due to the excess scar tissue, scars will appear raised, thick, and darker than typical scars. While hypertrophic scars remain confined to the area of the original wound, keloids extend into the surrounding tissue. Scar Cream is designed to prevent the excessive collagen production which causes these disorders.

    PracaSil™-Plus

    PRACASIL™-PLUS is the silicone base used in our Scar Cream. It is specifically designed for use in scar and skin treatments. PracaSil™-Plus reduces inflammation and buildup of scar tissue. It is also designed to create a resilient film on the skin, so that your scar receives as much exposure to the medication as possible.

    Pracaxi Oil

    PRACASIL™-PLUS CONTAINS Pracaxi Oil, which is derived from the pracaxi tree, found in the Amazon rainforest. Pracaxi Oil is rich in beneficial fatty acids and has historically been used for a variety of medicinal and cosmetic purposes. It can have anti-inflammatory, antioxidant, antibacterial, and antifungal properties. It is also used in hair and skin products to condition and smooth.

    Active Ingredients in COMPOUNDED SCAR CREAM

    • PENTOXIFYLLINE
    • TRANILAST
    • VERAPAMIL

Compounded Cosmetic Cream

IMG_0609[1]

Pharmacist making capsules

COMPOUNDED COSMETIC CREAM is designed to lighten dark spots on the skin, resulting from a variety of factors

Active Ingredients in COMPOUNDED COSMETIC CREAM

  • Butylated Hydroxytoluene
  • Hydroquinone
  • Sodium Metabisulfite
  • Triamcinolone

 

Management of Pain Compounding Clinical Practice Guideline

Effective pain management requires individualized therapy that takes into account the stage of disease, concurrent medical conditions, and characteristics of pain. Effective pain management also requires an initial pain assessment, an ongoing reassessment of the pain and an ongoing reassessment of effectiveness. It is best to use brief, easy-to-use assessment tools that reliably document pain intensity and pain relief. One routine clinical approach to pain assessment and management is summarized by the mnemonic “ABCDE”:

A. Ask about pain regularly. Assess pain systematically.

B. Believe the patient and family in their reports of pain and what relieves it.

C. Choose pain control options appropriate for the patient, family, and setting.

D. Deliver interventions in a timely, logical, and coordinated fashion.

E. Empower patients and their families. Enable them to control their course to the greatest extent possible.

Effective pain management also requires a thorough knowledge of administration methods – the most common routes of administration include oral, rectal, transdermal, nasal, intravenous and intraspinal – and the general pharmaceutical principles of each administration method. It also is necessary to measure each dose of medication accurately. Medication doses will always require titration, and therefore, the ability to measure and adjust doses accurately is supremely important. At Bedei Compounding Pharmacy Services (BCPS), we believe a compounding pharmacist’s skills are suited ideally to produce effective pain management. We also know that many healthcare professionals, who no doubt have the best intentions, struggle with many issues surrounding pain management. Common issues include:

I. How and why to procure an initial pain assessment.

II. How to begin therapy.

III. How to reassess and adjust therapy.

IV. Where to apply transdermal therapy.

V. Where to find resources to increase knowledge of pain management.

I.   How and why to procure an initial pain assessment.

Pain management is more effective when an assessment is taken. A basic assessment will help gather information about the history of the pain (when the pain began; the intensity of the pain; what makes the pain better and worse), will measure some level of pain intensity (for example a scale of 0 to 10), will help identify where the pain is, and gather information about the therapies that have been tried and measure their efficacy.

A challenging part of pain assessment is its intuitive nature. No matter how simple or thorough an assessment is, intuition on the part of the healthcare professional is required. It is helpful to pay particular attention to what has helped the pain in the past. For example, if oral gabapentin has been helpful, it may be very effective transdermally in the correct location. On the other hand, if a medication makes the pain worse, it may be wise to review that medication’s side effect profile. It also is wise to look at the location of pain. Very intense pain is indicated by a patient who cannot color within the lines. As their pain improves, they will begin to color in the lines of the diagram and the area they color will become smaller. Finally, pay particular attention to the “What is your pain now?” scale. This is a simple tool going from 0 to 10, but it is very helpful, especially when adjusting doses.

 II.   How to begin therapy.

Every healthcare professional feels the pressure to recommend the ideal pain therapy for whatever pain condition(s) from which their patient suffers. The prospect of a perfect first attempt at pain management is foolhardy. Improving the pain condition and subsequently adjusting doses and therapy for continued improvement is the most promising approach. The reason for this is that many patients have more than one source of pain at the same time. Consider a cancer patient who has recently received surgery and chemotherapy. Is it possible that some of their pain is from some form of inflammation? Is it possible that some of their pain would respond to opiate therapy? Is it possible that the chemotherapy regimen may have produced a secondary neuropathic pain? Is it possible that this person requires a minimum of three different medicinal therapies? One possible regimen would include an NSAID (for the inflammation), an opiate (for the cancer pain), and gabapentin (for the neuropathic pain). Get a drug on board for each type of pain you can identify.

It is relatively easy to begin therapy by reviewing the pain assessment and intuitively asking a few simple questions. First, look at any therapies that have been tried. How effective were those therapies? Were those therapies adjusted to maximum doses? Were they administered in the most effective routes? If a therapy was partially effective, it is possible that it could be very effective at the correct dose and correct route. Each therapy should be adjusted to its maximum therapeutic dose and route.

Sometimes a therapy is repeated unwittingly. How many patients in the aforementioned circumstance may have been given an opiate only to produce partial relief? The dose is never titrated and the therapy is thrown out only to be replaced with another opiate, which often produces a similar outcome. Should we really expect the third opiate to be any different? Don’t repeat what you know will fail.

A great resource to help with therapeutic ideas is the Algorithm for Chronic Pain. The algorithm contains a list of common medications that are used for chronic pain of all types. Helpful information includes therapeutic categories, modes of action, starting dose recommendations, proposed routes of administration and regimens. Use the Algorithm for Chronic Pain as a guide to starting therapy.  In review, the keys to effectively beginning pain therapy are:

1. Get a drug on board for each type of pain you can identify.

2. Each therapy should be adjusted to its maximum therapeutic dose and route.

3. Don’t repeat what you know will fail.

4. Use the Algorithm for Chronic Pain as a guide to starting therapy.

III.   How to reassess and adjust therapy.

Ongoing pain management therapy can be reassessed simply by using the Pain Reevaluation Form. This form is a quick version of the Initial Pain Assessment, and also is useful for counseling patients. Adjusting ongoing therapy challenges many health professions. However, with a simple stair-step approach, adjusting therapy can be simple and effective. Keep in mind that each therapy should be adjusted to its maximum therapeutic dose and route. It is important to have a thorough approach and never give up!

Consider the potential outcomes of pain therapy. The good news is that there are only four potential outcomes of therapy, and each outcome has a corresponding appropriate action to be taken to improve pain management. The potential outcomes are:

1. Fixed

2. Therapy produces a side effect

3. Partial improvement with no side effects

4. No improvement with no side effects

Corresponding appropriate actions/options may include:

1. Fixed: No further action is needed.

2. Therapy produces a side effect: Reduce dose to maximum therapeutic effect, or discontinue therapy and begin with new route or new therapeutic mechanism.

3. Partial improvement with no side effects: Increase frequency or strength of dose until no further improvement in pain or a side effect is produced.

4. No improvement with no side effects: A. Increase dose until improvement in pain is produced or a side effect is produced. B. Discontinue therapy and begin with new route or new therapeutic mechanism.

IV.   Where to apply transdermal therapy.

It often is difficult to know where to apply transdermal drug therapy. There are four possible places to apply topical pain therapy. They are:

1. The location of the pain.

2. The site of the original injury.

3. The dermatome location. Generally speaking, a dermatome is the location in the spinal column where the nerves from the location of pain enter the spinal column. This can be an excellent place to apply drug therapy.

4. Any trigger point locations.

 Keep in mind that the single best place to apply transdermal drug therapy is unknown. It may require a combination of locations to significantly reduce pain levels. By measuring what is applied and reassessing the outcome, it is possible to continually adjust doses until efficacy is obtained.

Doctor Cards

IMG_7609[1]       IMG_7581[1]    IMG_7597[1]     IMG_7591[1]                     IMG_7589[1]    IMG_7634[1]

Comments

You can contact us by submitting the form below:
Fields (*) marked are required.
Your Name*
E-mail Address*
Contact Number*
Comments