Prevent shingles - ScriptSave WellRx image

by Alyssa Kasher
PharmD Candidate of 2018

It’s likely you’ve heard about shingles, or may even know someone who has had the painful rash, but what exactly is shingles, and how can you prevent it? The varicella-zoster virus (VSV) causes two distinct forms of infection, chickenpox and shingles. It’s important to recognize how you can contract this virus and what you can do to protect against it.

If You’ve Ever had Chickenpox, You Can Develop Shingles

A primary VSV infection occurs when you’re first exposed to the virus, referred to as varicella or chickenpox. Chickenpox is a highly contagious condition spread through direct person-to-person contact, sneezing, or coughing. Most people recognize it from the itchy blisters or “pox” that appear all over the body.  In healthy people, the condition is mild and resolves within 5-10 days1.  As chickenpox resolves, the varicella-zoster virus retreats into the nerve cells and goes into hiding. The virus’s ability to evade the immune system allows it to lay dormant until future reactivation1. Although anyone previously infected with chickenpox will carry VSV in their system, not everyone will experience the virus’s reactivation.

According to the CDC, 1 in 3 Americans will experience the reactivation of the VSV. When this occurs, it manifests as a secondary infection called herpes zoster or shingles1. The virus travels down a nerve and produces a patch of painful lesions on the skin that may permanently scar or discolor the skin.

Shingles is More Dangerous Than Chickenpox

As the infection moves down the nerve, it causes inflammation resulting in damage or cell death2. This causes the most painful and lasting effect of the infection, called peripheral neuropathy or nerve pain. Inflammation may also occur in the eyes and the brain causing serious and potentially fatal complications1. Shingles is more dangerous than chickenpox, especially because it usually occurs in older people who may have weaker immune systems with less ability to fight off the infection.

How Can You Prevent Shingles? Vaccination

The first vaccine to prevent the primary VSV infection, or chickenpox, was not developed until 1995. This means much of the older population has been exposed to chickenpox. Zostavax, the first vaccine to prevent the reactivation of the virus (shingles), did not come out until 20064.  Many people may have already received the Zostavax vaccine. However, a better vaccine has taken its place.

Shingrix: A Better Way to Prevent Shingles

In the fall of 2017, Zostavax was replaced by Shingrix as the CDC recommended vaccine to best prevent shingles and related complications. Shingrix, unlike Zostavax, is not a live vaccine and cannot cause shingles. Shingrix is given in two doses, and is over 90% effective at preventing shingles3. The CDC recommends that everyone over the age of 50 of receive Shingrix. You should get the Shingrix vaccine if you have already had shingles, previously received Zostavax or if you’re not sure you had chickenpox as a child. Studies show that 99% of Americans over 40 have been exposed to the chickenpox virus whether they realize it or not3.

Patient populations at the highest risk of shingles include:

  • those over 50
  • immunocompromised patients
  • females
  • anyone with underlying chronic lung and kidney disease.

Facts About Shingrix3

  • After your first dose of Shingrix, you should receive the second dose within 2-6 months.
  • You can receive the vaccine at your community pharmacy without a prescription.
  • Shingrix is covered by Medicare Part D. Ask your pharmacist to see if your plan covers it.
  • Shingrix can cause injection site soreness and pain. Using ibuprofen or Tylenol can help.
  • Talk to your pharmacist or doctor to see if Shingrix is right for you.
  • Always discuss all conditions/medications with a doctor or pharmacist before getting a vaccine.

References

  1. Albrecht, MA. Clinical manifestations of the varicella-zoster virus infection: Herpes zoster. In: Basow DS, ed., UpToDate. Waltham (MA).: UpToDate; 2016.
  2. Albrecht, MA. Epidemiology and pathogenesis of varicella-zoster virus infection: Herpes zoster. In: Basow DS, ed., UpToDate. Waltham (MA).: UpToDate; 2016.
  3. Centers for Disease Control and Prevention. Vaccines & Preventable Diseases. Vaccines by Disease. Shingles. Retrieved at https://www.cdc.gov/vaccines/vpd/shingles/public/zostavax/index.html. Accessed 2018 Jan 22.
  4. Immunization Action Coalition. Chickenpox (Varicella): Questions and Answers. Retrieved at: http://www.immunize.org/catg.d/p4202.pdf. Accessed 2018 Jan 22.

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Medicine Chest Must Haves - image

Here are ten must-haves for every home medicine chest:

Plain soap

Good ol’ soap and water is still the best way to clean minor cuts and scrapes. It works just as well as antibacterial soap—and it’s less expensive!

A compression wrap

If you twist your ankle or wrist, remember the RICE treatment: Rest, Ice, Compression, Elevation. Elastic wraps, such as those made by ACE, are the compression component of the RICE equation. “These are excellent for giving support to a sprained joint,” says Jennifer Zimmer, MD, an internal medicine doctor at the Dallas Diagnostic Association and the Baylor Regional Medical Center in Plano, Texas.

Aspirin

Not only for headaches and hangovers, but if you’re at risk for something far more serious: “If you have chest pain, chew up 325 mg of uncoated aspirin,” advises Singh. “Heart attacks can happen any time and taking aspirin as soon as possible can help reduce the damage.” Aspirin can help break down the blood clot in your artery and limit the injury to your heart. Keep in mind, however, that there are many different types of chest pain and that aspirin is not the right treatment for many of them. Rare use is relatively safe but repeated aspirin use can cause harm. Talk to you doctor to learn about your heart-disease risk and what to do in an emergency.

Bandages (assorted sizes)

Not just for kids! You need these, as well, to keep your boo-boos and owies from becoming infected.

A thermometer

Experts recommend a digital thermometer over the mercury type (which are just as accurate but difficult to read). “A good thermometer can monitor for temperature elevation that could indicate infection in a wound or worsening of an illness,” says Zimmer.

Mild pain relievers

Stock acetaminophen or ibuprofen for minor pain and fever. “Remember to check doses, though, as children take a dose based on their weight,” advises Singh.

Antibacterial ointment

Apply after cleaning a wound to help reduce infection risk and increase healing time.

An antihistamine

Use to relieve minor allergy symptoms like sneezing, itching and swelling. Call 911 if you have a severe allergic reaction—such as difficulty breathing, or swelling of the tongue or lip—as an antihistamine won’t help.

Hydrocortisone cream

This is useful for taking itch out of rashes and insect bites.

Phone numbers

Inside the door of your medicine cabinet, adhere contact info for your family members, doctors, pharmacy, and your local poison control center. If there is an emergency, this cost-you-nothing strategy can prove to be priceless.

Remember to check the contents of your kit every 6 to 12 months to ensure that medicines haven’t expired, and that your contact numbers are still up-to-date.

Finally, it’s also handy to keep a first-aid kit in your car and your day-trip backpack. And think about other places a kit could be useful. Going on vacation? Remember to take one with you to the cabin, boat, or wherever else your road leads. Go well!

Nancy Gottesman, a health and nutrition writer in Santa Monica, CA, is stocking her first-aid kit now.

Copyright © 2018 Healthnotes, Inc. All rights reserved. www.healthnotes.com

Learn more about Healthnotes, the company.


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what is this med for image - wellrx

by Seth Root
PharmD Candidate – Midwestern University

If you’re on a prescription medication, you probably know it’s important to make sure you take that medication as prescribed by your doctor. What many patients don’t know, however, is that it is also important to know why you’re taking that medication, or why your doctor prescribed that medication for you. There are many reasons why knowing the purpose of your medications are important, but we’re only covering a few of them in this blog post.

Purpose of the Medication

Medications are generally made for a specific purpose, like aspirin is made to be a pain reliever. However, knowing what a medication is generally used for isn’t enough, as doctors may prescribe medications for things other than what the medication was originally meant to treat. For example, even though aspirin is meant to be a pain reliever, your doctor may prescribe it as a blood thinner.

Sometimes medications are prescribed for other purposes than what the manufacturer intended. This is known as off-label use. But this can make it difficult to accurately research your medications online. Researching your medications on the internet might be quick  and convenient, but even if the information is accurate (which often it is not) it might not reflect the information you need, as you might be taking the medication for a purpose other than what the drug was initially designed for. Therefore, if you have questions about why you’re taking a medication, the best person to ask is the doctor that prescribed it to you, or your local pharmacists.

This might have you thinking why it’s important to know the purpose of your medication. There are many reasons for this, one of which has to do with side effects. All medications have side effects. Side effects are important to consider as they can seriously impact your quality of life. How many medications you’re on is one of the most important determining factors regarding what side effects you’ll experience.

This is where knowing what purpose your medications are for comes into play, as sometimes we are on multiple medications for the same disease, but because you’re on multiple medications you’re experiencing side effects that you wouldn’t experience if you were on just one of the medications. This is known as a drug-drug interaction. If you can identify which medications are treating the same disease, it’s possible you can reduce the number of medications you’re on, which will help cut down on the number and/or intensity of side effects.

Where to Start

If you’re wondering where to start learning about your medications, as mentioned before the best place to start is by asking the doctor that prescribed the medication to you. Even if everything is good, you may be surprised with what you learn, like helpful tips on how to maximize the medication effect or ways to reduce the side effect. Another good person to ask is your pharmacist, especially if you’re on multiple medications. They can help identify drug-drug interactions you might be experiencing, can recommend similar medicines that might have less side effects and/or are cheaper, and can also give helpful tips about managing your medications and their side effects.

The biggest thing to do when learning about medications is to make sure to take them as prescribed. If for whatever reason you don’t want to continue taking the medication, the worst thing you can do is not tell your doctor or pharmacist about it. They’re here to help you. Even if you don’t want to take your medications, they can work around that the best they can or possibly find a more suitable medication. If you don’t take your medications as prescribed, they may think that your disease is not responding to the medications and therefore prescribe more medications to try to control it. This can lead to unnecessary prescribing and more side effects, as well as being more expensive. So please, talk to your doctor and/or pharmacists about your medications and the reason why you were prescribed them. In the long run, it will be helpful for you.

 


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Go Red For Women 2018 - American Heart Association

It’s a new year and you’re probably trying to do this “healthy” thing. You’re going for long walks or runs, limiting your donut calories and not smoking. You may be thinking you’ve eliminated your risk for, for heart disease, but wait. There’s more.

According to the American Heart Association (AHA), the biggest risk factors for heart disease include obesity, lack of exercise, smoking, high blood pressure or cholesterol, a poor diet, and stress.

For many women there are other factors for heart disease and stroke that you can’t control that may not even be on your radar. Your love life, a strong family history, race, and increasing age are all on the list of contributing factors.

CVS Health is continuing their support of the AHA’s Go Red for Women movement. They’ll be offering no cost “Know Your Numbers” health screenings at their MinuteClinics every Wednesday in February.

Visit a CVS MinuteClinic on February 14, 21, and 28 and receive a no-cost heart health preventative screening. If you go, you’ll get screenings to help determine your risk for heart disease – total cholesterol, HDL cholesterol, blood pressure, blood sugar, and body mass index (BMI).

A list of CVS MinuteClinic locations is available on the MinuteClinic website. For more information on the AHA Go Red for Women movement, visit GoRedForWomen.org.

Click to read the CVS press release.


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managing-insomnia

by Jenny Bingham, PharmD, BCACP
SinfoniaRx

What is insomnia?

The prevalence of insomnia increases with age, especially in women. Individuals can experience one of two different types: acute or chronic. Acute or transient insomnia lasts for days to weeks. Chronic insomnia lasts for more than one month. 1

A general consensus estimates that approximately one-third of adults experience insomnia. Characteristic symptoms include: difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and/or poor quality of sleep. 2

Why is it important to treat insomnia?

Untreated insomnia can have negative outcomes on an individual’s overall health. It is been associated with altered physical health, emotional health, mental health, social functioning, pain control, and overall health perception. 3

What can you do to treat insomnia?

There are two approaches to treating insomnia without medications. 4

Sleep hygiene

  • Keep a regular sleep schedule.
  • Do not exercise immediately before bedtime.
  • Avoid alcohol and stimulants (caffeine, nicotine) in the late afternoon and evening.
  • Maintain a comfortable sleeping environment that is dark, quiet, and free of distractions.
  • Avoid consuming large amounts of food or liquids immediately before bedtime.

Stimulus control

  • Go to bed only when you are sleepy.
  • Avoid daytime naps.
  • If unable to sleep, get out of bed and go to another room— only return to your bed when you feel the need to sleep.
  • Do not eat or watch TV in bed.
  • Wake up at the same time each day.

Individuals should also ask their provider about management of other underlying causes of insomnia, like psychiatric or other medical conditions. It’s important to limit prescription sleep aids to short-term use. After initiating any treatment for insomnia, whether behavioral or prescription, it’s important to reevaluate after a few weeks.

References:

  1. Schutte-Rodin S, Broch L, Buysse D, et al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008; 4:487–504.
  2. Ancoli-Israel S, Roth T. Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. I. Sleep. 1999 May 1; 22 Suppl (2):S347-53.
  3. Katz DA, McHorney CA. The relationship between insomnia and health-related quality of life in patients with chronic illness. J Fam Pract. 2002 Mar; 51(3):229-35
  4. Dopp JM, Phillips BG, Chisholm-Burns M. Sleep Disorders. Pharmacotherapy Principles & Practice and. 3e; 41: 737-747.

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Rhabdomyolisis can cause muscle cramps, particularly in the legs.

by Sapna S. Patel, PharmD (2017)

For many who have been diagnosed with hypercholesterolemia, commonly known as high cholesterol, changes in diet and exercise may not be enough. If your doctor has prescribed a statin medication to lower your cholesterol, you may have heard or read about the potential side effects of statin drugs and their impact on liver function.

Doctors will often prescribe statins to lower the total cholesterol and reduce the risk of a heart attack or stroke in people with high cholesterol levels. While statins are highly effective, they have been linked to muscle pain in some people, and in rare cases, even cause liver damage.

So what is rhabdomyolysis?Coca-Cola colored urine caused by rhabdomyolysis

Rhabdomyolysis is a severe, debilitating muscle pain (interferes with your ability to perform normal daily tasks) due to muscle damage and breakdown. This causes your damaged muscle to release their proteins into your bloodstream, become eliminated through your kidneys (ultimately leading to your kidney(s) shutting down), and appearing in your urine (which explains why the urine color of a patient experiencing rhabdomyolysis is referred to as “Coca-Cola” or “reddish-brown” color).

Some common statin medications are:

Statin medications can be very beneficial to your health. Statins can decrease the amount of “bad” cholesterol, which can clog your arteries, preventing oxygen-rich blood from reaching essential organs. Decreasing your “bad” cholesterol can lower your risk of having a heart attack or stroke. Ultimately, this leads to living a longer and healthier life.

The majority of Patients benefit from using statin medications if indicated by their physician. Less than 3% of patients on statins report muscle pain while less than 0.5% report rhabdomyolysis. So, don’t stop using your statin medication until your physician confirms this side effect.

Common Symptoms of Rhabdomyolysis are:

In the larger muscle groups, like your thighs, shoulders, lower back, and calves:

  • Muscle tenderness
  • Severe muscle pain
  • Muscle weakness/fatigue
  • Muscle Stiffness
  • Muscle Cramping

Other signs of rhabdomyolysis are:

  • “Coca-Cola” or “reddish-brown” urine
  • Skin changes (discoloration or blisters)

How do I know if a statin medication is causing my symptoms?

Ask your Physician for bloodwork to check for abnormal Creatinine Kinase (CK, CPK) levels, liver function, and kidney function tests. These labs are not routinely checked during bloodwork.

Symptoms of rhabdomyolysis usually occur 4-6 weeks after first starting on a statin medication. However, they can occur years after being on a statin medication, so it’s important to always be aware of the symptoms of rhabdomyolysis.

If your only symptom is muscle pain, think about other reasons why your muscles may be painful, sore, stiff, or crampy. Could it be due to unusual physical activity such as hiking up a new trail, shoveling the driveway after a massive snowstorm, or trying a vigorous exercise routine, like spin cycling or high intensity interval training?

What if I do have rhabdomyolysis?

If you do end up with a diagnosis of rhabdomyolysis, your physician will likely stop your statin medication. There are statins that have a lower risk for rhabdomyolisis, such as pravastatin (Pravachol) and fluvastatin (Lescol).

As a final note, if you’re taking a statin, you should also avoid eating grapefruit or drinking grapefruit juice. Grapefruit contains compounds called furanocoumarins that stop your body’s natural enzymes from doing their job. As a result, more of the statin drug is absorbed, making it more powerful than it would normally be.


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Anxiety medications and children photo

by Jenny Bingham, PharmD

Across the United States, the rate of antidepressant use in children is rising. It has led to prescription costs exceeding $100,000 in the four states with the highest antidepressant prescription rates for children: Colorado, Florida, Pennsylvania, and Texas.

As the number of antidepressant prescriptions rise, it’s only natural that parents will have a growing number of questions about those medications. Here’s a list of common questions other parents have had when starting pharmacotherapy for their child’s anxiety and/or depression:

How many pills will my child have to take?

The simplest answer is, it depends. Pharmacists are trained to know FDA approved indications for mental health medications. By incorporating pharmacists into the healthcare team, they can help find medications that have dual purposes and decrease the amount of pills in the regimen. Talk to your pharmacist about the medications and if there are alternatives.

How will pharmacotherapy affect my child?

Each patient responds differently to medications. Whereas some patients that are prescribed a common first-line antidepressant (fluoxetine) and tolerate it well, others may have an entirely different reaction. Certain medications can have negative side effects, including:

  • shaking
  • drowsiness
  • weight gain
  • insomnia
  • dizziness
  • dry mouth
  • blurred vision
  • bleeding, and,
  • constipation.

These side effects can be extremely detrimental to a child’s quality of life. It’s important to have open communication with your healthcare provider to ensure that side effects don’t get in the way of medication adherence, school performance, or self-esteem. Current literature provides clinicians a wide variety of information about which side effects are more prominently reported in individual cases. This database of knowledge helps further individualize therapy and avoid potential side effects.

What risks are associated with pharmacotherapy?

Parents should be aware of the potential for abuse, especially with commonly prescribed anxiety medications (ex. alprazolam) that are rated as controlled substances.

Adolescents are at an increased risk of suicidal ideation when initiating certain medications. Family members must be educated on how to monitor, identify, and report these to the provider.

One must also consider the risks of not seeking appropriate treatment, like self-medication with illicit drugs, tobacco, and alcohol. Self-medication can unfavorable effects on one’s mental and physical health.

Are there alternatives to pharmacotherapy?

If a parent decides against using medications, trained therapists can provide alternative options, if appropriate. Cognitive behavioral therapy is a common tool that incorporates education, relaxation exercises, coping skills, stress management, and assertiveness training.1

Other approaches include: interpersonal therapy, motivational interviewing, dialectical behavior therapy, supportive therapy, and family therapy. These tools can also be used in combination with medication to improve depression and anxiety. Parents should work closely with their physician to determine if this is a safe option as monotherapy.

Final Thoughts

Decisions about using medications to treat anxiety and/or depression in children must be catered specifically to the patient. It is imperative for health care providers to approach this sensitive topic as a group, including the patient and parents. Pharmacists are a great resource for optimizing medication effectiveness and reducing pill burden.

References:

  1. Beck JS. Cognitive Behavior Therapy: Basics and Beyond, 2nd ed, Guilford Press, New York 2011. p.391.

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and get registered to take advantage of our free medication adherence tools.

If you’re struggling to afford your medications,
visit www.WellRx.com to compare the cash price at pharmacies near you.
You may find prices lower than your insurance co-pay!

 

 

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Dry eye treatment eye drops

by Kali Schweitzer, PharmD candidate 2018
University of Arizona College of Pharmacy

For many people, dry eyes may only be a minor inconvenience. But for those who experience chronic dry eye, it can be a major problem, causing extreme discomfort. Left untreated, dry eye can have long term effects on your vision as well as your quality of life.

What causes dry eyes?

Dry eye occurs when you do not produce enough tears or if you are not producing quality tears.  As a result, there is not enough lubrication for the eye, leading to the gritty, burning, and irritated feeling that is most often associated with this condition.  There are a variety of things that may cause dry eye, including:

  1. Dry climate
  2. Wind
  3. Exposure to smoke
  4. Age
  5. Gender
  6. Certain medications and medical conditions.

For some, dry eye may be unavoidable, which is when finding an effective treatment that is not too costly becomes very important. In fact, one study found that the average direct cost for a patient seeking medical care for dry eye was $738 per year, and the cost to society per patient per year was over $11,000. So, the question is, what are your options if you are one of the millions of people in the United States who suffer from this condition?

Over-the-counter treatment for dry eyes

The key to managing dry eye symptoms and avoiding spending a fortune on prescriptions is to take advantage of the various over-the-counter options available.

The most popular over-the-counter treatment for dry eye is artificial tears, which help to lubricate the eye when you do not have enough tears of your own. There are many different varieties of artificial tears in the pharmacy aisle, and the most important distinction between them is that some are preservative-free while others are not. The preservative-free options tend to be more costly, but they are better for those who have more chronic symptoms because they are less likely to irritate the eyes following frequent use.

Another option that is available without a prescription is an omega-3 fatty acid supplement, which helps to increase tear production. Depending on what your doctor determines to be the cause of your dry eyes, they may have other recommendations for you that do not require a prescription for dry eyes.

Home treatment for dry eyes

In addition to over-the-counter medications, there are a number of other things you can try to prevent and/or reduce the symptoms of dry eyes. Some suggestions include blinking regularly, wearing sunglasses outside to protect your eyes, and drinking more water. If eyelid inflammation contributes to your dry eye symptoms, you may consider gently washing your eyelids, which can be done using a mild soap. Applying a warm compress over your eyes may also provide relief.

When do you need a prescription for dry eyes?

If prescription treatment does become a necessity, your doctor will discuss the different options with you. The ones most commonly used are Restasis (cyclosporine), which reduces inflammation, and Xiidra (lifitegrast), which helps you make more, quality tears. Another option is Lacrisert (hydroxypropyl cellulose), which is inserted between the eyeball and lower eyelid and slowly dissolves to release a lubricating substance. For now, these are only available as brand name medications, therefore price may be a barrier depending on your insurance coverage.

Finding the right dry eye treatment

Whether you seldom experience dry eyes or if you have constant symptoms, finding the right treatment is crucial. Dry eye can be irritating, costly, and even life-altering if not controlled. By working with your doctor, your pharmacist, your insurance company, and even prescription savings companies like ScriptSave, you will be in a better position to control your symptoms and save some money in the process.

References:

  1. Yu J, Asche C, Fairchild C. The Economic Burden of Dry Eye Disease in the United States: A Decision Tree Analysis. 2011 April. 30(4):379-387.
  2. https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/dry-eye?sso=y
  3. http://www.mayoclinic.org/diseases-conditions/dry-eyes/basics/lifestyle-home-remedies/con-20024129
  4. Micromedex

 

 

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noacs - warfarin alternatives

by Kali Schweitzer, PharmD candidate 2018
University of Arizona College of Pharmacy

Not so long ago, a diagnosis of atrial fibrillation (AFib), deep vein thrombosis (DVT), or pulmonary embolism (PE) meant that a prescription for the blood thinner, warfarin (Coumadin), was likely coming your way. In recent years, multiple other blood thinners have become available, and you may have wondered if any of them could be right for you.

What are NOACs?

The NOACs, or novel oral anticoagulants, are a new breed of blood thinner that have arrived on the market within the last ten years. This class of medications includes:

How are NOACs Different from Warfarin?

Multiple clinical trials comparing these alternative warfarin medications have all shown that the NOACs are just as effective as warfarin, and that they have a similar (or lower) risk of bleeding. Warfarin has been around for decades and has been proven to be both safe and effective at preventing blood clots, but it’s no secret that it has its problems. Here are some key differences to note when comparing the newer anticoagulants with warfarin and when deciding what is right for you:

  1. Warfarin requires frequent trips to the lab to have your INR (international normalized ratio) checked. Also referred to as PT time, Prothrombin time is a blood test that measures how long it takes blood to clot, or how well the medication is working. You may potentially need to change your dose to increase or decrease the clotting time. NOACs do not require lab monitoring or frequent dose changes.
  2. NOACs do not have the high potential to interact with food or other medications like warfarin does, meaning there are fewer restrictions. This means no more worrying about how much salad you can eat on a day-to-day basis, or if you are allowed to have that glass of grapefruit juice in the morning. It is still recommended, however, to check with your doctor or pharmacist before starting any new medications, as there are still some medications that may increase your risk of bleeding when taken with the NOACs.
  3. NOACs begin working quickly, while warfarin may take up to a week to start working. Because of this, patients with a DVT or PE starting warfarin may require “bridge” therapy with heparin or enoxaparin (other fast acting blood thinners) to prevent clots while waiting for the warfarin to take effect. This “bridge” therapy is not necessary with the NOACs.
  4. Unlike warfarin, not all of the NOACs have a reliable reversal agent if you were to begin bleeding. With warfarin, if your INR becomes too high or if you are having signs of bleeding, you may be given vitamin K, or phytonadione, to reverse its effects. Currently, Pradaxa is the only NOAC that has an approved reversal agent, called Praxbind (idarucizumab). While bleeding is rare while on the NOACs, the lack of reversal agent is something to keep in mind when deciding which medication may be right for you.
  5. NOACs may not be appropriate if you have decreased kidney and/or liver function. Your doctor will review your labs and information to determine if your kidneys/liver are functioning well enough for you to take one of these medications.

The recent approval of the NOACs has provided prescribers and patients with more options to choose from when a blood thinner is necessary. Because these medications are still relatively new, there is a lot left to learn about their use and limitations, so they may not be appropriate for everyone. It is always important to discuss any questions or concerns with your doctor when starting any of these medications or when switching from one to another.

 

References

Leung LLK, Direct oral anticoagulants and parenteral direct thrombin inhibitors: Dosing and adverse effects. In: UpToDate, Mannucci PM (Ed.), UpToDate, Waltham, MA.

Hanley CM, Kowey PR. Are the novel anticoagulants better than warfarin for patients with atrial fibrillation? Journal of Thoracic Disease. 2015;7(2):165-171. doi:10.3978/j.issn.2072-1439.2015.01.23.


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Emergency Preparedness - medications, ScriptSave WellRx

by Leah Samera
University of Arizona College of Pharmacy
PharmD Candidate, Class of 2018

Ready, a public service campaign designed to educate and empower citizens to prepare for emergencies such as natural and man-made disasters, proclaims September to be National Preparedness Month (NPM). In the aftermath of Hurricane Harvey and in anticipation of Hurricane Irma, you may be wondering how to go about preparing for such events. This is especially important to consider if you have a chronic disease or condition.

Illness Follows Disaster

Studies have found that upwards of 70% of the Hurricane Katrina survivors had at least one chronic condition. Additionally, 58% of the visits to emergency treatment facilities in New Orleans after Hurricane Katrina were due to illness, 24% of which were associated with chronic diseases. The research on disasters’ effects on chronically ill patients only serves to reinforce the fact that these emergency situations can lead to both exacerbation and death from chronic illnesses due to direct stress of the disaster, interruption of care, or both.

Emergency Plans and Kits

Organizations like the American Red Cross recommend having an emergency plan and kit prepared for use during a disaster. Some obvious items that should be included in such a kit are water, food, and first aid supplies. However, it is also critical that you have a 7-day supply of your medications on hand as well as any other tools or devices used for your health such as hearing aids with extra batteries, syringes, blood pressure cuffs, et cetera. In order to have at least a 7-day supply of your medications, you must order refills of your prescription medications as soon as you are able rather than before you run out. It is best to keep these items together and in a location that is easy to get to in an emergency.

Planning Ahead

Medications should be stored away from heat, light, and moisture; if possible, keep them in their original bottles and store the bottles in a waterproof bag or container. If you have medications such as insulin that need refrigeration, have a freezer pack and cooler available. It is also important to stay up-to-date on all immunizations, including tetanus, especially if you have diabetes. Additionally, because the stress of these disasters can exacerbate your conditions, it is best to also make appropriate lifestyle changes such as restricting salt intake if you have high blood pressure or learning the carbohydrate counting approach if you have diabetes.

Other Handy Emergency Items

Other items that you should have handy in case of an emergency include any over-the-counter medications you may need like pain relievers, as well as your medication list and insurance card. It is important to keep an up-to-date medication list that not only catalogs the names of your current medications but also their strengths, indications, directions, and prescribers; any bad or allergic reactions you may have had to medications in the past should also be documented. Your prescription benefit card may be needed for approval of an emergency supply if you run out of or lose your medications, or if your medications get damaged or contaminated.

In the event that you end up requiring medications and health resources:

  • RxOpen.org maps open and closed pharmacies, American Red Cross shelters, and infusion centers in areas affected by disasters.
  • The charity Direct Relief provides free prescription drugs and medical supplies to low-income patients at community health centers or clinics.
  • Keep a list of nearby pharmacies and hospitals as well as their phone numbers.

By doing what you can to prepare for disasters, you can lower your risk of exacerbations of your health conditions. As the theme for NPM states: “Disasters Don’t Plan Ahead. You Can.”

References:

  • National Preparedness Month. https://www.ready.gov/september. Accessed September 7, 2017.
  • Kessler RC, Hurricane Katrina Community Advisory Group Hurricane Katrina’s impact on the care of survivors with chronic medical conditions. J Gen Intern Med. 2007;22(9):1225–1230. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219784. Accessed September 8, 2017.
  • Sharma AJ, Weiss EC, Young SL, et al. Chronic disease and related conditions at emergency treatment facilities in the New Orleans area after Hurricane Katrina. Disaster Med Public Health Prep. 2008;2(1):27–32. https://www.ncbi.nlm.nih.gov/pubmed/18388655. Accessed September 8, 2017.
  • Be Prepared for an Emergency. Be Red Cross Ready! http://www.redcross.org/get-help/prepare-for-emergencies/be-red-cross-ready/get-a-kit. Accessed September 7, 2017.
  • Emergency Preparedness for Prescription Medications. http://www.mayo.edu/pmts/mc6000-mc6099/mc6012-39.pdf. Published 2016. Accessed September 7, 2017.

Are you concerned Hurricane Irma
may impact your prescription refills?
The State Law may be on your side; early refills are permissible.

For medications not covered by insurance,
the ScriptSave® WellRx program is here to help.

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