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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ScriptSave WellRx - personalized wellness KGUN 9 - image

TUCSON, Ariz. – A local Tucson company is developing an app to help you grocery shop in a healthier way. ScriptSave developed an app and web version of a service called “Personal Wellness” that gives you grocery purchase recommendations based on what health conditions you have.

They’ll partner with grocery stores, and you’ll visit the store’s website after you fill out your health profile on “Personal Wellness,” and it will recommend products. When you buy the products recommended from the app in store, you qualify for rewards like gift cards and free fitness products.

“Personal Wellness” will be completely free to use and will also pair with the prescriptions and non-prescription drugs people take.

The app will be available after pilot tests by the end of this year or early next year.

For the full story, visit KGUN 9.

3/28/2018


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Treating and preventing osteoporosis - image - wellrx

by Tek Neopaney, University of Arizona College of Pharmacy Student

Each year, millions of Americans, who may otherwise feel fine, are diagnosed with Osteoporosis. Developing osteoporosis puts people at higher risk for fractures, especially in the hips, spine, and wrists. Women are at much higher risk, with 10 percent of women age 50 and older affected by osteoporosis, compared with just two percent of men that age.

What is Osteoporosis?

Osteoporosis is defined by low bone mass that results in decreased bone density, and bones become more prone to fracture. Osteoporosis often has no symptoms until there is a bone fracture. Bone strength decreases with the loss of bone mass, which is related to many factors such as, a decrease in bone mineral density, rate of bone formation and turnover, and the shape of the bones.

Postmenopausal women often have low bone density due to estrogen deficiency. With early diagnosis of bone loss and fracture risk, available therapies can slow or even reverse the progression of osteoporosis and help prevent bone fracture1. Vertebrae and hip fracture is common in osteoporosis patients. About two-thirds of the bone fractures are asymptomatic2, meaning patients won’t even be aware they have a fracture. Many patients without symptoms assume they don’t have osteoporosis, so it’s important for all post-menopausal women to get an osteoporosis evaluation.

Calcium Vitamin Supplements

If you are unable to achieve adequate amounts of calcium and vitamin D from diet alone, you should take supplements for bone growth and development. Children ages 9 to 18 should consume approximately 1300 mg of calcium per day from calcium rich food sources, and 600 mg of vitamin D from vitamin D-fortified food. Children who have a wide variety of foods in their diet, and are growing well, should not need calcium and vitamin D supplementation3. Calcium and vitamin D supplementation likely only benefits children with inadequate calcium and vitamin D intake3.

Most postmenopausal women with osteoporosis, 1200 mg calcium (total dietary and supplement) and 800 international units of vitamin D are recommended. Although optimal intake of calcium (diet plus supplement) for pre-menopausal women and men with osteoporosis is not established, generally suggested doses are 1000 mg of calcium (diet and supplement) and 600 international units of vitamin D4.

Exercise – It’s Important!

Exercise is strongly associated with a reduction in hip fractures in older women5. Regular exercise has shown to have positive effect on bone mineral density (BMD). BMD is the measure of calcium in your bone. In studies, a variety of exercises such as, jogging, resistance training, swimming, and walking were effective. Women with osteoporosis should exercise for at least 30 minutes a day, three days a week, to build bone strength and help prevent fractures. Exercise helps to increase muscle strength, reducing the risk of fracture from fall.

Pharmacological Therapy

In addition to lifestyle measures and calcium and vitamin D supplementation, patients at high risk for fractures should also receive drug therapy. Patients with a history of fragility fracture or osteoporosis based on BMD, benefit from medication. All patients treated with medication should have a normal calcium and vitamin D level prior to starting drug therapy, and should also receive vitamin D and calcium supplements if their dietary source is inadequate6.

Oral bisphosphonates such as, alendronate (Fosamax), ibandronate (Boniva) are the first line of therapy for postmenopausal women. These agents decrease the rate of bone breakdown leading indirectly to an increased BMD. Bisphosphonates are effective, inexpensive, and have long-term safety data on preventing hip and vertebrate fracture6. These drugs are usually taken once a weekly.

Putting it All Together

With so many Americans developing osteoporosis, it’s important to realize it could happen to you, so talk to your doctor about your risks. To help prevent, and possibly reverse Osteoporosis:

  • Bond density screening is important to detect osteoporosis
  • Get enough calcium and Vitamin D in your diet or take supplements to help prevent osteoporois
  • Exercise helps build bone mass and strengthen your bones
  • There are available drugs to treat osteoporosis that are inexpensive and have proven safe to take over time.

References:

  1. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int 2014; 25:2359.
  2. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva 1994. https://whqlibdoc.who.int/trs/WHO_TRS_843.pdf  (Accessed on March 09, 2012).
  3. Winzenberg TM, Shaw K, Fryer J, Jones G. Calcium supplementation for improving bone mineral density in children. Cochrane Database Syst Rev 2006; :CD005119.
  4. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int 2014; 25:2359.
  5. Gregg EW, Cauley JA, Seeley DG, et al. Physical activity and osteoporotic fracture risk in older women. Study of Osteoporotic Fractures Research Group. Ann Intern Med 1998; 129:81.
  6. Crandall CJ, Newberry SJ, Diamant A, et al. Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review. Ann Intern Med 2014; 161:711.

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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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Serotonin Syndrome - WellRx blog image

by Bhargavi Jayaraman, PharmD Candidate

A Challenging Diagnosis, but What is Serotonin1?

The varying symptoms of Serotonin Syndrome can be difficult to diagnose. Early serotonin syndrome symptoms, including diarrhea, high blood pressure, anxiety and agitation, can be easily confused with less serious conditions. Serotonin is a chemical produced by the nerve cells that acts on almost every part of the body. It’s helps with sleeping, eating, digestion, and is considered to be a natural mood stabilizer. It also helps reduce depression and anxiety, heal wounds, stimulate nausea and maintain bone health. When your serotonin levels are normal, you should feel happier, more calm, emotionally stable, less anxious, and more focused. A deficiency of serotonin would make you experience anxiety and/or insomnia. Many people who experience depression, anxiety, or need mood stabilizers take medications that help to increase serotonin levels in the body.

Medications That Increase Your Serotonin Levels2

With the proliferation of antidepressant drugs on the market, there is an increasing number of medications that can raise your body’s serotonin levels. But it’s not just antidepressants that can have this impact. Medications that increase serotonin levels in the body include:

Too Much of Something is Never Good

If serotonin has so many benefits to the mood and can help everyone in their daily functioning, shouldn’t we all want to take as many serotonin increasing medications as possible? The answer is no. Too much of any chemical compound in our body is never a good thing. Serotonin syndrome occurs when medications cause an accumulation of a high level of serotonin in the body. Symptoms of too much serotonin in the body can range from mild to severe, and severe serotonin syndrome can be fatal if not treated1.

What are the Symptoms of Serotonin Syndrome2?

There are no tests to diagnose serotonin syndrome1. Instead, your doctor might perform a physical exam and ask you some questions to diagnose serotonin syndrome. Due to the lack of diagnostic criteria, the exact prevalence of serotonin syndrome is unknown, however, it is known to be an extremely rare condition. So if you are experiencing any of the symptoms listed below, it’s important that you don’t stop taking any of your medications, but rather, make an appointment to see your doctor to rule out serotonin syndrome.

Mild symptoms of serotonin syndrome may include:

  • Agitation or restlessness
  • Confusion
  • Rapid heart rate
  • High blood pressure
  • Dilated pupils
  • Loss of muscle coordination or twitching muscles
  • Muscle rigidity
  • Heavy sweating
  • Diarrhea
  • Headache
  • Shivering
  • Goosebumps

More severe symptoms of serotonin syndrome may include:

  • High fever
  • Seizures
  • Irregular heartbeat
  • Loss of consciousness

Prevention is Key2

Taking more than one drug that increases serotonin levels, or increasing the dose of one of these medications, can increase the risk of serotonin syndrome. Make sure your doctor is aware of all the medications you are taking, and discuss any risks and concerns with your doctor or pharmacist to make sure you understand how the medications can interact.

How Can You Naturally Increase Your Serotonin Levels1?

Since serotonin offers so many benefits to your mood and health, you may want to consider ways to naturally increase your serotonin levels. Some ways to stimulate natural production of serotonin include:

  • Exposure to light: sunshine or bright light to treat seasonal depression can raise your serotonin levels.
  • Exercise: getting regular exercise can help to elevate your mood and offers other health benefits!
  • A healthy diet: including foods that can help to increase serotonin levels, like eggs, cheese, turkey, salmon, nuts, tofu, and pineapple, can elevate your natural serotonin supply.
  • Meditation: helps to relieve stress and promotes a positive outlook on life, thereby increasing your serotonin levels.

References:

  1. Scaccia A. Serotonin: What You Need to Know. Healthline Newsletter. https://www.healthline.com/health/mental-health/serotonin. Published May 18, 2017. Accessed February 10, 2018.
  2. Serotonin syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758. Published January 20, 2017. Accessed February 10, 2018.

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asthma inhaler image

by Tek Neopaney

What is Asthma?

Asthma is a chronic disease that affects the airway tubes of the lungs. During asthma attacks, the walls inside of the airway become sore, swollen, and red and produce mucus, making it harder to breathe. The airway tubes become very sensitive when they are inflamed and may react strongly to allergens. Air movement in and out of the lungs is constricted when inflammation is present, resulting in shortness of breath.

What Makes Asthma Worse?

There are many triggers of asthma. Common inhaled allergens that you may encounter at a daycare, home, school or work can trigger an asthma attack. Some avoidable allergens include mold, excretions from dust mites, cockroaches, and mice.

It’s common for many patients with high blood pressure to also have asthma. Some of the most effective and proven blood pressure medications are known to cause negative effects in people with asthma, so care is required in developing effective treatment plans.

Of the many different drugs available for treating hypertension, beta blockers and angiotensin-converting enzyme (ACE) inhibitors have the most potential to cause problems for asthma patients.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are medications commonly used for pain. However, NSAIDs, like naproxen (Aleve), and ibuprofen (Motrin) can sometimes make asthma symptoms worse. Other body reactions, including upper airway illness, hormonal fluctuation, and extreme emotions, can trigger asthma attacks.

How Can You Control Your Asthma?

Influenza can worsen asthma symptoms and cause complications, so it’s important to get a flu vaccine annually. The best way to treat asthma is identifying and avoiding triggers, taking medication regularly in order to prevent symptoms, and treating asthma episodes as they occur. Home monitoring of the peak expiratory flow rate (PEFR) can be very helpful, because it measures the airflow through airway and thus the degree of obstruction of airways. A peak flow meter is inexpensive and an easy way to assess asthma control.

Symptoms of Uncontrolled Asthma

If you have any of the following symptoms it’s considered uncontrolled asthma:

  • Coughing, wheezing, rapid breathing, or tightness of the chest experienced daily
  • Nighttime awakening more than twice a week
  • Need to use a short acting inhaler more than twice a week
  • If the asthma symptom is interfering with normal activities

Medications Used in Asthma Treatment

Long acting anticholinergic agents or beta agonists are the mainstay of asthma therapy. Common medications include:

These medications should be used regular for asthma control. Often, these medications can be combined. For example, in case of severe asthma, patients are often prescribed Acidinium and formoterol fumarate to use together on a regular basis.

Short acting inhalers, sometimes called rescue inhalers, are used for immediate symptomatic control:

How Do Asthma Medications Work?

Long acting anticholinergic agents work by competitively inhibiting the action of airway constriction. Short acting inhalers help to open up the airways by relaxing muscles of airway tubes.

Making an Asthma Action Plans

When you have asthma, your goal is to have a normal active life, and good control of your asthma. If your asthma is not well controlled, you may need to increase your medication and learn more about what triggers your asthma attacks. Your physician and pharmacist can provide you with information and an action plan to take care of your condition, so you can continue to be active and healthy.

References:

  1. Bateman, Eric D., et al. “Overall asthma control: the relationship between current control and future risk.” Journal of Allergy and Clinical Immunology 125.3 (2010): 600-608.
  2. Kew, K. M., & Dahri, K. (2016). Long-acting muscarinic antagonists (LAMA) added to combination long-acting beta2-agonists and inhaled corticosteroids (LABA/ICS) versus LABA/ICS for adults with asthma. Cochrane Database of Systematic Reviews, (1).
  3. Friedman, B. C., & Goldman, R. D. (2010). Influenza vaccination for children with asthma. Canadian Family Physician56(11), 1137-1139.
  4. Zheng, T., Yu, J., Oh, M. H., & Zhu, Z. (2011). The atopic march: progression from atopic dermatitis to allergic rhinitis and asthma. Allergy, asthma & immunology research3(2), 67-73.

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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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ScriptSave WellRx and Sinfonia announce medication therapy management partnership

ScriptSave WellRx partners with SinfoniaRx to enhance patient experience with no-cost, convenient access to licensed medical professionals

New York, NY. February 06, 2018 – ScriptSave® WellRx, a prescription savings website and mobile app, and SinfoníaRx, a subsidiary of Tabula Rasa HealthCare (NASDAQ:THRC), a technology company optimizing medical safety through proprietary software solutions and decision support tools, have announced a partnership that will make Medication Therapy Management (MTM) available by phone at no cost to consumers who use the ScriptSave WellRx website or app.

Medication Therapy Management (MTM) programs allow pharmacists to interact directly with patients to optimize the effectiveness and safety of their medication regimens. MTM helps to ensure patients follow their prescription drug regimens through enhanced communications, leading to fewer adverse drug events (ADEs) and overall improved health outcomes.

“Rising costs for prescription medications, combined with the increasing number of health benefit designs that include higher out-of-pocket spend, have placed a bigger financial burden on the patient,” said Marcus Sredzinski, PharmD and Chief Operating Officer of ScriptSave WellRx. “This financial hardship can lead to poor medication adherence and compliance. We are excited to offer ScriptSave WellRx as a tool to help consumers stay on their medication therapy for better health outcomes.

“As one of the nation’s premier medication management companies, SinfoníaRx’s pharmacists bring an important component to ScriptSave WellRx, offering medication information to our members if they have a question about drug interaction, dosage or alternatives,” said Sredzinski.

The Need for Medication Therapy Management

Patients frequently leave their doctor’s office only to discover later they have questions about their prescribed medications. Questions about dosage, side effects, alternative options, and payment options are not uncommon. MTM connects patients with pharmacists to address these concerns and enhances a personalized approach to medication management. Under this partnership, SinfoníaRx will provide clinical pharmacists, while the ScriptSave WellRx technology will connect patients with these pharmacists via their free mobile app.

“By partnering with ScriptSave WellRx, we are helping patients use the latest technology to better understand their medication regimen,” said Kevin Boesen, PharmD, CEO of SinfoníaRx. “As pharmacists, we care about optimizing an individual’s medication therapy. This partnership will ultimately help ensure that patients take their medications correctly and stick to their regimen.”

The partnership will give more than half a million ScriptSave WellRx users access to this free customized care. By improving communication and providing important information, programs like the ScriptSave WellRx ‘Ask A Pharmacist’ MTM program with SinfoníaRx can help prevent deaths, needless hospitalization, unnecessary medical bills, and increased strain on America’s healthcare system.

“ScriptSave already offers patients important information and services regarding their prescriptions,” said Sredzinski. “By partnering with SinfoníaRx, our pharmacists will encourage patients to be proactive about their health and get answers about their medications after leaving the doctor’s office and pharmacy.”

About ScriptSave WellRx

ScriptSave WellRx, owned by parent company Medical Security Card Company, LLC (MSC) and a member of the MedImpact, Inc. family of companies, offers savings on prescription medicines at more than 62,000 local and chain pharmacies, nationwide. ScriptSave WellRx is an online resource that makes prescription medicines more affordable and easier to manage for people who are uninsured, underinsured, or insured with high deductible plans.

About TRHC and SinfoníaRx

TRHC (NASDAQ:TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable health care organizations to optimize medication regimens to improve patient outcomes, reduce hospitalizations, lower healthcare costs and manage risk. TRHC provides solutions for a range of payers, providers and other healthcare organizations. SinfoníaRx is a Tabula Rasa HealthCare company. For more information, visit TRHC.com.

Forward-Looking Statements

This press release includes forward-looking statements that we believe to be reasonable as of today’s date, including statements regarding Medication Risk Stratification and/or Medication Therapy Management under the new scope of work.  Such statements are identified by use of the words “anticipates,” “believes,” “estimates,” “expects,” “intends,” “plans,” “predicts,” “projects,” “should,” and similar expressions.  These forward-looking statements are based on management’s expectations and assumptions as of the date of this press release.  Actual results might differ materially from those explicit or implicit in the forward-looking statements. Important factors that could cause actual results to differ materially include: the need to innovate and provide useful products and services; risks related to changing healthcare and other applicable regulations; increasing consolidation in the healthcare industry; managing our growth effectively; our ability to adequately protect our intellectual property; and the other risk factors set forth from time to time in our filings with the SEC,  including those factors discussed under the caption “Risk Factors” in our most recent annual report on Form 10-K, filed with the SEC on March 14, 2017, and in subsequent reports filed with or furnished to the SEC, copies of which are available free of charge within the Investor Relations section of the TRHC website https://ir.trhc.com or upon request from our Investor Relations Department. Any forward-looking statement speaks only as of the date on which it was made. TRHC assumes no obligation and does not intend to update these forward-looking statements, except as required by law, to reflect events or circumstances occurring after today’s date.


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Medication for insomnia image

by Alyssa Kasher, PharmD Candidate 2018
University of Arizona College of Pharmacy

Sleep is a precious commodity that everyone needs to function. Individual sleep needs are different; some people need a few extra hours while others need less. Some people are light sleepers, while others “sleep like logs.” Sleep habits can also change temporarily, for example during college or after a baby is born. Despite varying needs, all people need adequate sleep to function. Sleep loss negatively affects work performance, mood and overall health. In light of this, it is important to identify factors that are causing you to lose sleep. It’s important to speak with your doctor to see if ongoing sleep problems are caused by clinical insomnia.

How do I know it’s clinical insomnia?

Clinical insomnia is diagnosed by having all of the following 3 conditions1:

  1.       Difficulty falling asleep, staying asleep, or waking up too early
  2.       The above difficulty occurs even with plenty of time to sleep in an ideal environment
  3.       Sleep loss causes decreased function during the daytime

What causes insomnia?

Historically, insomnia has been viewed as a condition that occurs secondary to another disease or condition. Recent studies show us that insomnia does occur by itself without any identifiable reasons1. You should still check with your doctor to see if another medication you take or condition you have is causing insomnia.

Treatment of insomnia

First line treatment for insomnia includes behavioral counseling and improving sleep hygiene. For information on non-drug therapies, check out our previous blog post written by Jenny Bingham, PharmDShould you and your doctor decide to use medication to treat insomnia, it is important to tell your doctor about other medication you are taking as well as any conditions you have.

Over the Counter Medications

  • Antihistamines purchased over the counter are commonly used to induce sleep as they can cause drowsiness1. While they are helpful, these medications should only be used short term. If your problems with sleep continue, you should consult with your doctor to ensure you get the appropriate treatment.

Prescription Medications

  • Non-benzodiazepines include other sleep drugs with varying mechanisms. They differ from benzodiazepines in that they usually have less anti-anxiety effects. Some of these drugs are approved only for short term use; while drugs formulated as extended release are better suited for long term use1.
  • Antidepressants can be used for sleep as many of them have a sedating effect. These are particularly useful in people who concurrently suffer from depression or anxiety, because the drug is also treating a potential cause of insomnia. The only antidepressant specifically FDA approved for insomnia is Silenor (doxepin) 1.
  • Other drugs are used for insomnia that have unique mechanisms
    • Rozerem (ramelteon) is a drug that encourages your body to release melatonin, which makes you sleepy. It has less side effects and less addiction potential than other drug types. It is also not a controlled substance.
    • Belsomra (suvorexant) is a first of its kind drug that blocks molecules in your brain that encourage wakefulness1. Because it has a long half-life, it can still cause day time drowsiness. It is a controlled substance due to abuse potential.

General Considerations

  • Sleep medications can make you drowsy, dizzy or experience day time sedation.
  • Many medications used to treat insomnia have a potential to be habit forming. They may also worsen insomnia if stopped suddenly. Use them exactly as directed by your doctor.
  • Sleep medications can impair your ability to perform tasks, so it is crucial to only take them once you are ready for bed. Do not use alcohol as impairment may be worsened.

Considerations in the Elderly

  • Since most sleep medications cause drowsiness to induce sleep, they can be especially dangerous when used in the elderly. This is true of both over the counter sleep medications (like diphenhydramine) as well as prescription drugs. This drowsiness can cause confusion, memory issues and serious falls. Consult your pharmacist or doctor before starting sleep medication.

 

References:

  1. Arand DL, Bonnet MH. Treatment of insomnia in adults. In: Basow DS, ed., UpToDate. Waltham (MA): UpToDate; 2016

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visit www.WellRx.com to compare the cash discount price at pharmacies near you.
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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.

Download the free WellRx app from the iOS app store or the Google Play Store,
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!

Controlling Your Fibromyalgia

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

Dull, aching pain throughout your entire body. Trouble sleeping. Irritable mood. What could possibly be going on? Is it just in your head? Does anyone else feel like this? Well, if you experience some of these symptoms, one potential cause could be fibromyalgia, which affects the lives of almost 4 million Americans.

Fibromyalgia is a chronic pain condition that, while common, is not entirely understood or easy to manage.  Because the exact cause of this condition is not known, effective treatments are difficult to come across, and it’s common for patients to find themselves spending a lot of money trying to find a cure. Often times the suggested treatment is a combination of both lifestyle changes and medications. Ideally, by following the recommendations of your health care team and putting effort into your treatment plan, you will be in a good position to prevent your fibromyalgia from controlling your life and emptying your wallet.

Lifestyle Changes Can Help Fibromyalgia Symptoms 

First and foremost, physical therapy as well as certain daily exercises may be the key to keeping your symptoms at bay.  Suggested exercises include yoga, tai chi, walking, swimming, biking, and other low impact activities. Exercise has the potential to increase quality of life and reduce severity of pain over time.

Another way to improve your symptoms is sleep hygiene, which involves evaluating and making changes to some of your day time habits that may keep you from getting a good night’s sleep.  Some things to try include avoiding caffeine too late in the day and removing screens (phones, computers, televisions) from the bedroom.  By getting more quality sleep at night, you have the potential to majorly improve your symptoms.

In addition to exercising and changing your sleep habits, certain types of therapy may also be beneficial for some patients. This could include both group sessions and one-on-one sessions to address any potential underlying problems that may be making your symptoms worse.

Medications for Fibromyalgia

When it comes to medications, there are multiple options available, and occasionally, combinations may be necessary.  Many of the medications used for fibromyalgia can also be used to treat other things, such as depression, seizures, muscle spasms, and more.  Your doctor may prescribe one or more of the following medications to help control your symptoms:

It is important to keep in mind that with fibromyalgia, there is no miracle cure.  Some people may wonder whether or not opiates or narcotics (such as oxycodone, morphine, etc,) can be used to help with their pain, but these do not have proven benefit with fibromyalgia and are generally not recommended. Trying medication after medication can become costly, especially if you need to start taking multiple medications.  By working on lifestyle changes and giving the medications a chance to work, you will be on the right track to saving money and energy as well as getting back to a normal life.

 

References

  1. https://www.cdc.gov/arthritis/basics/fibromyalgia.htm
  2. https://www.mayoclinic.org/diseases-conditions/fibromyalgia/home/ovc-20317786
  3. Goldenberg DL. Initial treatment of fibromyalgia in adults. In: UpToDate, Schur PH (Ed), UpToDate, Waltham, MA

Download the free WellRx app from the iOS app store or the Google Play Store,
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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Don't forget your meds on vacation

by Hayde Blanco, 2018 PharmD Candidate

Whether you’re heading for the ski slopes or escaping the cold in a tropical destination, medications are likely the last thing on your mind as you pack for vacation. Between booking a flight, making sure you have your passport, or packing last minute luggage, medications can be easy to forget. However, if you take medications regularly, they should be one of the first things you should be thinking about. Whether you’re just going to the next state or to another country may determine what you need to do before packing your medications.

Things to remember before leaving

Check if you can fill your medications in a different state in case you are not able to receive a refill before leaving. You might also need additional travel insurance, in case something happens when on vacation.

Medications cannot be mailed in the U.S. except under certain circumstances, so if you forget to take them, you might have to pick some up when you arrive at your destination. ​​

A few days or even weeks before leaving, make sure you will have enough medications for a little longer than your planned vacation. In case there is a delay in getting home, you will be prepared without having to worry about getting more medicine.

If you will be traveling into a different time zone, you might need to adjust when you’re taking your medications. Talk to your physician or pharmacist, if there are any medications that need be taken at the same time daily, or to check if you should change how you are taking any of your medicines.

Planes, trains, or automobiles?

If traveling by plane, make sure to take medications in a carry-on bag, in case checked luggage gets lost and so they are easy to access. All medications are allowed on a plane including insulin, inhalers, and over the counter medication. If anything needs to be refrigerated, such as insulin, remember to pack it in an insulated medicine bag or container.

Taking prescription medications internationally

If you are going into another country, some of the medications you are taking might be illegal there. If you are traveling internationally, check that your medications are not on the country’s list of illegal medications. Additionally, take them in their original containers and bring a copy of the prescription, just to stay on the safe side.

Some countries are significantly more strict than others in what medications are allowed into the country. Narcotics or medications with a higher potential for addiction tend to have more restrictions in some countries. This is particularly important to look into ahead of time as it can lead to your medications being confiscated and serious drug related charges such as drug trafficking. Check the international narcotics board if you need to take any opioids to see if they are permitted in your destination country.  Always remember to check for any medication restrictions in the country you are traveling to especially if it is somewhere you have never been before.

If you need to take an EpiPen or other similar medication for an allergic reaction, make sure it is under your name. If you are likely you get a severe allergic reaction, such as anaphylaxis, consider wearing a medical identification bracelet that includes what to do in case of an unexpected reaction.

Do you need a vaccine?

Get informed on any vaccines you might need before traveling to a certain location. It’s important to get vaccinated before traveling, because in the rare instance you would catch something, you don’t want to bring it back to the U.S. and cause a possible outbreak. To read more about getting travel vaccines, check out this previous post.

Know your medications and diagnosis

If you are traveling for an extended time, ask your doctor about a list of possible generic alternatives, as well as a prescription, and diagnoses of what you are taking your medications for. Since some areas will only fill prescriptions written in that country, they might need to write a new prescription, and the medication you are currently taking might not be an option where you are staying.

Although forgetting to pack a vitamin is usually not something to worry about, not taking a chronic medication, such as a blood thinner or a blood pressure medication, for a few days or weeks can lead to more serious consequences and potentially even a trip to the emergency department. In the excitement of planning and packing, don’t forget to pack your medications for your next vacation.

 

References:

  1. https://www.cheapflights.com/news/traveling-with-medication/
  2. https://www.osac.gov/pages/ContentReportDetails.aspx?cid=17386
  3. https://www.miusa.org/resource/tipsheet/medications
  4. https://www.medicinenet.com/script/main/art.asp?articlekey=63470
  5. https://pe.usps.com/text/pub52/pub52c4_019.htm#ep290406

Do you need to save on your prescription medications?
Visit www.WellRx.com to compare prices on medications at pharmacies near you.
Same medications. Same pharmacies. Better prices.

 

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