Opioids and alternatives image

by Benjamin Liang
PharmD Candidate Class of 2019, University of Arizona

Opioids and Their Risks

Opioids are a class of medication used to manage short-term and long-term pain. This medication class is well known to healthcare providers, but also to anyone keeping up with local and national news. The current opioid crisis affects thousands of people every year. When taken inappropriately, opioids can result in inadequate pain relief, drug tolerance, addiction, overdose, and even death. A majority of opioid overdoses that result in death are accidental or unintentional.4 Due to the side effects and risks associated with opioids, healthcare providers are being urged to change opioid prescribing habits to meet new opioid regulations and to keep patients safe.

Changing Opioid Regulations

Prescribers are currently facing new opioid regulations at the state and federal levels. The Centers for Medicare and Medicaid Services (CMS) have implemented a maximum daily limit for opioids and some states are also cracking down by regulating the amount of days allowed on initial prescriptions. Arizona restricts initial opioid prescriptions to 5 days and sets an opioid dose limit per day.1 New laws and regulations are changing prescribing habits in hopes of reducing the thousands of opioid related overdoses every year. If you are starting or currently taking opioids, ask your healthcare providers if there are any new rules and regulations specific to your state.

Alternatives to Opioids

There are many alternative medications that can be used to manage acute and chronic pain. Medication selection is based on identifying the cause of the pain. A sprained ankle might be treated with a nonsteroidal anti-inflammatory drug (NSAID) to reduce swelling and inflammation, but the same NSAID would not have benefit for pain caused by nerve damage.

Potentially useful medications for pain include:

Nociceptive pain

  • Non-opioid analgesic agents (aspirin, acetaminophen, NSAIDs)
  • Tramadol
  • Topical analgesic agents
  • Muscle Relaxants

Neuropathic pain

  • Gabapentinoids
  • Antidepressants (venlafaxine, duloxetine, amitriptyline)
  • Topical analgesic agents

Opioid Non-responsive cancer pain

  • Alpha 2 adrenergic agonists

The listed medications and classes are a general list not intended to help in your personal medication selection. The ideal approach to pain management identifies the underlying cause of the pain and selects the appropriate treatment.4  Please consult your healthcare providers for pain identification and medication selection.

Questions for Healthcare Providers

All of the drugs and drug classes listed above can help in pain management depending on the underlying issue. Classification of the cause and level of pain is something that should be handled by healthcare providers. Asking for your pain classification will assist doctors and pharmacists in identifying the correct pain management therapy.

There are some steps you should take before making changes or starting a new medication. When starting or changing medications, please consult your doctor and pharmacist regarding what to expect. Changes should not be made without consulting a healthcare provider because of potential medication interactions and repercussions of abruptly starting or stopping medications. Your healthcare provider should review your medication dose, route, and time to take your medication. The potential side effects and expected outcomes should also be reviewed.3

If you have any concerns with taking opioid medications, talk to your doctor and pharmacist to help identify if opioids or alternative medications are appropriate.

References
1. Ducey, O. o. (2018). ArizonaOpioid Epidemic Act. azgovernor.gov
2. Rosenquist, E. W. (2017). Overview of the treatment of chronic non-cancer pain. UpToDate
3. Rosenquist, E. W. (2018). Evaluation of chronic pain in adults. UpToDate
4. SAMHSA. (2015). Behavioral Health Trends. Rockville, MD: RTI International


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by Derek Matlock
Pharm.D. Candidate 2017
Washington State University

Nearly one-quarter of all U.S. deaths in 2016 we­­­re linked to heart disease, which refers to conditions involved in narrowing or blocking blood vessels, potentially leading to things like heart attack, chest pain, or stroke.

A Steady Decline in Stroke Deaths

Despite the continued and steady decline of deaths due to strokes, they continue account for 1 of every 20 deaths in the US. The decline of deaths due to strokes can be attributed to early identification of strokes, primary prevention, and secondary prevention.

Signs of a Stroke

FAST stroke acronym explained - image - ScriptSave WellRx

As a patient or caregiver, is it important to be able to identify the signs of a stroke as early as possible, as it can influence a positive outcome in patients at risk. The FAST acronym can be a simple and easy tool for identifying a stroke.

 

Face: Does the face look uneven? Ask them to smile.

Arm: Does one arm hang down? Ask them to raise both arms.

Speech: Does their speech sound strange? Ask them to repeat a phrase.

Time: Every second brain cells die. If any of these signs are observed, call 911.

Primary Prevention of a Stroke

Primary prevention refers to the management or treatment of patients who have no prior history of stroke. It involves addressing modifiable risk factors a patient may have, which may include: high blood pressure, diabetes, dyslipidemia, atrial fibrillation, sickle cell disease, post-menopausal hormone replacement therapy, oral contraceptives, diet, weight and body fat.

 

Additionally, your doctor or pharmacist may calculate your Atherosclerotic Cardiovascular Disease (ASCVD) risk score, which estimates a 10-year risk of heart attack or stroke and helps determine the appropriateness of using medications to lower your risk. Some medications that may be added include: statins for cholesterol; thiazide diuretics, ACE inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs), or calcium-channel blockers (CCBs) for blood pressure; and aspirin to help prevent blood clot formation.

Secondary Prevention of a Stroke

Secondary prevention refers to the treatment of patients who have already had a stroke or “mini-stroke.” Interventions commonly prescribed for secondary prevention are summarized using the following ABCDE acronym:

Antiplatelets and Anticoagulants: Antiplatelet medications, like aspirin, clopidogrel, and dipyridamole, can prevent formation of clots. Anticoagulants like warfarin, apixaban, rivaroxaban, and dabigatran can also reduce the ability for the blood to clot and thus lower stroke risk.

Blood pressure-lowering medications: Thiazide diuretics, ACEIs/ARBs, and CCBs help patients control the number one risk factor for a recurrent stroke, high blood pressure.

Cessation of cigarette smoking and Cholesterol-lowering medications: Quitting smoking can significantly lower the risk of strokes, while cholesterol-lowering medications, like statins (e.g., simvastatin, rosuvastatin, atorvastatin), have been shown to lower bad cholesterol as well as decrease the risk of recurrent stroke and mortality.

Diet: In addition to helping weight loss, following a heart healthy diet, or a low-sodium “DASH diet”, may help lower cholesterol, triglycerides, or blood pressure, which decreases your risk of a stroke.

Exercise: For patients capable of exercising, it is recommended to exercise moderately to vigorously for 20 to 40 minutes 3-4 times per week. Be sure to stay within your limits. Good exercises can include walking or riding an exercise bike. Some community centers and gyms even host classes for older patients with physical limitations.

Strokes Still a Significant Cause of Death

Strokes continue to account for a significant amount of deaths in the United States. Your doctor or pharmacist may recommend lifestyle modifications and medications to help lower the possibility of experiencing a new or recurrent stroke. If you are being prescribed medications to lower your stroke risk, be sure to provide your doctor with a thorough medical history and medication list, as some conditions and medications may guide the recommendations your doctor makes. Your pharmacist can also be a valuable resource to any questions you may have.

 

References:

  1. American Heart Association: Heart Disease and Stroke Statistics 2017
  2. Mayo Clinic: Heart Disease
  3. MedicalNewsToday: Top 10 Causes of Death in the U.S.
  4. Medscape: Stroke Prevention
  5. UpToDate: Overview of Primary Prevention of Coronary Heart Disease and Stroke
  6. UpToDate: Overview of Secondary Prevention of Ischemic Stroke

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Cystic Fibrosis breathing treatment - image - ScriptSave WellRx

What is Cystic Fibrosis (CF)?

Cystic fibrosis (CF) is a complex genetic disease that affects the lungs, digestive system, reproductive tract, and sweat glands. In the United States, roughly 30,000 people are living with cystic fibrosis, and another 1,000 are being diagnosed with the disease each year. Most CF patients are diagnosed by age two.

Cystic fibrosis is a progressive condition, involving body’s mucus glands1. Despite its widespread effects on the body, the majority of patients in United States suffer from lung complications with CF. These patients cannot removes excess mucus from their lungs which can lead to the accumulation of thick, viscous secretions1. Mucus accumulation is often a breeding ground for bacterial growth. Children and adolescents with CF often have decreased growth, which could be caused by a combination of malabsorption, decrease in appetite, and increase in energy expenditure due to this condition2. Some CF patients do not make adequate pancreatic enzymes, which are needed to help the body absorb the fat soluble vitamins A,D, E, and K. These vitamins are essential for body growth, immune function, and reproductive health.

Dietary Supplementation

It is important for CF patients to eat a proper diet. They often require a higher caloric intake than other people. Pancreatic enzymes should be replaced if the patient is diagnosed with pancreatic insufficiency. These are some examples of targeted nutrients and/or pharmacological agents that are used in practice:

Non-Pharmacological Nutrients in Cystic Fibrosis3,5

  • Omega 3 fatty acids to lower inflammation.
  • Probiotic supplement to improve digestion.
  • Anti-inflammatory foods, such as extra virgin olive oil, avocadoes, walnuts, and flaxseed oils.
  • Sodium – patients with CF are prone to sodium loss. However, they should carefully monitor their blood pressure if their doctor recommends a high sodium diet.
  • Fluoride – vitamins formulated for the CF patient do not contain fluoride. It is essential to feed them fluoride supplement.
  • Zinc – CF patients under the age of two, who have inadequate growth despite the proper nutrient support, should be evaluated for zinc deficiencies.

Treatments for Cystic Fibrosis

Cystic fibrosis treatment strives to help patients reach a better quality of life by improving breathing and lung capacity. Devices, like oscillatory positive pressure, remove the mucus and secretions of the lungs. Hypertonic saline can be used to increase air flow into the lungs and break up mucus. Breathing exercises and physical therapy can help dislodge the mucus in the chest and promote better breathing4.

Symptoms of Lung Complications in CF Patients

Force expiratory volume (FEV1) is a measure of how much air a person can exhale in a forced breath, and is a good indicator of lung function. It’s an easy, convenient method for monitoring lung function at home. FEV1 below individual goal is the indication of reduction in pulmonary function3. In young children, viruses are the cause of acute exacerbations leading to a decline in pulmonary functions. Diagnosis of pulmonary exacerbations is based on decline in individual health condition with pulmonary symptoms, as compared to recent baseline health status3. Symptoms that are commonly present include:

  • New or increased cough
  • Increase in sputum production or chest congestion
  • Increased fatigue
  • Decreased appetite
  • Changes in sputum appearances

Pharmacological Treatments

CF patient are at a severe risk for influenza infection. Prophylaxis or treatment with oseltamivir (Tamiflu) or zanamivir (Relenza) is often recommended under certain circumstances6. Annual vaccination against viral influenza is recommended to all patients with CF six months and older6.

Many patients with CF have chronic bacterial infection of lungs because of the thick viscus mucus accumulation. Systemic antibiotics are indicated to all patient with CF if they experience new or increased cough, and changes in the color of their mucus, which can indicate bacterial presence due to unnecessary mucus accumulation in the lungs. Antibiotic selection will depend on the results of a sputum culture.

Patients with the CF should focus on the type of food they consume to ensure they are getting proper nutrients. Daily use of the FEV1 is important, which helps to clear the mucus and prevent possible infections.

References:

  1. Cohen, T. S., & Prince, A. (2012). Cystic fibrosis: a mucosal immunodeficiency syndrome. Nature medicine, 18(4), 509-519.
  2. Borowitz D, Baker RD, Stallings V. Consensus report on nutrition for pediatric patients with cystic fibrosis. J Pediatr Gastroenterol Nutr 2002; 35:246.
  3. Reilly JJ, Edwards CA, Weaver LT. Malnutrition in children with cystic fibrosis: the energy-balance equation. J Pediatr Gastroenterol Nutr 1997; 25:127.
  4. Rosenfeld M, Emerson J, Williams-Warren J, et al. Defining a pulmonary exacerbation in cystic fibrosis. J Pediatr 2001; 139:359.
  5. Stallings VA, Stark LJ, Robinson KA, Feranchak AP, Quinton H, Clinical Practice Guidelines on Growth and Nutrition Subcommittee, Ad Hoc Working Group J Am Diet Assoc. 2008;108(5):832.
  6. https://www.uptodate.com/contents/cystic-fibrosis-overview-of-the-treatment-of-lung-disease?sectionName=Influenza%20vaccine&anchor=H20&source=see_link#H20

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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: https://www.immunize.org/catg.d/p4202.pdf. Accessed 2018 Jan 22.

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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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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.

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 discount price at pharmacies near you.
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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

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 discount price at pharmacies near you.
You may find prices lower than your insurance co-pay!

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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!