Cost of not taking your medications image - ScriptSave WellRx

by Roxanna Orsini

It’s a fact. Medications don’t work if patients don’t take them. Taking your medications as prescribed by your physician can help improve the quality and length of your life.

Importance of taking your medications

According to the Centers for Disease Control and Prevention (CDC), nearly 50% of Americans have used at least one prescription with in the last 30 days. One recent study shows that patients who were compliant with taking their statin therapy medications for at least two years had a 30% reduction in the risk of hospitalization for acute myocardial infarctions (heart attacks).1

Even with all the benefits medications can have on a patient’s health, there is still an issue with adherence to medication therapy.

After a patient visits their doctor

  • 20% – 30% of new prescriptions never reach the pharmacy.2
  • Of those prescriptions that do get filled, 50% of the time they are not taken as prescribed by the doctor.2
  • After six months of treatment for a chronic condition, patients tend to reduce the amount of medication they are taking, or stop treatment altogether.

Annual results of medication nonadherence

  • 125,000 deaths and at least 10% of hospitalizations.2
  • Costs the United States health care system between $100 billion and $289 billion annually.2,3

Most common reasons medication treatments are adjusted

Patients often discontinue or alter how they are taking their medications due to a variety of factors. A patient may no longer be adherent to their prescription therapy due to:

  • Cost of the medication
  • Experiencing a potential side effect
  • The patient no longer felt they needed the medication, and,
  • The patient feeling they are currently taking too many medications.

If a medication is too costly, ask your provider if they have any samples to provide, or even ask about possible generic alternatives. Prescription discount services, like ScriptSave WellRx, can often help reduce the cost. You may be surprised to find our cash prices is even lower than your insurance copay! Visit our website to check your medication prices.

When you’re considering an adjustment to your medication therapy, it’s important to follow up and discuss the decision with your healthcare provider. Some medications, if discontinued suddenly, can cause more harm than good.

Ways to improve the way you take your medications

Complications from medication nonadherence are 100% preventable. Here are a few tips to help you remember to take your medications:

  • Using an alarm or calendar
  • Filling a weekly pillbox
  • Taking the medication at the same time every day, create a routine
  • Ask your pharmacy about getting a 90-day supply
  • Ask your insurance provider if mail order provides prescription benefits.

Make sure to keep open communication with your healthcare provider. There are times a patient does not report a side effect or concern with the medication until the next appointment. Try reaching out to your provider right away. They are there to help you find a medication that can help improve your health condition.

References:

  1. Lansberg, P., Lee, A., Lee, Z., Subramaniam, K. and Setia, S. (2018). Nonadherence to statins: individualized intervention strategies outside the pill box. Vascular Health and Risk Management, Volume 14, pp.91-102.
  2. Rosenbaum, L. and Shrank, W. (2013). Taking Our Medicine — Improving Adherence in the Accountability Era. New England Journal of Medicine, 369(8), pp.694-695.
  3. Viswanathan, M., Golin, C., Jones, C., Ashok, M., Blalock, S., Wines, R., Coker-Schwimmer, E., Rosen, D., Sista, P. and Lohr, K. (2012). Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States. Annals of Internal Medicine, 157(11), p.785-95.

If you’re struggling to afford your medications,
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by Sterling Harpst
2019 PharmD Candidate

Testing Your DNA May Actually Help Make Your Medicines Work Better

Many patients have heard of the personal genetic testing kits available for purchase from websites such as 23AndMe or AncestryDNA. There are currently over 250 Direct-to-Consumer (DTC) companies providing services to analyze saliva samples and create customized reports on what your genetic information says about you.1 Advertising for these companies often include claims that DNA testing can be used to determine an individual’s ancestry, risk for getting certain diseases, or even athletic ability.

What is of interest for many patients, however, is the claim that genetic information can be used to make their medicine more effective. With all of the information being presented, it can be easy for patients to become overwhelmed and unsure of how to make sense of it all. Here’s what consumers should know about the evolving field of Pharmacogenomics.

What are genes?

Inside your body there are millions of cells carrying chromosomes. Chromosomes makes up what is referred to as your “genetic blueprint.”  These are passed on to you from your parents and are made of unique information (genes) which code for specific traits. It is thought that there are nearly 30,000 genes in the human body which determine things like eye color, skin tone, height, and even the likelihood you may get a certain disease.2

What is Pharmacogenomics?

Pharmacogenomics is a relatively new field that looks at how a person’s unique genetic material affects their response to drugs. Imagine that three people get the same disease. Conventional medicine would often recommend they be prescribed the exact same medication. This may make one patient well again very quickly but have no impact on the other two. Essentially, pharmacogenomics aims to explain why changes in genetic information cause some drugs to work differently in different people. This new and exciting field hopes to make personalized medicine a reality, resulting in better diagnoses, earlier treatment decisions, more effective medication use, and customized therapy. By combining an understanding of drugs and genes, there is hope that one day all medicine can be personalized based on a patient’s DNA.

The Limitations of Genetic Tests

Although companies make a number of claims about what information their tests can provide, there are a few limitations to consider before completing any genetic test.

Interpretation

Perhaps the biggest limitation to pharmacogenomics is our ability to fully interpret what genetic information means. Modern technology allows us to analyze tens of thousands of genes, however truly understanding that information is another challenge entirely. Imagine a dictionary full of words, except only a few pages have a definition listed for each word. This dictionary could be used to describe where pharmacogenomics currently stands. Although we have advanced tremendously in recent years, we are still far from fully understanding of the meaning of every gene.

Ability to Make Changes

While there are certain therapies that require genetic testing before use, most do not. Many of the DTC genetic tests are designed to report only information related to drug metabolism. For example, if you do not make specific chemicals necessary to break down a drug, the drug may stay in your system longer and result in side effects. If you make those same chemicals in very high amounts, that drug may not reach the intended effect because your body removes it too quickly. For the purpose of making medication changes, this is often the only result tests can provide.

Minimal Regulation

Although there are many tests available today, there is little regulation when it comes to making sure companies are producing accurate results. Claims that you will know your chances for developing diseases such as Alzheimer’s are based on likelihood, not certainty. Many companies advertise tests that can be used to customize your diet and lifestyle as well. Without well documented clinical studies to provide evidence of these statements, the Centers for Disease Control and Intervention (CDC) and Food and Drug Administration (FDA) are often hesitant to agree.3

For some of the newer or less well-known companies, there are significant concerns with the privacy of your genetic information. The Genetic Information Nondiscrimination Act (GINA) was signed into law in 2008, preventing health insurances and employers from discriminating based on genetic information.4 However, with patient permission it is still legal to sell this data, making it very important to read the privacy policies on how they will use your information before taking a test.

If You’re Considering a DTC Genetic Test

It is important to know that the FDA and CDC do not approve genetic testing in place of traditional health care evaluation. The results may provide a likelihood regarding your chance to benefit from certain medications, but the tests are not final. Often the results may not be significant enough to change anything about your medicine. Here are a few points to keep in mind:

  • Talk with your doctor first before completing any genetic test. It is important to know what they would recommend based on your specific circumstance.
  • Ask your doctor if they would be able to interpret the test with you. Some reports can be complicated and very difficult for patients to understand. Genetic counselors are healthcare professionals that are specifically trained to help interpret the meaning of genetic testing results.
  • Before making any changes to medications or lifestyle, ask the opinion of your doctor. Since test results can be challenging to understand, changes could result in dangerous consequences if made incorrectly.
  • Understand your rights regarding privacy. Before sending your DNA to anyone, it is best to know what your information will be used for. Your genetic information is personal, and you may not want companies to share that information for personal gain.

References

  1. Phillips, Andelka M. “Only a Click Away – DTC Genetics for Ancestry, Health, Love and More: A View of the Business and Regulatory Landscape.” Applied & Translational Genomics, vol. 8, 2016, pp. 16–22., doi:10.1016/j.atg.2016.01.001.
  2. “Human Genome Project Completion: Frequently Asked Questions.” National Human Genome Research Institute (NHGRI), 30 Oct. 2010, genome.gov/11006943/human-genome-project-completion-frequently-asked-questions/.
  3. “Regulation of Genetic Tests.” National Human Genome Research Institute (NHGRI), 17 Jan. 2018, genome.gov/10002335/.
  4. Su P. Direct-to-Consumer Genetic Testing: A Comprehensive View. The Yale Journal of Biology and Medicine. 2013;86(3):359-365.

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health information technology - PHI - ScriptSave WellRx image

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

Changes in Health Information Technology (HIT)

Technology in our daily lives is increasing at an astounding pace. Each day, our lives are becoming more connected to technology, but more specifically, to information technology. Recent news events related to personal information have brought some concerns to light. Companies that provide technology services are storing user data and potentially using the data for their own purposes. Technology users are becoming savvier about the data they produce, which companies have access to the data, and how the data is being used. There are government regulations set in place for protecting your health information.

Let’s look at how healthcare providers are using health information and what you can do to protect and use your information effectively.

What are healthcare providers are doing?

The impact healthcare providers have on you is dependent on the amount of information available. Access to health information can help in patient care. Healthcare providers are trying to get connected and stay connected with patients. Consistent, scheduled care can allow healthcare providers to prevent problems or treat them before they take a toll on daily activities.2

Some ways pharmacists are using health information technology is through medication therapy management, clinical decision support, chronic care management, and annual wellness visits. Medication Therapy Management (MTM) utilizes prescription medication claims and information from the patient to find problems with medications, costs, and adherence. Clinical decision support connects patient health information to a knowledge base to guide therapy and reduce medication errors. Using standardized records systems, pharmacists can manage chronic conditions by using data from multiple sources such as pharmacies, hospitals, and clinics.

The progression of a chronic disease can be tracked through the records from multiple sources, thus allowing pharmacists to adjust medication therapy as needed. Access to health information through multiple sources also allows providers to have a better picture of patients’ health during annual wellness visits.1

How can I stay safe?

Healthcare providers are required to provide patients with a Health Insurance Portability and Accountability Act (HIPAA) consent form. Signing this form allows the healthcare facility to utilize your health information for therapy and billing. The healthcare facilities also follow the guidelines set by HIPAA to secure your information and to use it only when necessary. If you are concerned about health information practices you can ask if the facility follows HIPAA guidelines. Most facilities can provide a report on why your information was used and to whom it was shared. You can also request a copy of your health records and make corrections to them, if appropriate.3

What can you do to help your healthcare providers?

Healthcare providers can make more informed decisions when your health information is accurate and complete. The best way to help providers reach informed decisions is to ensure your health records are up to date. These are some categories that should be up to date in your own health records:

  • Allergies
  • Current Medication List
    • Name of the medication
    • Strength of the medication
    • Schedule for taking the medication
    • Route of administration
    • Length of time on each medication
  • Current and Past Health conditions
    • When you were diagnosed
    • Surgical history

Shared decision making is a way for patients and their providers to work together to determine what is right for the patient in order for you, as the patient, to make an informed decision about your health care. When selecting treatments, screening tests, and care plans, it’s important to talk to your provider about your preferences and to fully understand how your personal health information is being used. After all, it is yours!

References

  1. Abubakar, A., & Sinclair, J. (2018). Health infromation tehnology in practice. Pharmacy Today, 58-65.
  2. Dullabh , P., Sondheimer , N., Katsh, E., Young, J.-E., Washington, M., & Stromberg, S. (2014). Improving the Health Records Request Process for Patients Insights from User Experience Research. Chicago: NORC at the Univeristy of Chicago.
  3. S. Department of Health and Human Services. (2017, February 1). Your Rights Under HIPAA. Retrieved from U.S. Health and Human Services: https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

If you’re struggling to afford your medications,
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You may find prices lower than your insurance co-pay!

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Prescription options for allergy meds - scriptsave wellrx

by Marcus Harding
PharmD Candidate Class of 2019, University of Arizona

Seasonal allergies affect anywhere between 10-30% of people worldwide.1 Allergies to one or more common allergens are reaching upwards of 40-50% in school children.1 Allergies occur due to an immune response to something the body considers “foreign,” in other words, strange or unfamiliar. When in contact with the “allergen,” the body produces antibodies which release a chemical called histamine. Histamine and some other chemicals are what cause allergic reactions.1,3

Symptoms of a seasonal allergic response include but are not limited to:3

  • Sneezing and a runny nose
  • Itchy nose and throat
  • Itchy, watery eyes

Symptoms of a more severe allergic response include:

  • Shortness of breath
  • Rash
  • Welts
  • Swelling of mucous membranes

What to Do

When seasonal allergic symptoms occur, you should talk to your primary healthcare provider for help. While your physician can prescribe medications to minimize these symptoms, it is rare that they would be covered by your insurance. This is because most of the medications used for allergies are “over-the-counter” (OTC) medications. This means these medications can be purchased without a prescription, and can be easily found at your local drug store. If you are expecting a medication to be covered by your insurance, but find that it is not, there are options for you. Despite these medications being OTC, they can still be rather expensive, and if you need the medication consistently, the cost can add up. So, what are your options when it comes to these medications if your insurance won’t cover them?

There are many resources available to help you find the best price for OTC medications. The ScriptSave® WellRx app is free and can help you find the best price based on your location. If your physician writes a prescription for an OTC medication, you can use the ScriptSave WellRx app or discount card to get savings on that drug. You can visit www.WellRx.com to download a free card and find the cheapest cash price at a nearby pharmacy.

Lastly, your local pharmacist is a great resource when it comes to cost savings. They are a wealth of knowledge as it pertains to medication information and cost, and if they do not know the answer, they will know where and how to find the answer.

Allergy Medication Options

So now that you have the resources to find the best price, how can you decide which medication to choose? There are so many different types of medications for seasonal allergies, it is hard to know which is the best for you.

Antihistamines are the most common type of medication used for seasonal allergies.1 These are divided into two types, which are the first and second-generation antihistamines. The first-generation antihistamines are more likely to cause drowsiness and sedation compared to the second generation.2 The OTC first-generation antihistamines include:

The OTC second-generation antihistamines include

Second-generation antihistamines are not only less sedating, but also last longer, and are most often only needed once a day, whereas first-generation anti-histamines may need to be taken multiple times a day. All of these examples can be found as tablets, capsules, or suspensions.2

Some common side effects to look out for are:2

  • Dizziness/drowsiness (more common in first-generation)
  • Dry mouth
  • Blurred vision
  • Nausea/vomiting
  • Confusion

Another type of medication that can be used for seasonal allergies is nasal decongestants.1 These medications help to shrink the blood vessels in your nose to reduce the amount of leaking from your nose. These medications result in rapid relief of nasal congestion; however, they are only recommended for 3-5 days of use. Using these medications any longer than the recommendation can cause “rebound congestion,” basically making your symptoms worse. There are several different forms of these medications including topical, oral tablets and nasal sprays.4

Some of the side effects of these medications include:4

  • Rapid and irregular heartbeat
  • irritability
  • nasal dryness
  • high blood pressure
  • difficulty sleeping
  • loss of appetite
  • urinary retention
  • dizziness

Keep in mind that there are daily and monthly limits to the amount of Sudafed you can purchase based on state laws. Although these medications can act rapidly and help with symptoms right away, they should not be used for more than 5 days at a time.4

One last common type of OTC medication used for seasonal allergies is nasal corticosteroids1. These medications act to slow down the body’s immune response to the allergen, reducing the amount of inflammation. Although there are corticosteroids that work for the whole body, these are nasal sprays that are directed to the nose to help with symptoms that occur locally or in the general area, therefore, there are very few of the normal side effects of steroids because the medication is specifically targeted to the nose. Most of the side effects that can happen are in the nose/throat area, although they are not very common.4

The current nasal corticosteroids include:

The side effects of these medications can include:4

  • Nausea
  • Headache
  • Cough
  • Nose bleeds
  • Congestion
  • Throat swelling/irritation
  • Upper respiratory infection.

There are many options for treating your allergies with over the counter medications, including medications that are not antihistamines. If your doctor prescribes a medication and it is not covered by insurance, talk to your pharmacist about OTC alternatives and use the resources available to you to find the best price. That way you can treat your symptoms, feel better, and keep more money in your pocket.

 

References

  1. American Academy of Allergy, Asthma & Immunology. (2018). AAAA. Retrieved from http://www.aaaai.org/. Accessed on 5/16/2018.
  2. Carson S, Lee N, Thakurta S. Drug Class Review: Newer Antihistamines: Final Report Update 2 [Internet]. Portland (OR): Oregon Health & Science University; 2010 May. Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK50554/
  3. Jeffrey L. Kishiyama, M. (2014). Pathophysiology of Disease: An Introduction to Clinical Medicine, 7e. Gary D. Hammer, MD, PhD, Stephen J. McPhee, MD.
  4. Platt, Michael. International Forum of Allergy & Rhinology. Sep2014 Supplement, Vol. 4, pS35-S40. https://www.ncbi.nlm.nih.gov/pubmed/25182353

If you’re struggling to afford your medications,
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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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Prevent shingles - ScriptSave WellRx image

by Alyssa Kasher
PharmD Candidate of 2018

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

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

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

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

Shingles is More Dangerous Than Chickenpox

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

How Can You Prevent Shingles? Vaccination

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

Shingrix: A Better Way to Prevent Shingles

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

Patient populations at the highest risk of shingles include:

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

Facts About Shingrix3

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

References

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