pharmacist helping customer - wellrx blog image

Most people think of their pharmacist simply as the person who fills their prescription – but pharmacists are trained medical professionals who have earned their Pharm.D.

As part of their education, pharmacists study medications, including how they work within the body, how they interact, and even how they treat diseases on a molecular level. What this means is that your local pharmacist is a fantastic resource.

Your pharmacist can help answer questions about any medications you are taking, provide safety information, and help monitor your side effects, among many other things. So, let’s take a closer look at how your pharmacist can be a resource for managing your health.

1. Your Pharmacist Can Help You Safely Use Medications

Pharmacists are an important part of your healthcare team – especially if you have a medical condition that requires you to take prescription medications.

Your pharmacist is able to provide you with clear instructions on how to take your medications, including:

  • If your medications should be taken with a meal or on an empty stomach
  • How frequently and at what times of the day you should take a medication
  • When and how you should discontinue taking a medication
  • How to properly store your medications

Finding Drug Interactions

Because pharmacists stay current on the latest pharmacology research, they can help you identify potential interactions between medications. This is important for patients who take multiple medications and for patients who see multiple doctors.

For example, a patient may be prescribed drugs by both their cardiologist and their primary physician. Both doctors may not always have complete information on what medications the other has prescribed. However, your pharmacist will be able to tell you:

  • If these medications have potential interactions that you should be aware of
  • If any over-the-counter medications or supplements that you’re taking can also interact with your prescriptions
  • How to tell if you’re experiencing a drug interaction or simply normal side effects

Of course, one of the best ways you can help your doctors and your pharmacist is by providing them with up to date and accurate information. To help, create a complete list of your medications and take a copy with you to the pharmacy.

Related Article: What You Need to Know about Drug Interactions

Provide Your Pharmacist With A List Of Your Medications

Whenever you go to pick-up prescriptions, bring your full list of the prescription, and non-prescription, medications that you’re taking. Also include any vitamins or other nutritional supplements you take.

Give or show a copy of this list to your pharmacist. This is especially important if you don’t always fill your prescriptions at the same pharmacy.

Using this list, your pharmacist will have a much clearer picture of your medication history. As a result, they can more easily identify potential drug interactions, and suggest alternatives. So, keep a list handy and be sure to bring it along with you the next time you visit the pharmacy.

Keep track of your Rx medications with the ScriptSave WellRx Medicine Chest

2. Your Pharmacist Can Help Identify Or Explain Potential Side Effects

While your pharmacist is a great resource for identifying potential drug interactions, they’re also able to tell you about medication side effects.

Pharmacists not only spend years studying how medications work, but they also stay updated on current drug information. This means they have a wealth of knowledge on what you can expect when you start taking a new medication. Your pharmacist can tell you:

  • What side effects you might experience
  • Which side effects are normal
  • How long you can expect a side effect to last
  • When a side effect is serious and requires further attention

Because medications often work in complex ways, and our understanding of how they work can change as we learn more about them, pharmacists are a go-to resource for the most recent and thorough drug information. That means your pharmacist can literally be a life saver.

Related Article: Side Effects of Statin Drugs

Talk With Your Pharmacist About New Prescriptions

When you start taking a new prescription drug, always ask your pharmacist about potential side effects. They’ll be able to keep you informed on what you can expect, and they’re able to provide you with additional details about potentially life-threatening side effects.

Your pharmacist might even know of a newly available alternative drug with fewer side effects than the one you’re currently taking. You can then ask your doctor if it’s an option to help treat your condition.

3. Your Pharmacist Can Help You Manage Your Medications

If you have multiple prescriptions, then you know how difficult it can be to always keep track of all of your medications. While you can’t take your pharmacist home with you, they are an excellent resource for helping you to manage your prescriptions.

Your pharmacist can provide tips on how to carefully monitor your medications, and can share what resources are available to you. They may even recommend options like:

Just as importantly, your pharmacist is able to tell you what to do if you miss a dose of your medication. Depending on the type of medication, size of the dose, and how long it’s been since you last took it, your pharmacist will help you decide on the best course of action.

Set pill and refill reminders with the ScriptSave WellRx App

Ask Your Pharmacist About Medication Options

New medications are being developed and then approved by the FDA every month. If you’re taking multiple medications, your pharmacist may know of newer alternatives. This can help reduce the dose or number of medications you take to treat certain conditions.

Regularly check in with your pharmacist to see if they know of any new options to make your treatment easier to manage. You can then follow-up with your primary physician to see if this is a good option for you. 

Find Rx Discounts with ScriptSave WellRx

We’re here to help you find the lowest cash prices for your prescriptions. Download the ScriptSave WellRx mobile app, search for your drug, and find the lowest prices at the nearest pharmacies. Then, just show your phone to your pharmacist and they’ll take care of the rest.

Don’t have a smartphone? No problem! Just search for your prescriptions on our website, find the best price, and then download, print, or email your Rx coupon. You can also have a ScriptSave WellRx discount card mailed to your home!

history of american pharmacies - wellrx blog image

How They Started and Where They Are Today

By Rosanna Sutherby, PharmD

American pharmacies have come a long way from the years of colonial apothecaries to the modern automated pharmacies of today. Evolution in pharmacist education and changes in the legislature has shifted the roles of pharmacists. Read on for a brief history of pharmacies in the United States.

The Birth of American Pharmacy

In 1630, Governor John Winthrop, founder of Boston, hired British apothecary Robert Cooke to assist him in preparing remedies using herbs imported from England and other natural ingredients.

In 1729, the Irish immigrant Christopher Marshall opened one of the first apothecaries in colonial America. It was located in Philadelphia. For 96 years, the Marshall Apothecary served as a community pharmacy as well as a training ground for aspiring pharmacists. Marshall’s granddaughter, Elizabeth Marshall, took over the store in 1805 and became the second American female pharmacist. The first was Elizabeth Gooking Greenleaf, who bought and ran an apothecary in Boston in 1727.

In 1821, almost 100 years later, the first pharmacy school, Philadelphia College of Pharmacy, opened. Shortly after, in 1852, the first national pharmacy association, the American Pharmaceutical Association (APhA), was established.

Changes in Education

Initially, the way into the profession of pharmacy was through apprenticeship. Someone interested in pharmacy would train under the tutelage of an established pharmacist. The opening of the first pharmacy school shifted education to formal institutions, and even these institutions underwent several changes over the years. Early colleges offered a Graduate in Pharmacy (Ph.G.) degree, which could be turned into a Pharmaceutical Chemist (Ph.C.) degree with an additional year of study.

By the 1940s, the Bachelor of Science in Pharmacy (B.S.Pharm.) was introduced, and in 1997, the Doctor of Pharmacy (Pharm.D.) six-year program became the only accredited pharmacy degree.

The Role of the Pharmacist

Early American pharmacies were referred to as apothecaries, and pharmacists were often called druggists or chemists. The role of the pharmacist then included preparing and dispensing remedies and counseling patients. By the 19th century, Edward Parrish of the APhA standardized the name “pharmacist” for all pharmaceutical practitioners. Until the 1950s, pharmacists prescribed, made, and dispensed medicines and provided patient counseling.

The passing of the 1951 Durham-Humphrey Amendment to the Federal Food, Drug, and Cosmetic Act of 1938 shifted the role of pharmacists. Until then, pharmacists were able to prescribe and dispense any medication except narcotics. The Durham-Humphrey Amendment restricted pharmacists to dispensing medications only with a physician’s prescription. Pharmacist recommendations were limited to over-the-counter (OTC) medications, and their role shifted to dispensing drugs and ensuring medication safety.

In the 1980s, a movement toward clinical pharmacy began to expand the role of pharmacists. By 2003, the Medicare Prescription Drug Improvement and Modernization gave pharmacists the ability to, once again, counsel patients on prescription drugs as well as OTC medications. The clinical pharmacy movement expanded the pharmacist’s role in the community pharmacy to include administering vaccines, counseling patients, and other patient care services. Pharmacists now can focus on disease and chronic condition management, medication management, health and wellness, and other services that help improve patients’ quality of life.

The Evolution of Community Pharmacies

The role of modern-day community pharmacies differs from that of the apothecaries of colonial America. Pharmacists of colonial apothecaries prepared most of the remedies that they dispensed. By 1900, the industrial revolution introduced new forms of medications, such as tablets, gelatin capsules, and enteric-coated pills. These medication forms were mass-produced and lined the shelves of pharmacies of the 1900s. However, compounded medicines, including liquids, creams, ointments, lotions, eye drops, and eardrops, were still common. Today’s pharmacies are largely automated, with robots that count and bottle commonly used medicines, and compounding has become less common.

Record-keeping in the pharmacy has also seen significant advances. Pharmacists have moved from handwriting all prescriptions to using systems in which prescriptions are transferred electronically directly from the prescriber’s office to the patient’s community pharmacy.

To keep track of patient records, pharmacists handwrote all the patients’ prescriptions on index cards that used carbon to transfer the information to receipts. Today’s pharmacies keep electronic patient records.

As the roles of community pharmacists have evolved over time, so have those of pharmacy technicians. The support staff of precomputer pharmacies consisted mainly of cashiers. The introduction of computers in the pharmacy shifted the pharmacy support role from cashier to pharmacy technician. Technicians now are responsible for more than ringing up sales at the register. They can input prescriptions in the computer, answer telephone calls, and assist the pharmacist in preparing medications and setting up immunizations.

Pharmacies today can include patient care areas where pharmacists can provide various clinical patient care services. Clinics with prescribing practitioners inside the stores are becoming more prevalent. The role of pharmacists in community pharmacies has come full circle from colonial times, but today’s highly automated and computerized pharmacies are quite different from yesteryear’s nostalgic apothecaries.

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

https://aihp.org/wp-content/uploads/2018/08/1-Early-Pharmacy-in-America.pdf

http://www.pharmacy.auburn.edu/about/pdf/history-pictures.pdf

https://www.aphafoundation.org/sites/default/files/ckeditor/files/WIP%20mural%20descriptions.pdf

https://brewminate.com/a-brief-history-of-the-pharmacy-in-the-united-states/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821736/

https://www.stlcop.edu/practice/about.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6789634

https://www.pharmacytoday.org/article/S1042-0991(16)30677-6/fulltext

get to know your pharmacist - wellrx blog image

by Marina Matthews, PharmD Candidate,
University of Kansas School of Pharmacy

As one of the most trusted and accessible health care professionals, pharmacists work on the front lines of patient care. Approximately 67,000 pharmacies operate in the United States today, and nearly 95 percent of the population lives within 5 miles of a pharmacy.

While pharmacists are best known for dispensing prescription medications and helping patients use them safely, today’s pharmacists are trained and licensed to provide a number of additional services needed by many patients.

Pharmacist Training

In 2000, the licensing switch was mandated from Registered Pharmacist (RPh) to Doctor of Pharmacy (PharmD). This means all graduates after 2000 have to be licensed as a PharmD and are trained as such. Not only did the licensing switch, but the amount of schooling has also changed. Pharmacy school is an additional 4 years of graduate training after receiving an undergraduate degree or completing all pre-requisites.

Additionally, pharmacists can receive further postgraduate training in the form of a residency or fellowship. These programs can be one or two years of specialized training in various areas of pharmacy, such as emergency medicine, critical care, oncology, and outpatient care.

These pharmacists are highly skilled and most continue to become Board Certified in their specialty. Board certification requires you pass a specialty-specific exam of medical and clinical knowledge.

Pharmacist Services

During school, pharmacists are trained to provide a variety of services. Conducting health and wellness testing, helping patients manage chronic conditions, administering immunizations and helping patients understand and manage their medications are just some of the things pharmacists can help with.

In some states, legislation has been passed allowing pharmacists to provide services to patients that enhance access to care. Services include intramuscular medication administration, such as once monthly antipsychotics. Pharmacists may also prescribe medications under collaborative agreements with providers, and provide point-of-care testing for blood pressure, blood sugar, or flu tests and vaccines.

During COVID-19

Because of the coronavirus, the pharmacist’s role has become more apparent to the community. Some states have already passed laws allowing pharmacists to administer COVID-19 testing to increase access to tests, and it will most likely be nationwide in the near future.

In times of physical distancing, pharmacists are readily available by phone to answer questions and address any medication issues patients have. This provides a network to the community which can reduce visits to the hospital and physician offices. As a community hub for immunizations, once a vaccine is on the market for COVID-19, pharmacists will be able to administer them to patients in the community.

Pharmacists are valuable team members to the health care community. They provide access, support, and necessary services to patients that extend far beyond dispensing prescription medications. While states license and determine the scope of practice for pharmacists, Congress can – and must – better ensure that patients have access to healthcare through pharmacist-provided services.

Using pharmacist services will improve access to healthcare, particularly in medically underserved communities. It also can prevent increased costs of healthcare as it prevents patients from seeking care in more costly settings, including the hospital emergency department.


References:

  1. https://www.pharmacytimes.com/publications/career/2019/careerswinter19/public-perceives-pharmacists-as-some-of-the-most-trusted-professionals
  2. https://www.accp.com/
  3. https://www.bpsweb.org/

5 common rx questions - wellrx blog image

By Rosanna Sutherby, PharmD

Many people have questions and concerns about their medications. Part of my work as a pharmacist involves helping patients navigate the complexities of their medication regimens. The following are the five questions that I hear most commonly at the pharmacy.

1. Can I Drink Alcohol While Taking My Medication?

Many medications interact with alcohol. Alcohol is a central nervous system (CNS) depressant and can increase the drowsiness effect of some medicines. It can also cause nausea and vomiting with some medications, and increase the risk of bleeding with others. Because it is metabolized by your liver, alcohol can interact with other medicines that are also processed through the liver. Mixing alcohol with these medicines can decrease their effectiveness as well, or even make them toxic.

You should avoid drinking alcohol if you are taking any the following medications:

  • sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), and temazepam (Restoril)
  • anxiety medication, such as alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium)
  • antidepressants, such as fluoxetine (Prozac), citalopram (Celexa), and venlafaxine (Effexor)
  • attention deficit-hyperactivity disorder (ADHD) medications, such as methylphenidate (Concerta, Ritalin) and amphetamine/dextroamphetamine (Adderall)
  • warfarin (Coumadin)
    Related: Losing the War on Warfarin
  • muscle relaxants, such as cyclobenzaprine (Flexeril) and Carisoprodol (Soma)
    Related: Medications to Treat Low Back Pain
  • seizure medicine, such as gabapentin (Neurontin), topiramate (Topamax), and lamotrigine (Lamictal)
  • antihistamines, such as diphenhydramine (Benadryl), loratadine (Claritin), and cetirizine (Zyrtec)
  • nausea medicine, such as meclizine (Antivert) and promethazine (Phenergan)
  • opioid pain medication, such as hydrocodone and oxycodone
  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), meloxicam (Mobic), and celecoxib (Celebrex)
  • acetaminophen (Tylenol)
  • diabetes medication, such as glyburide, metformin, and glipizide (Glucotrol)
  • metronidazole (Flagyl)

This list does not include all medicines that may interact with alcohol. Talk with your pharmacist or healthcare provider about the effect of alcohol on your medication.

2. Should I Take My Medication With Food?

It is wise to take some medications with a meal to prevent upset stomach; however, not all drugs should be taken with food. Some medicines work better when taken with a meal, while others require an empty stomach to obtain the best effect.

  • Antibiotics: Take antibiotics with food to minimize diarrhea and upset stomach. Do not take fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin, gemifloxacin, and ofloxacin) with milk or other products that contain cations (e.g., calcium, magnesium, and aluminum).
  • Acetaminophen (Tylenol): You can take acetaminophen with or without food; however, the medication is absorbed faster when taken on an empty stomach.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Always take NSAIDs with food to decrease the risk of stomach bleeding.
  • Antihistamines: Antihistamines, such as fexofenadine (Allegra), loratadine (Claritin), and cetirizine (Zyrtec) work better if you take them on an empty stomach.
  • Antidiabetic medications: To prevent episodes of low blood sugar, you should take medication to treat diabetes with your first meal of the day or 30 minutes before meals.
  • Thyroid medicine: Thyroid medication, such as levothyroxine (Synthroid, Levoxyl, Unithroid) should be taken first thing in the morning on an empty stomach.
  • Medication for osteoporosis (porous, brittle bones): Bisphosphonates (drugs that slow down bone loss), such as alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva) must be taken on an empty stomach with a full glass of water 30 to 60 minutes before eating or taking any other medication.
  • Iron supplements: Iron is absorbed better in an acidic environment; therefore, take it on an empty stomach for maximum absorption. However, if you cannot tolerate iron on an empty stomach, you can take it with food.

3. Can I Take Ibuprofen or Acetaminophen With My Antibiotic?

Generally, you can take ibuprofen or acetaminophen to reduce fever or pain while taking most antibiotics. However, you should avoid ibuprofen and other NSAIDs if you are taking a fluoroquinolone antibiotic, such as the following:

  • ciprofloxacin (Cipro)
  • levofloxacin (Levaquin)
  • moxifloxacin (Avelox)
  • gemifloxacin (Factive)
  • ofloxacin (Floxin)

4. I Forgot to Take My Medicine! What Should I Do?

Generally, if you forget to take your medicine, you can take your medication as soon as you remember if it is not close to the time for your next dose. Do not double your dose, except in the case of oral contraceptives. You can take two birth control pills if you miss one dose. If you miss more than one dose, follow the instructions provided by the manufacturer.

Talk to your pharmacist for more specific instructions on what to do if you forget to take your medicine.

5. Does My Insurance Cover My Medication?

Insurance plans have formularies that help determine what medications will be covered. Often, these formularies are further divided into tiers that represent different out-of-pocket pricing for the medicines. The cost of your medication may depend on your coverage and the tier in which it falls.

If your insurance does not cover your medication or if your medicine falls into a high tier, prescription discount cards can offer prescription savings.

What Are Prescription Discount Cards?

Prescription discount cards, or prescription savings cards, help you obtain the lowest prescription price for your medication. If your insurance does not cover your medication or the cost is too high on insurance, a free Rx savings card may save you up to 80% or more off the retail price. You can use the ScriptSave WellRx discount card for the best prescription savings at a pharmacy near you.

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines

www.wellrx.com/hn/us/assets/health-condition/insomnia/~default/

www.wellrx.com/hn/us/assets/health-condition/anxiety/~default/

www.wellrx.com/hn/us/assets/health-condition/depression/~default/

www.wellrx.com/hn/us/assets/health-condition/epilepsy/~default/

www.wellrx.com/hn/us/assets/health-condition/motion-sickness/~default/

www.wellrx.com/hn/us/assets/health-condition/type-2-diabetes/~default

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191675/

www.wellrx.com/prescriptions/

www.wellrx.com/family-prescription-savingswww.wellrx.com/prescription-discount-card

Do you have GERD - blog image

by Misgana Gebreslassie, PharmD Candidate,
Class of 2020 University of Colorado

Roughly 18 to 26% of Americans have GERD, and the majority are adults between the ages of 30 to 60 years. GERD is a short for gastroesophageal reflux disease, a condition where stomach fluid (acid) backs up into the esophagus (the tube connecting the mouth and the stomach) and causes aggravating symptoms.

Other names that you may have heard for GERD are acid reflux or heartburn. Often acid reflux is caused by muscle weakness of the lower esophageal sphincter, a valve that lets food and drinks into the stomach. [1,2,6]

What are the symptoms of GERD?

Symptoms are typically present after eating and can be different from person to person. The most common ones are: [1,6]

  • Heartburn or burning in the chest
  • Sour taste or burning feeling in the throat
  • Stomach pain
  • Difficulty swallowing food or choking
  • Sore throat or hoarse voice
  • Cough that is not relived by anything
  • Spitting up
  • Frequent burping
  • Asthma

How is GERD treated?

Treatment of acid reflux include lifestyle changes, antacids such as Tums, or stronger stomach acid suppressants like histamine 2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs). [2,3]

Changes to diet or lifestyle can help control symptoms of heartburn and the following changes can be helpful: [2,3,4]

  • Stay away from foods and beverages that can lead to acid reflux or heartburn. Foods and beverages like: coffee, alcohol, chocolate, fatty foods, spicy foods, and citrus fruits/juices
  • Raise the head of your bed 6 to 8 inches
  • Try eating smaller portions and avoid sleeping or lying down within 3 hours of eating a meal
  • Lose weight. Being overweight can contribute to GERD
  • Stop cigarette smoking
  • Wear loose fitting clothes

Do Antacids Treat GERD?

Antacids work by neutralizing or reducing the acidity of the stomach. They are used for milder symptoms and are taken as symptoms occur to relieve heartburn symptoms.  These drugs can affect the absorption of other drugs. Always ask your pharmacist to check for interactions with your current medications as well as how and when to take them.[4]

What Other Drugs Can Treat GERD?

Histamine 2 receptor antagonists (H2RAs) work by suppressing acid secretion in the stomach. They are stronger than antacids in controlling heartburn symptoms. Overall, they are very well tolerated.[3]

Proton pump inhibitors (PPIs) also work by suppressing acid secretion in the stomach. They are used when heartburn symptoms are not well controlled by H2Ras or when symptoms are troublesome affecting quality of life.

PPIs work best when taken on empty stomach half an hour before the first meal of the day. PPIs may alter the way some drugs work. Ask your pharmacist or doctor to check for interactions with your current medications before taking them.[5]

Medicine
Type
Generic
Name
Regulatory
Status
Brand
Name
AntacidsCalcium CarbonateOTCTums
Aluminum hydroxide, magnesium
oxide and simethicone
OTC Maalox
Histamine 2 receptor antagonistsCimetidine OTC Tagamet
Famotidine OTC Pepcid
Nizatidine OTC Axid
Ranitidine OTC Zantac
Proton Pump Inhibitors (PPIs)EsomeprazoleRxNexium
DexlansoprazoleRxDexilant
Lansoprazole15mg – OTC Prevacid
Omeprazole OTC Prilosec
Omeprazole + sodium bicarbonate OTC Zegerid
PantoprazoleRxProtonix
RabeprazoleRxAciphex
OTC = over the counter (without prescription); Rx = prescription only; * Regulatory status obtained from FDA website [7]

All antacids and H2RAs are available over the counter whereas this would only apply to some PPIs. Sometimes these medicines are cheaper without a prescription. If cost is a concern for you ask your pharmacist to help you find ways to reduce your medication cost.[7]

scriptsave wellrx lower prescription price image

References:

  1. Gastroesophageal Reflux Disease (GERD). In DynaMed Plus [database online]. EBSCO Information Services. http://www.dynamed.com.proxy.hsl.ucdenver.edu/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD. Updated April 26, 2019. Accessed on 8/8/10/2019
  2. Patient education: Acid reflux (Gastroesophageal Reflux Disease) in adults. The Basics. In: UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited date unknown). Available from  https://www-uptodate-com. Accessed on 8/10/2019
  3. Kahrilas PJ. Medical management of gastroesophageal reflux disease in adults. In: Talley NJ & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited March 28, 2018]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
  4. Vakil NB. Antiulcer medications: Mechanism of action, pharmacology, and side effects. In: Feldman M & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited March 22, 2018]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
  5. Wolfe MM. Proton pump inhibitors: Overview of use and adverse effects in the treatment of acid related disorders. In: Feldman M & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited Nov 29, 2017]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
  6. Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association Medical Position Statement on the Management of Gastroesophageal Reflux Disease. Gastroenterology. 2008 Oct;135(4):1383-1391
  7. Over-The-Counter (OTC) Heartburn Treatment. U.S. Food & Drug Admiration. https://www.fda.gov/drugs/drug-information-consumers/over-counter-otc-heartburn-treatment. Published date unknown. Updated on March 5, 2018. Accessed 8/10/2019


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measles vaccine image

by Gabriel Rallison, PharmD. Candidate, Class of 2020
University of Arizona

If you follow recent news, you’ve probably heard about measles outbreaks cropping up in California1, Washington2, and New York.3 The Centers for Disease Control and Prevention (CDC) reports, as of September 2019 there have been 1,241 confirmed cases of measles in the United States this year, a number already higher than the previous four years combined.4 With so many cases, this year marks the largest outbreak of measles in the United States in 27 years.5

What is measles?

Measles, also known as rubeola, is a viral disease that can lead to fever, cough, runny nose, and red, watery eyes.4 These symptoms will usually appear about 7 to 14 days after being infected, before which a person may not even know they are sick.

In addition, a few days after these symptoms start to show, a measles rash will appear. This rash normally starts on the face and spreads down the body, starting with small red spots that will merge over time. The rash will usually remain for about five days before fading away.

Why should I be concerned?

The measles virus is spread when an infected person coughs or sneezes, releasing viruses into the surrounding area. Once in the air, the virus can remain there for up to 2 hours, with anyone passing through the area at risk of breathing in the virus and getting sick.3,4

This virus is very contagious, which means that if exposed people are not protected by a vaccine, they have a 9 out of 10 chance of catching the disease!2 While measles is technically considered eliminated in the US, recent cases come from unvaccinated people traveling outside of the country, catching measles abroad, and bringing it home with them.1,2,4

Measles symptoms generally are not very severe, but this disease can have very serious complications including:

  • permanent hearing loss
  • severe lung diseases
  • swelling of the brain
  • pregnancy complications
  • death.4

Before the vaccine for measles was developed, over 3 million people were infected annually, with 48,000 hospitalized and 400 dying from measles and related complications each year.

How can I protect myself?

The best protection for measles is the vaccination.1,2,3,4 The measles vaccination is available as a combination vaccination with mumps and rubella, together called the measles-mumps-rubella or MMR vaccine.4

This vaccine works by teaching your body’s immune cells what to watch out for and helps prepare the body’s defenses for the viral attack. The vaccine is very effective, and when used as recommended is 97% effective at preventing measles.4

For most adults, the CDC recommends getting one dose of the vaccine, with certain conditions requiring a second dose achieve full immunity.9 In small children, the recommendation is to get one dose at 1 year old, and a second dose between 4 to 6 years old.9 The vaccine can and should be given to children under 1 year of age if planning on traveling internationally.3,9

Is the vaccine safe?

Yes, the MMR vaccine has been shown in repeated studies and trials to be safe and effective.2,3,6 While there have been concerns expressed that vaccines may cause autism, dozens of studies over the last 25 years including tens of thousands of patients have found no link between vaccines and autism.7,8

Additionally, the vaccine component purported to cause harm, a preservative called thimerosal, has never been a part of the MMR vaccine.6 The most common side effect of vaccines is redness and soreness at the injection site, and in rare cases a mild fever or rash may arise.4

Where can I get the vaccine?

The MMR vaccine is available at your doctor’s office or your pharmacy and is free of charge with most insurance plans.  If you don’t have a regular doctor or pharmacy, you can use https://vaccinefinder.org/ to find a location near you.10

Pharmacies are especially convenient, with 9 in 10 Americans living within 5 miles of a pharmacy.  At most pharmacies, no appointment is required, and your pharmacist can have you vaccinated and on your way in mere minutes. So then, what are you waiting for?

References

  1. Disneyland, Universal Studios Hollywood Visitors Reportedly Exposed to Measles. TIME. Aug 24, 2019. https://time.com/5660904/new-zealand-teenager-measles-southern-california/ Accessed Sept 20, 2019.
  2. Measles Cases Mount in Pacific Northwest Outbreak. NPR News. Feb 8, 2019. https://www.npr.org/sections/health-shots/2019/02/08/692665531/measles-cases-mount-in-pacific-northwest-outbreak. Accessed Sept 23, 2019.
  3. US in danger of losing measles-free status, a ‘mortifying’ effect of anti-vax movement. USA Today. Sept 13, 2019. https://www.usatoday.com/story/news/nation/2019/09/13/us-could-lose-measles-free-status-if-outbreak-continues-new-york/2300281001/ Accessed Sept 19, 2019.
  4. Measles (Rubeola). Centers for Disease Control and Prevention. N.d. https://www.cdc.gov/measles/index.html Accessed Sept 19, 2019.
  5. U.S. measles cases reach highest level in 27 years. NBC News. May 31, 2019. https://www.nbcnews.com/health/kids-health/u-s-measles-cases-reach-highest-level-27-years-n1012401 Accessed Sept 23, 2019.
  6. Vaccine Safety. Centers for Disease Control and Prevention. N.d. https://www.cdc.gov/vaccinesafety/index.html Accessed Sept 20, 2019.
  7. Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism. Journal of the American Medical Association. April 21, 2015. https://jamanetwork.com/journals/jama/fullarticle/2275444 Accessed Sept 23, 2019.
  8. MMR Vaccine Does Not Cause Autism: Examine the evidence! Immunization Action Coalition. N.d. http://www.immunize.org/catg.d/p4026.pdf Accessed Sept 23, 2019.
  9. Immunization Schedules. Centers for Disease Control and Prevention. N.d. https://www.cdc.gov/vaccines/schedules/index.html Accessed Sept 19, 2019.
  10. Vaccine Finder. HealthMap.  N.d.  https://vaccinefinder.org/


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by Cherokie Dyer, PharmD Candidate,
Class of 2020, University of Florida

When was the last time you felt stressed?

Stress is so common that there is an organization called, “The American Institute of Stress.” According to this group, there are 50 common signs and symptoms of stress. Many of the signs we think about when it comes to stress are difficulty making decisions, excessive anxiety, worry, guilt, and nervousness. Other common signs include increased frustration, irritability, and edginess. We can determine these signs based on our interactions with people. But… did you ever think about what stress is doing to your body on the inside?

How does Stress affect the body?

Stress can be a good thing in an emergency. It turns on your ‘fight or flight’ response. This gives you that ‘adrenaline rush’ feeling, which is the release of cortisol and epinephrine. Stress raises your blood pressure, makes your heart beat faster, and boosts sugar levels in your blood. It can also slow down your digestive tract, make your muscles tense up, and make your breathing become more rapid. All these bodily reactions are great to help you act during a crisis.

However, it’s not good when our bodies are constantly flooded with stress for a long period of time.

  • Heart racing and blood rushing may cause inflammation in arteries and lead to heart attacks or strokes.
  • Constant boosts in blood sugar can affect insulin and lead to pre-diabetes.
  • An impaired digestive tract can keep the body from getting valuable nutrients and lead to hard or loose stools.
  • Constantly tensed muscles can cause tension headaches and migraines.
  • Rapid breathing can cause hyperventilation and lead to panic attacks.
  • Increased cortisol may cause the body to hold on to belly fat.
  • These reactions can start to make the menstrual cycle irregular or lower sperm counts.
  • Stress can also affect eating patterns making us want to eat more or less than usual.

Believe it or not, constant stress can wreak havoc on our body in a multitude of other ways. Especially if you already have medical conditions like heart disease, diabetes, irritable bowel syndrome, or obesity. Your constant stress could very well be the thing that’s preventing your medications from helping you get better.

Two Key Strategies to Manage Stress

Try to prevent it and cope with it when it comes. Figure out the things that trigger your stress. Do your best to avoid them or work around them. For instance, if leaving on time for work stresses you out, invest in a new alarm or get up even earlier to give yourself more time.

There are other ways to prevent stress besides just avoiding your triggers.

  • Carve out some more alone time for yourself
  • Do more of the things that you bring you joy
  • Make the effort to get near 8 hours of sleep
  • Eat more fresh foods and whole foods
  • Avoid stimulants like caffeine.

If you are already feeling stressed out, then there are a ton of options that you can try:

  • Calming activities like prayer, yoga, massages, and/or deep breathing
  • Active movements like going for walks, jogs, lifting weights, or taking group classes like kickboxing
  • More of your favorite hobby, listen to music you like, play with your pet more often, or participate in volunteer work.

The options are endless and there is no correct answer!

Bottom Line

Stress can be negative for both our sanity and our bodies. There are a variety of ways to deal with stress. Identify when you feel the most stressed out. Do your best to avoid that trigger and/or cope with those feelings, and your body will thank you in return.


Cherokie Dyer is a PharmD candidate of 2020 who is also pursuing a career in nutrition and holistic wellness. She founded Healthy La Vie, a wellness platform aimed to help people live healthier lives through health education, nutrition and holistic wellness tips. She’s written many articles bringing the world of medicine and nutrition together on the Healthy La Vie blog.

References

https://www.stress.org/stress-effects
https://www.stress.org/military/combat-stress/management
https://www.stress.org/daily-life



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by Emily Ross, PharmD Candidate,
Class of 2020

Improving Medication Adherence and Management

Managing several different medications can be overwhelming, confusing and time-consuming. Without effective medication management, errors and missed doses may happen easily. This can lead to ineffective drug therapy and not getting results from taking medications. One key to proper medication management is organization. There are simple ways to create organizational systems into your daily routine to get the most benefit from your drug therapy.

Medication Management Tools

  • Pill Box: One of the simplest ways to keep medications organized is to use a daily or weekly pill box. There are a variety of sizes and colors to fit your needs. These range from simple ones that have a compartment for each day to more complex ones that have dividers for each dosage time (ex: morning, afternoon, evening).
  • Medication List: Keeping and maintaining a current list of all the medications you take is very useful to keep up to date on your treatment. It is important to include all over the counter drugs, supplements, and herbals that you may take as well. Taking this to your doctor appointments and the pharmacy ensures all your providers are aware of your medications and can help prevent duplicate drug therapies and potentially harmful drug interactions.
  • Medication App: There is an app for about anything – including managing your medications! There are several apps available to download to your phone or mobile device. Read about the different features of each one and then choose one that best meets your needs. These are available for both android and apple devices. Some examples are:
    • MyMeds: Connects patients, caregivers, and providers to help have better understanding of current medications
    • MyMedSchedule Plus: Simple and easy to use, offers reminders, pictures of medications and tracks how often the medication is taken
    • The ScriptSave WellRx App: In addition to providing prescription price transparency, the ScriptSave WellRx app allows patients to set Take Your Pill reminders, as well as when it’s time to refill prescriptions.

      The WellRx platform also provides free access to some potentially life-saving functionality:
      • Drug Interaction Warnings: Patients can receive and share warnings with their caregivers when drugs in their personal in-app Medicine Chest might interact with each other.
      • Lifestyle Interaction Warnings: This includes warnings about potential drug interactions with certain foods patients eat, or activities they might engage in.
      • Expanded Drug Information: Patients can view detailed information, images, and videos for drugs within the Medicine Chest. Much of this information is available in English and Spanish.

Tips for Managing Your Medications

Now that you have all your medications organized, the next step is remembering to take them! It is easy to forget or miss a dose of your medication but with a few helpful tips – you can minimize the amount of times this happens and improve adherence.  

  • Reminders: This can be as simple as programming a daily reminder or alarm into your phone that alerts you when it is time to take your medication. You could go the more classic route and have a note that is posted in a spot that you see it every day such as the bedside table, bathroom mirror or fridge. You can also set reminders in the ScriptSave WellRx mobile app.
  • Timers: If a device separate from your phone is more your style, there are several options that can provide an alarm or noise to help remind you that it is time to take medication. Likely, there are many items you already own, such as an alarm clock or kitchen timer, that can be set to the time you need to take medication. E-pill® offers several medication alarms and even has devices that combine pill boxes with reminder alerts.
  • Routine: Include taking medications into a daily routine. First, think of a task you do every day, such as brushing your teeth. Make a point to take your medication at the same time you brush your teeth. By joining the tasks together, taking your medications will become part of your daily routine and decrease the chance of missing a dose.
  • Medication Synchronization: Many pharmacies offer medication synchronization programs that allow you to pick up all your medications at one time. This not only cuts down on trips to the pharmacy but also lessens the chance of allowing a prescription to run out before returning to the pharmacy for more refills.
  • 90-Day Supply: If allowed by your insurance, obtaining a 90-day supply of medication is a good way to have adequate stock and minimize pharmacy trips. Similar to the idea of syncing your medications, there is less of a chance of running out of medication and missing doses.

With all these organization and adherence tips, you’ll be a pro at knowing your medication and taking them on time! There are many benefits that come from organization, such as reducing the stress of managing and taking multiple medications. Additionally, it may decrease health care cost by saving the need for more doctor appointment or medications due to gaps in drug therapy.

These are easy steps that can be done to increase how well your medicines work for you. By using the tools for a good organization system and following the adherence tips, you can improve your overall health and well-being.

References:

Fayed, L. (2019, June 24). How to Manage and Organize Medication for Your Safety. Retrieved from https://www.verywellhealth.com/ways-to-manage-your-medication-514511

MyMeds: Redefining the Medication Experience. (n.d.). Retrieved from https://my-meds.com

MyMedSchedule: Free medication schedules, reminders, and health tracker. (n.d.). Retrieved from https://secure.medactionplan.com/mymedschedule/

Pill Timers. (n.d.). Retrieved from https://www.epill.com/alarms.html

ScriptSave WellRx App Makes Medication Management Easier: https://news.wellrx.com/2019/01/23/scriptsave-wellrx-app-makes-medication-management-easier/



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Treatment for Depression and Anxiety: The Fight to End Suicide

by Cherokie Dyer, PharmD candidate class of 2020,
University of Florida

Alarming Suicide Statistics

Over the past 17 years, rates for death by suicide has dramatically risen here in the United States. From 1999 to 2016, 25 states had over a 30% increase in their suicide rates. There’s rarely any one reason for someone to commit suicide. However, most suicides are attributed to life stressors, loss of a relationship, and a recent or approaching crisis. Another huge contributor is the presence of a mental health disorder such as depression or anxiety.

In the year of 2017, the CDC states that there were:

  • 44,965 suicide deaths
  • 13.9 suicide deaths per every 100,000 people
  • 39% of adults 18 and older had serious psychological distress in the past 30 days
  • 56.8 million physician visits resulted in mental, behavioral, and neurodevelopmental disorders as a diagnosis
  • 5.5 million emergency room visits were due to mental health disorders

The Good News

The amount of people being treated for depression and anxiety disorders is also rising. In 2012, the World Health Organization stated that 350 million people across the globe were affected by depressive disorder. This is followed with an increase in diagnosis and treatment of these disorders.

Common Anti-Depressant and Antianxiety medications include:

Brand Name Generic Name Drug Class
Zoloft Sertraline Selective Serotonin Reuptake Inhibitor
Lexapro Escitalopram Selective Serotonin Reuptake Inhibitor
Prozac Fluoxetine Selective Serotonin Reuptake Inhibitor
Wellbutrin Bupropion Dopamine/Norepinephrine Reuptake Inhibitor
Cymbalta Duloxetine Serotonin/Norepinephrine Reuptake Inhibitor
Effexor Venlafaxine Serotonin/Norepinephrine Reuptake Inhibitor
Pristiq Desvenlafaxine Serotonin/Norepinephrine Reuptake Inhibitor
Remeron Mirtazapine Alpha-2 Antagonist
  Amitriptyline Tricyclic Antidepressant

It’s great that more people are getting help for their mental health conditions. The increase in people getting treatment will help to decrease the number of people wanting to harm themselves. If you have sought treatment for anxiety or depression or know someone who sought treatment, I am so happy! Everyone’s life is valuable. If you or someone you know suffers from anxiety or depression and hasn’t yet felt comfortable seeking treatment, don’t hesitate. The awareness of these conditions and options for treatment are expanding; set up an appointment to talk about what you are experiencing.

Things to Remember about your Antidepressants or Antianxiety Meds

These medications take time to work. In many cases, you won’t see an effect until after about 1 month. Taking your medications as prescribed can help strengthen their effectiveness and prevent side effects like dizziness, fatigue and nausea. If significant time passes and you still don’t feel any better, ask your doctor to try you on another medicine. Never quit these medicines abruptly as this can result in bothersome, and sometimes serious withdrawal symptoms. Be sure to follow your doctor’s instruction to taper these medications if it’s determined that they need to be stopped.

Outside of Medicine

Outside of prescription medication, these are 3 valuable ways to improve mental health. Incorporating these changes along with your medication can also increase their effectiveness.

Nutrition: Your body makes all your brain chemicals from the food you eat daily. That’s your protein, complex carbohydrates (fruits, veggies, whole grains), and good fats. If you don’t eat this kind of balanced diet, you may consider taking a daily multivitamin.

Sleep: Getting close to 8 hours of sleep each day gives your body the time to make more brain chemicals. It’s the best opportunity for your body to fix and replace other cells like the nerves and muscles.

Exercise:  Daily exercise improves your brain activity and increases the release of brain chemicals. A great example would be going for a brisk walk outside. The movement, along with getting at least 10 minutes of sun each day, is another great way to both exercise and get your daily vitamin D allowance. Not to mention exercise is a good way to relieve anxiety and avoid personal stressors! 

Suicide Lifeline

If you or someone you know are thinking about harming themselves in any way, call the National Suicide Prevention Lifeline at 1-800-273-8255. You can also text HOME to 741741 to receive texts from the Crisis Text Line. If you feel there is an emergency, you should always call 911 or go to the nearest hospital.


Cherokie Dyer is a PharmD candidate of 2020 who is also pursuing a career in nutrition and holistic wellness. She founded Healthy La Vie, a wellness platform aimed to help people live healthier lives through health education, nutrition and holistic wellness tips. She’s written many articles bringing the world of medicine and nutrition together on the Healthy La Vie blog.


References:

Suicide Prevention websites:

https://www.crisistextline.org/

https://suicidepreventionlifeline.org/

Statistics:

https://www.grandviewresearch.com/industry-analysis/anxiety-disorders-and-depression-treatment-market

https://www.cdc.gov/nchs/fastats/mental-health.htm

https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a1.htm?s_cid=mm6722a1_w

Medication and Nutrition information:

https://www.fda.gov/consumers/free-publications-women/depression-medicines-help-you

http://www.martiefankhauser.com/


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by Jennifer Bingham, PharmD, BCACP & Stephanie Forbes, PharmD

The Prescription Opioid Addiction Epidemic

Pain is complex and the sensation and intensity can vary among individuals who are suffering, so there are many treatment options — mind-body techniques, acupuncture or physical therapy, and medications, both over the counter and prescription. For many patients with severe pain from injuries or surgery, opioid painkillers are supposed to provide pain relief, but because they have been heavily marketed and inappropriately prescribed, there has been an ever increasing number of deaths throughout the U.S. caused by misuse and addiction.

What is Narcan®?

Narcan® (naloxone hydrochloride) is an opioid antidote.1 It is indicated for patients that has suspected opioid overdose symptoms, such as respiratory and central nervous system depression.1 It is available in two formulations, including injectable and nasal preparations. The nasal spray contains one dose per unit,1 hence it is important to contact 9-1-1 for emergency medical assistance once opioid overdose is suspected to ensure additional assistance is available if needed. 

Who Should Use Narcan Nasal Spray?

Narcan nasal spray is intended for use by people who are experiencing an opioid overdose or are showing signs of opioid overdose.2,3 As mentioned above, it’s use is not a substitute for emergency medical care. Whenever administering Narcan, always call 9-1-1 right away.  Since it is an opioid antagonist, Narcan only works to reverse the effects of opioids, both prescription and non-prescription. Some examples of opioids it reverses are morphine, codeine, opium, hydrocodone, heroin and methadone.4

Who should have Narcan Nasal Spray?

People who receive Narcan are typically taking high doses of opioids for pain management over a long treatment period.2,5 Additionally, those taking extended-release or long-acting opioid medications or receive rotating opioid medication regimens may also have Narcan.   Patients who have a known hypersensitivity to naloxone hydrochloride should not use Narcan.1 Narcan access (needing a prescription) varies across states and the medication should be replaced before the expiration date passes.5

How to Store Narcan Nasal spray?

Narcan nasal spray should be stored in the blister and cartons provided until use.1 A controlled room temperature between 59°F to 77°F with protection from light is recommended for storage, and the product should not be frozen. The nasal spray may be stored at temperatures outside of this range (39°F to 104°F) for brief periods of time only.

Ask your pharmacist if you should talk to your provider about Narcan.

References:

  1. Narcan Nasal Spray (naloxone hydrochloride) [prescribing information]. Radnor, PA: Adapt Pharma Inc; January 2017.
  2. Naloxone. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone/. Last Updated April 11, 2019; Accessed June 3, 2019. 
  3. Coffin, Phillip MD, MIA. Prevention of lethal opioid overdose in the community. UptoDate®. Last Updated June 25, 2018. Accessed June 3, 2019.
  4. What Are Opioids. Department of Health and Human Services. https://www.hhs.gov/opioids/prevention/index.html. Last Updated May 15, 2018. Accessed June 4, 2019
  5. Opioid Overdose Reversal with Naloxone. National Institute of Drug Abuse. https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio/. Last Updated April 2018, Accessed June 3, 2019.

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by Cindy Cho, PharmD Candidate Class of 2019,
The University of Arizona College of Pharmacy

Are You Doing This Important Step After Using Your Inhaler?

If you use an inhaler for a breathing condition, like asthma, you may have been told by your doctor that you will need to rinse your mouth with water and spit after you use your inhaler. It may seem like a cumbersome additional step, especially since it already takes time out of your day to use your inhaler, so why is it important to spend time to rinse and spit after using your inhaler?

Not All Inhalers Require You to Rinse and Spit

Just to clarify, you don’t need to rinse and spit with every inhaler. There are numerous inhalers on the market with different active ingredients and different purposes (For more on this, refer to this post on the difference between rescue and controller inhalers: (https://news.wellrx.com/2016/08/18/breathing-condition-meet-lifesaver/).

However, a common type of inhaler that does require you to rinse your mouth after each use is called an inhaled corticosteroid (ICS) inhaler. ICS inhalers contain small amounts of steroids to help people breathe easier. Other types of inhalers have different active ingredients (e.g., albuterol, formoterol, tiotropium), so it is not necessary to rinse your mouth after using those.

Common ICS Inhalers

Examples of common ICS inhalers, or combination inhalers that contain a corticosteroid, are:

  • Advair Diskus & Advair HFA (fluticasone/salmeterol)
  • Aerobid (flunisolide)
  • Alvesco, Omnaris, Zetonna (ciclesonide)
  • Arnuity Ellipta (fluticasone furoate)
  • Asmanex (mometasone)
  • Azmacort (triamcinolone)
  • Dulera (mometasone/formoterol)
  • Flovent, Flovent HFA (fluticasone)
  • Pulmicort, Rhinocort (budesonide)
  • Qnasl, Qvar (beclomethasone)
  • Symbicort (budesonide/formoterol)

If you are using one of these inhalers or have been told that your inhaler contains a steroid in it, you will need to rinse your mouth with water and spit after each use.

Why do I Have to Rinse and Spit with ICS Inhalers?

ICS inhalers have a small amount of corticosteroid medication that reduces inflammation in your bronchial tubes and ultimately open your airways to help you breathe easier.1 These medications can be delivered through metered dose inhalers, dry powder inhalers, or through a nebulizer. When you breathe in your steroid inhaler medication, a small amount of steroid can stick to your mouth and throat as it makes its way into your lungs to help you breathe. If this small amount of steroid is not rinsed out from the inside of your mouth or throat, it can cause a fungal infection known as thrush.2

What You Need to Know About Thrush3

Oral thrush in adults generally looks like thick, white or cream-colored spots inside the mouth. The inside lining of your mouth may appear swollen and slightly red and may feel uncomfortable or a burning sensation. The good thing is that thrush is a treatable infection. Your doctor will prescribe an antifungal medicine in the form of a tablet, gel, lozenge, or mouthwash to help treat it. The better news is that this condition is preventable with proper rinsing and spitting.  

What You Can Do

Make sure to rinse your mouth with water and spit after using your ICS inhaler to prevent thrush. Another way to make it easier for you to incorporate rinsing your mouth after using your ICS inhaler is to brush your teeth after using your inhaler. As a friendly reminder, your ICS inhaler should be used on a routine basis, unless your doctor tells you otherwise, even when your breathing seems better. These inhalers will help maintain your breathing over time to prevent breathing-related complications and keep you out of the hospital.

References:

  1. Barnes PJ. Inhaled Corticosteroids. Pharmaceuticals (Basel). 2010;3(3):514-540. Published 2010 Mar 8. doi:10.3390/ph3030514
  2. Shuto H, Nagata M, Terashi Y, Yamaguchi M, Takizawa T, Shuto C, Watanabe K, Tosaka K, Okano M, Noguchi H. Esophageal candidiasis as complication of inhaled steroid therapy. Arerugi 2003; 52(11)1053–1064
  3. Oral thrush – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/oral-thrush/symptoms-causes/syc-20353533. Published March 8, 2018. Retrieved February 22, 2019.

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by Ryan Lowe, PharmD Candidate,
University of Arizona

The More Medications, The Merrier?

Have you ever heard of the term “polypharmacy” before? When you break that word down you get “poly”, which means multiple, and “pharmacy”, which means medications. Polypharmacy is defined as the use of multiple drugs, or more than are medically necessary.1 Depending on who you’re talking to will determine where their cut off is for ‘multiple drugs’, with some thinking as few as three is considered polypharmacy, while others say you need as many as five.

An example of using more drugs than are medically necessary would be having two blood pressure medications when your blood pressure has been running low. There are a lot of concerns about polypharmacy, especially in the elderly population.

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Polypharmacy in the Elderly

A study published in 2004 wanted to find out how prevalent polypharmacy was in the nursing home setting. With over 13,000 patients in the study, they found that approximately 40% of them were taking 9 or more medications.2 While 9 medications may seem absurd, as this study shows it’s not that unheard of.

As you can well imagine, taking multiple medications can lead to a variety of potential concerns. First off, the more medications you take means the more money it will cost to pay for those medications. Added hospital or clinic visits to manage those medications also contribute to the rise in costs. Another major concern is that of drug side effects, commonly referred to as Adverse Drug Events (ADEs).

Some patients report a side effect to one medication which then gets an entirely new medication to replace it. This can lead to a cycle of adding new medications which leads to polypharmacy. The more medications you must take also makes it harder to remember when to take them. Some patients struggle to take only one or two medications every day, so having upwards of nine becomes a very daunting task. Despite all these risks, there is still one concern that is at the forefront of any pharmacist’s mind: drug interactions.

The Major Risk of Drug Interactions in Polypharmacy

Drug-drug interactions, or DDIs, happen when one medication interferes with the way another medication works in your body. If you are taking nine medications at the same time, there is a much greater risk that at least two of those drugs will interact with one another. These interactions can range from the benign to the severe, sometimes increasing the effect of one drug or preventing it from doing its job.

Here is a list of some (but not all) of the most common drug interactions:

  • Warfarin: If you take warfarin to help thin your blood to prevent a stroke or DVT, you should know that warfarin has numerous DDIs. Ibuprofen or Aleve should be avoided when taking warfarin, and many antibiotics can also affect the level of warfarin in your body.
  • Grapefruit: You may have heard about some drugs interacting with grapefruit (including juice), but what drugs and why? Grapefruit can block an enzyme in your body that many drugs use as their metabolizing agent. When this happens, the amount of drug rises in your body to sometimes dangerous levels. If you’re taking any of these drugs then you should avoid eating grapefruit: some statin medications (like simvastatin and atorvastatin), nifedipine, cyclosporine, buspirone, amiodarone, and fexofenadine (generic Allegra).3
  • Levothyroxine: When you take levothyroxine, you’re supposed to take it one hour before you eat breakfast in the morning. This is because levothyroxine interacts with almost every food you can think of. If you take the drug with breakfast, lunch, or dinner then it will not be able to absorb fully, and it won’t reach its desired effect.

There are several tools available to check for drug interactions. The free ScriptSave WellRx app has a feature that allows you to check the medications you are taking for any harmful interactions. The app also has a lot of other useful features. For example, you can set reminders for taking your medications in case you have a hard time keeping track of them all, or when to refill them. You can also look up information about your medications including what it should like and possible side effects. The app is available for both Apple and Android, and can also be used in Spanish! If you still have questions, you can call the Ask a Pharmacist line at 1-866-268-2611 to speak to a pharmacist directly.

References:

  1. Maher, Robert L, et al. “Clinical Consequences of Polypharmacy in Elderly.” Expert Opinion on Drug Safety, vol. 13, no. 1, 2013, pp. 57–65., doi:10.1517/14740338.2013.827660
  2. Dwyer, Lisa L., et al. “Polypharmacy in Nursing Home Residents in the United States: Results of the 2004 National Nursing Home Survey.” The American Journal of Geriatric Pharmacotherapy, vol. 8, no. 1, 8 Feb. 2010, pp. 63–72., doi:10.1016/j.amjopharm.2010.01.001.
  3. “Consumer Updates – Grapefruit Juice and Some Drugs Don’t Mix.” U S Food and Drug Administration Home Page, Office of the Commissioner, 18 July 2017, www.fda.gov/ForConsumers/ConsumerUpdates/ucm292276.htm.

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