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

When most people think of a diet that leads to poor diabetes control, they may think of a diet high in carbs and sugar. While those types of food do impact your blood sugars, consuming too many saturated fats can be an enemy against diabetes control,too. This is because a hallmark of pre-diabetes, type 2 diabetes, and worsening type 2 diabetes is insulin resistance.

Saturated Fat and Insulin Resistance

First, what is insulin? Insulin is a hormone produced by your pancreas to control your blood sugar levels. Insulin helps move the sugar from the blood into your cells for storage and energy. In other words, insulin is the key that unlocks the door of our muscle cells to let sugars in. Insulin resistance in the state of your body where insulin is not responding properly to move the sugar into the cells, which causes a rise in blood sugars as a result. The pathophysiology of insulin resistance is somewhat convoluted, but what is known is that saturated fat plays a role. It has been known since 1927 that increased consumption of fat delays the process of blood sugars going into the cells, which means that sugars hang around longer in the bloodstream.1 The results of both animal and human studies also show that a high intake of saturated fat is associated with insulin resistance and development of type 2 diabetes.2 This is because an uncontrolled state of insulin resistance leads to a higher risk of getting type 2 diabetes. People are also at higher risk of insulin resistance if they are overweight or obese.

Not All Fats are Bad

Contrary to the connotation of the word, not all fats are unhealthy. Two main sources of fat that we will focus on are saturated and unsaturated fats. Saturated fats are found commonly in animal products, such as red meats and dairy products. On the other hand, unsaturated fats come from mainly plant based sources and consists of foods like olive oil, nuts, and avocados. Studies have shown that in people with diabetes, saturated fats cause insulin resistance whereas unsaturated fats can improve insulin sensitivity.3 Because of this, the consumption of vegetables fats is favored in place of animal fats and processed grains.3 Not only are plant based foods lower in saturated fats, they are generally lower in calories and jam-packed with nutrients and fiber to nourish the body.

Ways to Improve Insulin Resistance

Lifestyle changes, particularly diet, address ones of the root causes of type 2 diabetes: insulin resistance. Following a plant-based diet can be a solution since animal products can contain a high amount of saturated fat. A plant-based diet generally includes legumes, whole grain, fruits, vegetables, and nuts, and discourages most animal products and refined foods.4 The Adventist 2 study, which included about 89,000 people extended across 50 years, demonstrated a substantial decrease in diabetes incidence in those who ate a vegetarian diet. The study also suggested that those who eat meat once or more days a week have significantly higher rates of diabetes.5 Plant-based diets also have been shown to work better in reducing blood sugars, body weight, and cardiovascular risk compared to diets that include animal-based products.6

Plant-based eating patterns, such as the DASH diet, healthy Mediterranean, and healthy vegetarian diets, have been shown to be associated with better health and lower risk for disease according to nutritional epidemiology, randomized controlled intervention trials, and most literature.7 These diets are also appropriate for the vast majority of people. Furthermore, exercise, with or without weight loss, helps improve insulin sensitivity so your body can use the insulin it naturally produces better.8 That in turn can mean lower doses of your diabetes medications, or even coming off the diabetes medications altogether, which can lower your costs on how much you spend on diabetes care. It is shown that after adjusting for population age and sex differences, the average medical expenses for people living with diabetes were about 2.3 times high than people who do not have diabetes.9

Dangers of Uncontrolled Blood Sugars

Controlling blood sugars is important because the longer a high amount of glucose is in the bloodstream, the more damage it can cause to your blood vessels, nerves, and tissues. Therefore, it is very important to have your doctors check your feet, eyes, and kidneys at least yearly if you have diabetes. People with uncontrolled blood sugars are also at higher risk for cardiovascular complications like heart attacks and strokes and are more prone to infections.10 Plant-based diets have demonstrated improvements in blood sugar control, which can possibly reduce or prevent the incidence of long-term complications of type 2 diabetes.

What You Can Do

Talk to your doctor or dietitian about eating more plant-based foods. It may also be easier to think of changes to what you eat as a lifestyle choice instead of as a diet. Small changes to the foods you consume can make a big impact on your health in the long run. Eating healthier doesn’t mean it has to be more expensive either. Shopping for produce in season, or even visiting your local 99 cent store that carries groceries can be helpful methods to save you money and keep you healthy too. You don’t have to be vegan to experience the benefits of a plant-based diet either. Any steps you take to adding more plant-based foods onto your plate can improve your blood sugars.5

Key Takeaways

To summarize, striving to increase the amount of plant-based foods you eat, minimize consumption of animal-based foods, increase your physical activity, along with taking your diabetes medications regularly, can make a positive impact on your blood sugars and overall health!

References:

  1. Dietary Factors That Influence The Dextrose Tolerance Test, J. Shirley Sweeney MD, Archives of Internal Medicine, December 1927
  2. ARIC Study Investigators; Plasma fatty acid composition and incidence of diabetes in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) Study, The American Journal of Clinical Nutrition, Volume 78, Issue 1, 1 July 2003, Pages 91–98, https://doi.org/10.1093/ajcn/78.1.91
  3. Rachek, L. (2014). Progress in Molecular Biology and Translational Science (pp. 267-292). Elsevier.
  4. McMacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. J Geriatr Cardiol. 2017;14(5):342-354.
  5. Tonstad, S., Stewart, K., Oda, K., Batech, M., Herring, R., & Fraser, G. (2013). Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutrition, Metabolism and Cardiovascular Diseases,23(4), 292-299. doi:10.1016/j.numecd.2011.07.004
  6. Trapp, Caroline B., and Neal D. Barnard. “Usefulness of Vegetarian and Vegan Diets for Treating Type 2 Diabetes.” Current Diabetes Reports, vol. 10, no. 2, 2010, pp. 152–158., doi:10.1007/s11892-010-0093-7.
  7. Laddu, D., & Hauser, M. (2019). Addressing the Nutritional Phenotype Through Personalized Nutrition for Chronic Disease Prevention and Management. Progress In Cardiovascular Diseases, 62(1), 9-14. doi: 10.1016/j.pcad.2018.12.004
  8. Duncan GE, Perri MG, Theriaque DW, Hutson AD, Eckel RH, Stacpoole PW: Exercise training, without weight loss, increases insulin sensitivity and postheparin plasma lipase activity in previously sedentary adults. Diabetes Care 26:557–562, 2003
  9. Economic Costs of Diabetes in the U.S. in 2017. (2018). Diabetes Care, 41(5), 917-928. doi: 10.2337/dci18-0007
  10. American Diabetes Association. 2019 Standards of Medical Care in Diabetes. http://care.diabetesjournals.org/content/42/Supplement_1. Published December 17, 2018. Accessed December 17, 2018.

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hypothyroidism - dr. checking patient - scriptsave wellrx blog

by Jamie Voigtmann, PharmD Candidate

Your body has a number of glands, but the thyroid gland is the small gland at the base of your neck that makes hormones to regulate your metabolism. This impacts your body’s metabolic rate (how you burn calories) as well as heart and digestive function, mood, and more. But what happens if something impacts the thyroid?

How Does the Thyroid Work?

First, the hypothalamus releases TRH which activates the pituitary to release TSH.1 This in turns activates the thyroid to produce and release T4 and T3 into the body but at an approximately 14:1 ratio, with T4 being 14 and T3 being 1.2 Then T4 and T3 bind to proteins and travel to other tissues in the body. There, the T4 will be changed to T3 by removing one molecule iodine.1 This is important because T3 is the active thyroid hormone unlike T4, which is inactive; T3 allows the body to control metabolism, temperature, and heart rate.1 Finally, the T4 and T3 in the body cause a negative feedback loop to the hypothalamus and pituitary. This can make the hypothalamus and the pituitary produce more hormones when T4 and T3 are low or produce less hormones when T4 and T3 are high.1

thyroid process - diagram - scriptsave wellrx blog image

What are the Causes and Symptoms of Hypothyroidism?

Hypothyroidism is most commonly caused by an autoimmune disorder which is when the body’s immune system attacks its own tissues rather than infections. Because of this, the autoimmune disorder causes a decreased amount of T4 and T3 being made.3 Other causes, although unlikely, include a low amount of iodine through diet, removal of the thyroid, radiation therapy for cancer treatment, and certain drugs (amiodarone, lithium, iodine, and rifampicin). Signs and symptoms of hypothyroidism are commonly dry skin, sensitivity to the cold, constipation, poor memory, fatigue, weight gain, puffiness around the eyes, and a slowed heart rate. These signs and symptoms are highly suggestive of hypothyroidism, but alone cannot diagnose this condition. Diagnostic measures most commonly include high TSH levels and low T4 levels.

What are the Treatment Options?

Synthetic T4 Replacement

The most common T4 replacement medication is levothyroxine, and it is recommended as the first treatment option for hypothyroidism.2 Although it is not the active form (T3), it can be made into T3 in the body’s tissues and is generally well-tolerated by many patients. Benefits of levothyroxine include normalizing thyroid function, once daily dosing, few side effects, low cost, and safety in pregnancy.2 But one thing that is very important and specific about levothyroxine is how it is taken. Levothyroxine must be taken on an empty stomach so that it can be appropriately absorbed by the body.3 This is easiest to accomplish in the morning right after waking up, at least 30 minutes before eating breakfast; but, it is possible to take levothyroxine before bedtime as long as it is 4 hours after eating.2 Levothyroxine must also be taken separately (approximately 4 hours before or after) from products such as calcium, iron, and antacids that contain aluminum or magnesium in order to optimize its absorption and efficacy.3 These products are commonly in the form of vitamins or supplements, as well as Tums, Mylanta, Milk of Magnesia, Alka-Seltzer, Maalox, and Rolaids.

Synthetic T3 Replacement

Hypothyroidism therapy also can consist of liothyronine, which is the active form of thyroid hormone: T3. Liothyronine has some disadvantages for the treatment of hypothyroidism when compared to levothyroxine. Currently it is only approved for once daily dosing, but this does not mimic the true release pattern of T3 from the thyroid.4 One small, randomized study showed an improvement in weight loss and decreased lipid profile compared to levothyroxine, but only if liothyronine was taken three times daily.4 Because of this, liothyronine is not currently recommended over levothyroxine because it’s once daily dosing does not provide better results.2 But, it is possible an extended-release formulation of liothyronine can prove to be clinically beneficial in the future.2 Overall, liothyronine has some disadvantages for the treatment of hypothyroidism when compared to levothyroxine such as unknown dosing schedule for best effect and increased cost.

Synthetic Combination Therapy

Some medications used to treat hypothyroidism have a mixture of T4 and T3. Unfortunately, there are many differing studies with different T4:T3 ratios and have unclear results.3 But, many of these clinical trials do not show benefit of T4 and T3 over T4 alone (levothyroxine).2 It has been reported that few patients taking levothyroxine alone still experienced signs and symptoms of hypothyroidism, although their TSH level was corrected to its normal value; and it has been discussed that these patients could potentially benefit from combination T4 and T3 therapy, but evidence is limited.2,3 Overall, levothyroxine remains the standard of care when treating hypothyroidism, with combination therapy of T4 and T3 only being considered after a patient tries levothyroxine and it does not work effectively.2

Natural Desiccated Therapy

This type of hypothyroid medication is also a combination of T4 and T3 but instead of being synthetic (made from chemicals), it is naturally obtained. This is because it is derived from thyroids of animals, particularly domesticated pigs.2,5 The common name of this type of medication is Armour Thyroid.5 The T4:T3 ratio is always 4:1, unlike the natural body’s ratio of 14:1.2 This can lead to an increased level of T3 at once and can result in adverse effects including increased heart rate and anxiety.2 But, there was one minor study completed that reported results of patients preferring desiccated therapy over levothyroxine due to decreased symptoms of hypothyroidism.5 Because this study was small, did not use appropriate questionnaires, and did not assess safety, it does not warrant its use over levothyroxine for hypothyroidism.2 Natural desiccated therapy falls into the same category of combination therapy . It should only be considered for patients who have tried levothyroxine and did not correct his/her thyroid function.2

References

  1. Yen PM. Physiological and molecular basis of thyroid hormone action. Physiol Rev. 2001; 81(3): 1097-1142.
  2. Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014; 24(12): 1670–1751.
  3. Chakera AJ, Pearce SHS, Vaidya B. Treatment for primary hypothyroidism: current approaches and future possibilities. Drug Des Devel Ther. 2012; 6: 1–11.
  4. Celi FS, Zemskova M, Linderman JD, et al. The pharmacodynamic equivalence of levothyroxine and liothyronine. a randomized, double blind, cross-over study in thyroidectomized patients. Clin Endocrinol (Oxf). 2010; 72(5): 709–715.
  5. Hoang TD, Olsen CH, Mai VQ, Clyde PW, Shakir MK. Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study. J Clin Endocrinol Metab. 2013; 98(5): 1982-1990.
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nocturnal cramps - scriptsave wellrx blog image

by Katie Tam, PharmD Candidate
Class of 2019, University of Arizona

Do you wake up in the middle of the night feeling as if your lower legs are paralyzed and cramped? Do your lower leg muscles feel as if they are hard to the touch and tight? If you experience these symptoms, you may have nocturnal leg cramps.

What are Nocturnal Leg Cramps?

Nocturnal leg cramps (leg cramps at night), also called Charley horses, are involuntary contractions or spasms of the muscles in the legs that usually occur during the night. These leg cramps often involve the posterior calf muscles, but can also involve the feet or thigh muscles. Because the muscles are tightened and knotted, nocturnal leg cramps are extremely painful sensation. Symptoms of straining, tightening, cramping, and knotting may last up to 10 minutes per episode.1 Since leg cramps can last for a while, the patient may experience muscle tenderness and soreness for up to a day after symptoms are gone. Nocturnal leg cramps are more common in women and in adults over the age of 50.1 Laboratory evaluation and specialized testing are usually not necessary to confirm diagnosis.

Are Nocturnal Leg Cramps the Same as Restless Leg Syndrome? 

In a word, no. Nocturnal leg cramps are not the same as RLS (Restless Leg Syndrome).

Nocturnal Leg Cramps Restless Leg Syndrome
Usually occurs at night or at rest Usually occurs at night or at rest
Cause pain and cramping Cause discomfort and crawling sensation
Stretching the muscle relieves pain Moving the legs relieves discomfort

Causes of Nocturnal Leg Cramps

The exact cause of nocturnal leg cramps is often unknown. However, there are several factors that may increase your risk of leg cramps:

  • Sedentary lifestyle
  • Over-exertion of the muscles from exercise
  • Standing for long periods of time
  • Improper sitting position, like crossing your legs1

The following medical conditions are also known to cause nocturnal leg cramps:

  • Pregnancy
  • Endocrine disorders (diabetes, hypothyroidism)
  • Structural issues (flat feet, spinal stenosis)
  • Neurodegenerative disorders (Parkinson’s disease)
  • Neuromuscular disorders (myopathy, peripheral neuropathy)
  • Medications (diuretics, intravenous iron sucrose, raloxifene, statins, naproxen, conjugated estrogens, beta agonists)
  • Dehydration/electrolyte imbalances2

Management and Treatment of Leg Cramps

  1. Stretch: The best method to relive pain and cramps is to stretch the affected muscle and hold the stretch for one minute.
  2. Exercise: Walking around sends a signal to the muscle that it needs to relax after contracting, which will help ease the leg muscle.
  3. Massage: Kneading, rubbing, and massaging the affected muscle can also relieve the cramps.
  4. Apply heat: Other methods that have shown some benefit include taking warm baths and showers, and applying a hot towel or pad to the affected area to relax the tight muscles.2
  5. Over the counter medications: No current medications have shown safe and effective results in patients with nocturnal leg cramps. However, calcium channel blockers (diltiazem), vitamin B12 complex, carisoprodol (Soma) have some good evidence and may be considered in some patients.3 Magnesium have some benefit in pregnant patients and mixed results in non-pregnant patients with leg cramps. No evidence supports the use of nonsteroidal anti-inflammatory drugs (naproxen), potassium, or calcium.3

Prevention and Self-Care Strategies:

  1. Hydration: Drink lots of water and fluids every day to keep your body hydrated and help your muscles contract and relax more. Men should drink 15.5 cups (3.7 liters) of fluids and women should drink 11.5 cups (2.7 liters) of fluids a day.
  2. Stretch before bed: If you experience nocturnal leg cramps, stretch your calf muscles for a few minutes before bed.
  3. Doing light exercise: Walking around your neighborhood or house before bedtime may help prevent leg cramps at night.
  4. Wearing comfortable shoes: Wearing shoes that support your feet can help prevent leg spasms.
  5. Untucking the covers: Loosening the bed covers at the foot of the bed will give your legs more space to move and prevent cramps.1

The next time you experience nocturnal leg cramps, identify the cause. Then, try one of the treatment methods to relieve your leg cramps. After resolving your leg cramps, use the self-care strategies to help prevent future leg cramps. However, if your leg cramps persist for long periods of time and occur every day, talk to your physician to determine whether or not you have leg cramps or other alternative medications that are appropriate.

Resources:

  1. Leg Cramps at Night. https://my.clevelandclinic.org/health/diseases/14170-leg-cramps-at-night. Accessed January 10, 2019.
  2. American Academy of Family Physicians. Nocturnal Leg Cramps. Accessed January 10, 2019.
  3. Abdulla AJ, Jones PW, Pearce VR. Leg cramps in the elderly: prevalence, drug and disease associations. Int J Clin Pract. 1999;53(7):494–496.

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searching online for health information - scriptsave wellrx - blog image

When it comes to health information on the internet, many patients are no longer sure what to believe. Just as important, patients often don’t know how to apply what they have read. Healthcare providers have the opportunity to help patients navigate through the vast variety of online health information.

Take the Practice Trends Today quiz (here) from the American Pharmacists Association (APhA) to learn more about helping patients understand the results of their online healthcare searches.

Click Here to take the quiz.


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by Heather Lee, University of Arizona PharmD Candidate

With flu season upon us, make sure you pencil in a date to get your flu shot. You may wonder why this is so important, and why your healthcare providers are always asking whether you received it. Influenza (the flu) is a huge threat to public health. It has been shown that around 5 to 20 percent of the United States population get the flu during flu season.1 Hospitalization rates and death rates are quite high, with more than 200,000 people being hospitalized and around 36,000 deaths every year. Getting the flu vaccine not only lowers your risk of getting sick, but it also protects the people around you, too.2 With the risk of it turning into a serious and fatal threat, you should vaccinate against it to protect yourself and the ones you love.

What is the flu?

The flu is a disease that is caused by a virus. It is contagious, meaning it can be spread from person-to-person. It is spread when someone who has the flu sneezes, coughs, or talks and spread droplets. The droplets land on the noses or mouths of nearby people, or on surfaces that were near the sick person. If other people touch the surface and then touch their mouth, nose, or eyes, they can also get infected with the flu.2

Some common flu symptoms include:

  • Fever and chills
  • Cough
  • Sore throat
  • Runny/stuffy nose
  • Muscle/body aches
  • Headache
  • Feeling tired2

More serious complications of flu include:

  • Pneumonia
  • Inflammation of the brain or heart
  • Worsening of a health condition, such as asthma or heart failure
  • Sepsis (a life-threatening infection)2

Who Needs It?

It is recommended that everyone who is able to get the vaccine who is 6 months of age or older should receive the vaccine every season.3 There are some people who are at high risk of developing flu complications, so it is important to receive the vaccine if you fall into the following categories:

  • Children younger than 5 years, but especially children younger than 2 years
  • Adults 65 years and older
  • Pregnant women
  • Women up to 2 weeks postpartum
  • Residents of nursing homes and other long-term care facilities
  • American Indians and Alaska Natives
  • If you have certain medical conditions (asthma, heart disease, chronic lung disease, etc).4

Children who are between 6 months to 8 years require 2 doses of the vaccine if they are getting vaccinated for the first time or if they have only gotten one dose.5 Receiving two doses will provide children with a better immune response and more protection.5 The two doses should be separated by at least 28 days. For adults, only one dose per season is necessary. Research has shown no benefit in boosting immunity in adults who have received two doses in the same flu season, even in elderly people who have weakened immune systems.6

*There are some groups who should not get the vaccines. These include children younger than 6 months, if you have had a life-threatening allergic reaction to the flu vaccine or an ingredient it contains (eggs or gelatin), or if you have Guillain-Barrré Syndrome (an immune system disorder).2

Side Effects of Flu Shot

The most common side effects usually affect the area of injection, such as redness, pain, or swelling of where you received the shot.2 Other side effects are headaches, muscle aches, fever, or an upset stomach. These side effects usually go away in a few days. It is rare to get a serious side effect from the flu vaccine, but the person administering the vaccine can observe you for any serious side effects. The flu shot will not cause you to get the flu; it serves to boost your immune response to prevent the flu.

Sign Me Up

The benefits of getting the flu vaccines drastically outweigh the risks of the vaccine. Even though you may risk getting a sore arm or a headache, you still walk out with a lower chance of getting infected with the flu. Preventing the flu helps to keep you from developing the more serious complications, such as being in the hospital with pneumonia or even death. The best time to get vaccinated is usually the end of October, but you can still get vaccinated throughout the flu season.6

Receiving the flu shot in January or later is still better than nothing, since flu season can last as late as May. Your local pharmacy should have the flu vaccine available during flu season, and there is usually no appointment necessary. The next time you step into your local pharmacy, stop by and ask your pharmacist when you can get the flu vaccine so you can protect you and your loved ones.

Resources:

  1. NIH Fact Sheets – Influenza. National Institutes of Health. https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=133. Accessed November 28, 2018.
  2. S. Department of Health and Human Services. Flu (Influenza). Vaccines.gov. https://www.vaccines.gov/diseases/flu/index.html. Published October 11, 2006. Accessed November 28, 2018.
  3. Influenza (Flu). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm. Published September 6, 2018. Accessed November 28, 2018.
  4. Influenza (Flu). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/about/disease/high_risk.htm. Published August 27, 2018. Accessed November 28, 2018.
  5. Influenza (Flu). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/protect/children.htm. Published November 8, 2018. Accessed November 28, 2018.
  6. Influenza (Flu). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/about/qa/misconceptions.htm. Published September 25, 2018. Accessed November 28, 2018.

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seasonal affective disorder - blog image- scriptsave wellrx

When winter rolls around, the holidays and the festivities that accompany the season follow suit. Turkey, the new year, and family, all of these jolly terms invoke the feeling of celebration and happiness. If you find yourself getting moody when the snow starts falling every year, do not fret. You are not alone. If you feel depressed during certain seasons, this is called seasonal affective disorder (SAD). About 5% of adults in the US experience SAD, and this usually lasts for approximately 40% of the year.1 This usually starts in the late fall and early winter and goes away during the spring and summer.2 This typically corresponds to when there is less sunlight, and symptoms improve with the returning sunlight that spring provides.1 The most challenging months for people tends to be January and February. It can even happen in the summer months, but this is less common.

Risk Factors

There are some characteristics that may increase your risk of getting SAD. If you are a female, you are four times more likely to develop this than men.2 In addition, where you live can play a role. If you live farther (north or south) from the equator, you are more likely to develop it. For example, it was seen that 1% of those who live in Florida can develop it versus 9% of those who live in Alaska.3 If your family has a history of other types of depression, this can play a role.2 Along with this, if you have been diagnosed with depression or bipolar disorder, your depression may worsen with the seasons. It has also been observed that younger adults have a higher risk. The age of onset is typically between 18 to 30 years of age.3

Seasonal Affective Disorder Signs And Symptoms

In order to be diagnosed with SAD, you must fulfill the criteria for major depression that occurs during specific seasons for at least 2 years. This may be more frequent than non-seasonal depressions.2 The symptoms of SAD typically look like those of major depressive disorder.

The typical symptoms of depression include:

  • Feeling depressed most of the day, nearly every day
  • Feeling hopeless/worthless
  • Having low energy or feeling sluggish
  • Losing interest in previously enjoyable activities
  • Trouble with sleep
  • Changes in appetite or weight
  • Difficulty concentrating
  • Frequent thoughts of suicide or death2

It is surprising that even the symptoms associated with winter SAD and summer SAD can differ. The typical winter SAD symptoms include:

  • Having low energy
  • Excessive sleepiness throughout the day (hypersomnia)
  • Overeating with possible weight gain
  • Craving for carbohydrates
  • Withdrawing from social activities (feels like “hibernating”)2

The typical summer SAD symptoms include:

  • Poor appetite with associated weight loss
  • Difficulty sleeping or staying asleep (insomnia)
  • Agitation, restlessness, or anxiety
  • Violent behavior2

Treatment and Therapies

There are a couple treatment options to help resolve the symptoms quicker and make you feel better, rather than just waiting it out. SAD is mainly treated through light therapy.4 Light therapy involves you sitting in front of a light box for 20-60 minutes daily in the mornings.2 The idea behind this is so you can replace your reduced intake of sunlight during the fall and winter months. However, this may not be enough and you may be treated through a different method, such as antidepressant medications, talk therapy, vitamin D supplementation, or a combination of the therapies. Medications include the selective serotonin reuptake inhibitors (SSRI) and bupropion, which are types of antidepressants. Common SSRI’s include sertraline (Zoloft), fluoxetine (Prozac), and citalopram (Celexa). You may have to follow up with your doctor whether this is an appropriate treatment for you, and you may have to switch antidepressants around to determine which is the right one that works for you. It may take several weeks for the medications to work, so your doctor may recommend to start taking it before your symptoms usually start every year.5

Another treatment option is talk therapy, which is also known as psychotherapy. A type of talk therapy that is used for SAD is cognitive behavioral therapy (CBT). CBT involves you talking with a mental health counselor to identify negative thoughts and replacing them with positive thoughts. They will help you identify activities that are enjoyable to help you cope with the winter and to help you manage stress. Vitamin D supplementation itself is not regarded as an effective treatment, but there have been some studies that suggest it may be as effective as light therapy.2 On the other hand, there are some studies that oppose that thought. The reason why you might be supplemented with this is that low levels of vitamin D were found in people with SAD.

Following up with your Doctor

If you find yourself nodding to these symptoms and thinking they sound like what you are experiencing, don’t worry. Schedule an appointment with your doctor to discuss your signs and symptoms. If you are taking any medications at home, such as prescription, over-the-counter, and herbals, be sure to update them with this information, because this may change what treatment you receive. From there, your doctor can discuss with you what treatment options may be appropriate. It may take a couple tries to figure out what treatment works best, but this is common. With treatment, you will soon be able to tackle the winter with renewed vigor.

 

References:

  1. Warning Signs of Mental Illness. https://www.psychiatry.org/patients-families/depression/seasonal-affective-disorder. Accessed November 9, 2018.
  2. Seasonal Affective Disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml. Accessed November 9, 2018.
  3. Melrose S. Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depress Res Treat. 2015;2015:1-6. doi:10.1155/2015/178564
  4. Seasonal Affective Disorder. MedlinePlus. https://medlineplus.gov/seasonalaffectivedisorder.html. Published March 6, 2018. Accessed November 9, 2018.
  5. Seasonal affective disorder (SAD). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/diagnosis-treatment/drc-20364722. Published October 25, 2017. Accessed November 9, 2018.

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by Samantha McKinnon, PharmD Candidate 2019
University of Arizona College of Pharmacy

Diabetes, Cancer, HIV, seizures, pregnancy, organ transplant… chances are high that you or someone you know have experienced or are currently suffering from one of these conditions. But what do they all have in common? They’re all diagnosed or screened for with lab tests. Diagnostic lab test results influence approximately 60 to 70 percent of medical decisions. Without lab tests, we wouldn’t know what to do!1

What Are Lab Tests?

A lab test is searching for something specific in your body, and can use your blood, saliva, urine, feces, breath, or organ tissue (tissue biopsy). These tests can help you and your physician determine the presence, absence, or extent of disease or monitor the effectiveness of a treatment2. They are performed by having blood drawn, spitting into a cup, having your cheek swabbed, urinating into a cup, or breathing into a special device. Some examples of lab tests you may already be familiar with are a DNA test to determine if a man is the father of a child, a urine drug test for employment, an HIV screen to test if someone does or does not have HIV, a finger-prick blood sugar test, or an alcohol breath test (breathalyzer).

Why Should I Get a Lab Test?

If you’re experiencing any unusual symptoms, a lab test may help guide you toward a diagnosis. For example, if you’ve been feeling tired and fatigued lately a lab test may determine if your thyroid is underperforming, if you have anemia, if you have an electrolyte imbalance, or if you’re developing a chronic disease such as diabetes. Sometimes, lab tests are repeated to confirm a diagnosis. If you know you’re a carrier for a disease or have a close relative with a disease you should be screened regularly3.

Catching a condition or disease early gives you more treatment options, more opportunity for lifestyle modifications, and saves you time and money4. Screenings help establish a baseline that is unique to you, and some screenings (such as breast or colon cancer) become mandatory with age. A lab test can determine how well certain organs are working, and monitor their function – most especially the kidneys, liver, heart, thyroid, and pancreas, this is especially handy as you age.

Anyone needing an organ transplant or anyone wanting to donate an organ or blood will have blood typing and compatibility testing done. Certain medications, called narrow therapeutic index drugs, as well as antibiotics, are monitored to make sure those levels don’t get too high or too low and verify treatment is working. Lab tests also can be used to substantiate specific events; such as an exposure to heavy metals, or the administration of a rape kit.

What Lab Tests are Important?

Critical or required lab tests vary by individual and their current health levels. An 80-year-old man with diabetes and a foot infection is going to need different tests than a healthy 28-year-old pregnant woman. Some lab tests are precise and reliable, while others provide general clues to possible health problems. For a generally healthy individual, some common tests that are done at your routine checkup that establish your baseline are things like:

  • Complete Blood Count (CBC) which differentiates types of blood cells
  • Comprehensive Metabolic Panel (CMP) that determines your cholesterol, hormone levels, electrolytes, and enzymes;
  • Hemoglobin A1C (HbA1C or A1C) which measures how much sugar is attached to your hemoglobin (the stuff in your blood that carries oxygen) and determines your risk of developing diabetes.

If you have an infection, a culture and sensitivity test will be ordered so your physician knows what the offending bacteria is and the appropriate antibiotic to treat it. Participating in your own health care is paramount to your well-being, so ask your doctor what tests are right for you.

Important Questions to Ask Your Doctor Before Having a Lab Test5

  • What will this test measure? A patient on the “blood-thinner” warfarin would want to check their INR, a patient with diabetes would measure their A1C. Knowing what you’re measuring will ensure you get only the necessary tests.
  • Why is this test necessary? Someone that has seizures may need their medication levels monitored to ensure the levels are safe and appropriate. A person with an unsteady gait may need a test to rule in or rule out Huntington’s Disease. If it’s necessary, your doctor will be able to explain the test and why.
  • Are there risks or side effects to this test? Most lab tests are benign, but some do come with some risks or negative side effects. A biopsy patient may want to have someone else to drive them to and from their appointment. Ask your physician so you can prepare accordingly.
  • How do I prepare for this test? Some tests require fasting, others require drinking a special preparation beforehand, while some require no preparation at all. Every test is different, but it’s important to follow the directions so you don’t have to repeat the test.
  • What results should I expect from this test? Results can be confusing. Sometimes you want a positive, sometimes you want a negative, other tests you may want a high number or a low number. Understanding what a normal value is will help you to interpret your result.
  • How often will I need to do this test? As mentioned earlier, some tests will be repeated to ensure the diagnosis is correct. Some screenings are done annually to monitor any changes.  Some tests are daily or weekly. Other tests are only done once, so be sure to ask how often a test is needed.

If you don’t understand something, be sure to ask your doctor to explain it to you. Some additional factors that may influence your lab test results are:

  • age
  • sex
  • race
  • weight
  • diet
  • alcohol or tobacco use
  • caffeine intake
  • stress level, and,
  • hydration status

Always request a copy of your results, and retain it for your personal medical record. After all, it is your health!

References

  1. Ngo, Andy, et al. “Frequency That Laboratory Tests Influence Medical Decisions.” The Journal of Applied Laboratory Medicine, The Journal of Applied Laboratory Medicine, 1 Jan. 2017, jalm.aaccjnls.org/content/1/4/410.
  2. Kennedy, A G. “Evaluating Diagnostic Tests.” Journal of Evaluation in Clinical Practice., U.S. National Library of Medicine, Aug. 2016, ncbi.nlm.nih.gov/pubmed/27091221.
  3. Elmore, Joann G. “Screening for Breast Cancer.” JAMA Internal Medicine, American Medical Association, 9 Mar. 2005, jamanetwork.com/journals/jama/fullarticle/200479.
  4. Yong, PL. Saunders, R. and Olsen, L. (2018) Missed Prevention Opportunities from The Healthcare Imperative: Lowering Costs and Improving Outcomes Roundtable. Available at https://www.ncbi.nlm.nih.gov/books/NBK53914
  5. Talking with your doctor. No author. Available at https://www.nia.nih.gov/health/doctor-patient-communication

 


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by Randall Flores, PharmD Candidate 2019
University of Arizona

Bleeding can manifest itself in a variety of different ways which, at times, may not be easy to recognize. Some bleeds are also more serious than others and may require emergency medical attention. Bleeding frequency may also vary depending on a variety of factors such as underlying bleeding disorders or the use of certain medications.5

Potential Signs of Different Types of Bleeding

Gastrointestinal Bleeds5 
  • Bloody or black, tar-like stool
  • Weakness
  • Paleness
  • Swollen or firm abdomen
  • Vomiting or coughing blood
  • Abdominal or stomach pain
Urinary Tract Bleeds5  
  • Bright red or brown-colored urine
  • Pink urination
  • Frequent urination
  • Pain while urinating
  • Lower-back pain
Nosebleeds5  
  • Prolonged headache
  • Confusion, lethargy, and/or slurred speech
  • Discomfort to bright light
  • Double vision
  • Enlarged pupils or different size pupils
  • Dizziness and/or stumbling
  • Stiff neck or back
  • Seizures
  • Irritability
  • Loss of appetite
  • Sudden or forceful vomiting not due to upset stomach
Throat Bleeds5  
  • Choking
  • Vomiting or coughing up blood
  • Swelling or discoloration in the neck
  • Change in tone of voice
Eye Bleeds5  
  • Swelling or pain within or around the eye
  • Reddening of the white part of the eye
  • Double or blurred vision
  • Change in vision

Monitoring Lab Results While Taking Anticoagulants

Anticoagulation therapy is vital to the prevention and treatment of thromboembolic diseases; however, close monitoring is very important to treat and prevent harmful adverse effects. Lab monitoring is an important part of anticoagulation therapy to determine if it is necessary to counterbalance the anticoagulant effect of the drug4. Each drug has its own recommendations on lab monitoring depending on how it works in the body and possible adverse effects.

Coumadin (warfarin) remains the most prescribed oral anticoagulant medication worldwide despite the higher risk for bleeding compared to alternative anticoagulants1. The use of warfarin entails frequent blood tests and patient education about food and drug interactions4. The laboratory test that are most frequently monitored are prothrombin time (PT) and international normalized ratio (INR). PT is a test used to measure the number of seconds it takes for a clot to form3. INR on the other hand, is a more standardized PT measure so that it may serve as a reference value on how to adjust the dose depending on the result3. Higher INRs represent thinner blood, while lower INRs represent thicker blood.  [ Read more on our blog post, Losing the War With Warfarin? ]

New oral anticoagulants (NOACs) now formally known as direct oral anticoagulants (DOACs) have a few advantages over the use of warfarin. DOACs include dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis). One of the biggest advantages over warfarin is that DOACs typically do not require dose adjustments and routine monitoring4. There are however some recommendations of monitoring certain parameters in patients with specific circumstances and comorbidities. Kidney function is an important parameter to monitor because all DOACs are eliminated by the kidney and impairment is a risk factor for bleeding1.

Antidote Medications to Reverse the Effects of Anticoagulants?

There are several reversal agent options for warfarin, despite its challenging management. The reversal agents used for warfarin include phytonadione (vitamin K), fresh frozen plasma (FFP), and prothrombin complex concentrate (PCC)2. The availability of these agents makes warfarin a viable option for patients who are at increased risk of bleeding and enables it to still be recommended by guidelines2.

DOACs are becoming more popular due to safety and efficacy over other anticoagulants, however only one of these agents has an FDA-approved reversal agent. Praxbind (idarucizumab) received accelerated FDA approval due to its promising results in clinical trials as a reversal agent to dabigatran (Pradaxa)2.

Currently, there is one agent called andexanet alfa that in phase III clinical trials as a reversal agent to the remaining DOAC agents2. As the use of DOAC agents become more popular, the need for effective antidotes is demanded.

Whether a someone is on anticoagulant therapy or not, it is important for people to have a general understanding about bleeding risks and how to identify different types of bleeds. Patients on anticoagulant therapy should also have a general idea about the monitoring that their therapy entails, potential risks, and management of those risks. The more patients know, the lower their chance of hospitalization from bleeding.

References:

1 Conway, S. E., Hwang, A. Y., Ponte, C. D., & Gums, J. G. (2016). Laboratory and Clinical Monitoring of Direct Acting Oral Anticoagulants: What Clinicians Need to Know. Pharmacotherapy, 37(2), 236-248. doi:https://doi.org/10.1002/phar.1884

2 Griffiths, C., Vestal, M., Livengood, S. and Hicks, S. (2017). Reversal agents for oral anticoagulants. [online] The Nurse Practitioner. Available at: https://journals.lww.com/tnpj/fulltext/2017/11000/Reversal_agents_for_oral_anticoagulants.2.aspx [Accessed 21 Sep. 2018].

3 Hull , R., Garcia, D., Vazquez, S. (2018). Warfarin (Coumadin) Beyond the Basics. UpToDate. Retrieved from https://www.uptodate.com/contents/warfarin-coumadin-beyond-the-basics

4 Ramos-Esquivel, A. (2015). Monitoring anticoagulant therapy with new oral agents. World Journal of Methodology5(4), 212–215. http://doi.org/10.5662/wjm.v5.i4.212

5 The Basics of Bleeding Disorders. (2018). National Hemophilia Foundation. Retrieved September 19, 2018, from https://stepsforliving.hemophilia.org/basics-of-bleeding-disorders/identifying-types-of-bleeds


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As a nation, we spend over $5 trillion a year to feed our bodies.[1] That’s the value of food sold each year in the United States through retail and food service including nearly 38,000 supermarkets, an estimated 150,000 convenience stores, and over one million restaurants. The U.S. food industry is immense, touching every person in the nation every day.

We then spend trillions more each year taking care of ourselves. The U.S. healthcare industry is massive, projected to be over $5 trillion a year by 2025 and representing an estimated 20% of the country’s GDP.[2]

So we have two titanic industries that touch each consumer… and yet food and healthcare are largely disconnected. Plus, with 40,000+ unique products in a typical grocery store, the choices are overwhelming to the average consumer trying to shop for foods to appease any number of nutrition-sensitive health conditions.

Personalized Wellness

At ScriptSave, our vision of personalized wellness aligns managed care organizations, healthcare providers, employers, food manufacturers and retailers to improve and maintain the wellness of each individual. The power of the personalized wellness vision lies in the economic benefits provided to each member of this ecosystem.

hippocrates quote - food - scriptsave wellrx blog image

The personalized wellness food-health supply chain begins with the individual consumer, an understanding of his or her health condition, and food products beneficial to that condition. As the source of food, retailers become, in a sense, an extension of personalized healthcare, and a trusted partner in wellness for each individual. What better loyalty for a retailer than helping customers live healthier lives?

Public Health Implications

The implications from a public health perspective are enormous. 70% of Americans are on at least one prescription drug and 60% of the U.S. population is dealing with at least one chronic health condition. Our aim is to evaluate food products based on their nutritional attributes and provide insight to possible grocery alternatives that are more favorably aligned with each shopper’s personal health and wellness goals.  Our vision is no less ambitious than to improve health outcomes for millions of individuals.

ScriptSave is mobilizing key participants to realize the Personalized Wellness vision. Purchase validation of beneficial products creates a powerful feedback loop:

  • Improves future recommendations
  • Powers performance-based incentives provided by managed care organizations
  • Helps providers drive improved outcomes
  • Provides brand manufacturers powerful insight to shopper needs

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The Rise of Artificial Intelligence

It is only recently that artificial intelligence data and technologies are available to personalize, at a product level, food recommendations that are beneficial to each individual. Deconstructing nutrition information to countless data attributes enables powerful linkage between health conditions and the hundreds of thousands of food products available across the United States. What makes it all work is the ability to convey personalized food guidance to the individual via the smartphone in their hand while in the store aisle.

“Food is the area consumers really want to deal with the most,” states Jane Sarasohn-Kahn, health economist for Think Health. “Nobody really wants to take medicine. People would rather project-manage health through food as prescription.”[3] A recent meeting with a physician group highlighted the shortcomings of efforts to date as doctors explained patients forget nearly everything within 24 hours of leaving the office.

Perhaps what is most powerful about the personalized wellness vision is that everyone across the food-healthcare supply chain benefits from improved health outcomes and quality of life for the individual. Retailers gain stronger customer relationships as they come to be viewed as true partners in wellness, and consumer goods brand manufacturers have a path to redemption from the processed foods abyss.

About ScriptSave:

For more than two decades, ScriptSave has been closing the gaps in healthcare and prescription coverage with innovative savings programs for the uninsured, under-insured, and insured. Headquartered in Tucson, ScriptSave solutions, analytics, and unique expertise save consumers money and increase medication adherence, while attracting and retaining loyal, profitable customers, members, and patients for our clients. ScriptSave is a member of the MedImpact, Inc. family of companies. For more information on ScriptSave WellRx – Personalized Wellness, go to www.wellrxplus.com. Follow us: @SSWellRx (Twitter), ScriptSave WellRx (Facebook).

References:

[1] “U.S. Food Retail Industry – Statistics & Facts”, Statista, www.statista.com/topics/1660/food-retail/

[2] Mark Hagland, “Medicare Actuaries: U.S. Healthcare Spending to Soar to $5.631 Trillion and 20.1 Percent of GDP in 2025”, www.healthcare-informatics.com, (July 18, 2016)

[3] Drug Store News, Future Trends: Self care, wellness shift to drive innovation in new, emerging health segments, www.drugstorenews.com, (August 18, 2017)


This blog post has been excerpted from the ScriptSave WellRx Personalized Wellness Whitepaper. You can read the full whitepaper content at Winsight Media:

http://www.winsightgrocerybusiness.com/wellness/health-wellness-gets-personal

http://www.winsightgrocerybusiness.com/wellness/personalized-wellness-virtual-dietitian

http://www.winsightgrocerybusiness.com/wellness/healthcare-food-align-benefit-individual

 

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by Randall Flores, PharmD Candidate 2019
University of Arizona

In the past few decades, there has been an alarming and steady increase in obesity rates in the U.S. This affects people of all races and ages. More Americans live with obesity than breast cancer, Alzheimer’s, Parkinson’s and HIV all together. The medical community has been aware of the rising epidemic for many years, yet its response has not been effective at addressing the problem.

What is a Healthy Weight (BMI)?

Obese or overweight is defined as weight that is higher than what is considered a healthy weight for a given height measured as Body Mass Index (BMI)1. The levels of weight measured by BMI are listed below:

  • BMI < 18.5 = underweight
  • BMI 18.5 to <25 = within normal weight
  • BMI 25 to <30 = overweight
  • BMI >30 = obese

The Facts About Obesity

With an estimated population of 328.73 million people in the U.S.,6 the prevalence of obesity was 39.8% between 2015-2016, affecting nearly 93.3 million people.1 The estimated health care cost of obesity was $147 billion in 2008 which was $1,429 higher than those of normal weight. Obesity seems to have a racial/genetic link as Hispanic and non-Hispanic blacks had the highest prevalence with 47% and 46.8% respectively.2 Much of the obesity seen in the U.S. starts at a younger age and transcends into adulthood with a prevalence of 18.5% (ages 2-19) nearly affecting 13.7 million children.2 Similar to adults, obesity in children is more common in certain populations; Hispanics having the highest prevalence (25.8%) followed by non-Hispanic blacks (22%).2

Obesity-Related Health Conditions

The most common obesity-related diseases that result in premature deaths include type 2 diabetes, heart disease, stroke, and certain types of cancers such as colorectal, pancreatic, and endometrial cancer.1,4 People who have obesity are also at increased risk for serious diseases including the following;3

High blood pressure Low quality of life
High levels of bad cholesterol &
low levels of good cholesterol
Sleep apnea & breathing problems
Gallbladder disease Mental illness, depression, anxiety, &
other mental disorders
Osteoarthritis Body pain & difficulty with physical functioning

A Push for Prevention

The epidemic of overweight and obese citizens in the nation is complex and has no simple solution. There are many factors that play a role in obesity. Due to its complexity, the epidemic of obesity needs to be approached through multiple outlets, with tactics in local, state, and federal organizations as well as professional health organizations.5 The long-term goal to decreasing obesity is shifting to norms of a healthy lifestyle, which include healthy eating and regular physical activity.5 Healthcare should also shift more of its efforts towards preventing obesity. Another key player in reversing the obesity epidemic is implementing community efforts that support a healthy lifestyle, such as food services, schools, childhood care, and clinics/hospitals.

Obesity and being overweight affects millions of people in our nation and worldwide. Obesity is associated with an increased risk of many serious diseases that are otherwise preventable. We must shift our efforts to the epidemic of obesity to halt its progression and strive towards a healthier future for younger generations to come.

 

References:

  1. Adult Obesity Facts | Overweight & Obesity | CDC. (2018). Retrieved from https://www.cdc.gov/obesity/data/adult.html
  2. Children Obesity Facts | Overweight & Obesity | CDC. (2018). Retrieved from https://www.cdc.gov/obesity/childhood/index.html
  3. Adult Obesity Causes & Consequences | Overweight & Obesity | CDC. (2018). Retrieved from https://www.cdc.gov/obesity/childhood/index.html
  4. Obesity and Cancer. (2018). Retrieved from https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet
  5. Strategies to Prevent Obesity. (2015). Retrieved from https://www.cdc.gov/obesity/strategies/index.html
  6. S. and World Population Clock. (2018). Retrieved from https://www.census.gov/popclock/

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by Heather Lee, PharmD Candidate
University of Arizona

A Guide to Medication Warnings

When you visit the dentist, you expect to answer typical questions regarding your oral health, such as how often you are brushing your teeth or the infamous question of whether or not you floss. It may surprise you when your dentist asks what medications you take at home. Why would it matter if the dentists knows what you’re taking? Many medications, which includes prescriptions, over-the-counter, and even herbal medications, can affect your oral health and it is important for the dentist to know what you take so they can determine the best course of action for your oral health.

Blood Thinners

Many patients are currently on blood thinners or antiplatelet therapy to prevent the risk of blood clots. Common examples of blood thinners include warfarin (Coumadin), dabigatran (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto), and edoxaban (Savaysa). Common examples of antiplatelet medications include clopidogrel (Plavix), ticlopidine (Ticlid), prasugrel (Effient), ticagrelor (Brilinta), and/or aspirin. Taking these medications is important to prevent blood clots, but they can also increase the risk of bleeding, especially during a dental procedure. The risk increases if you are taking multiple medications to prevent clots.  It is important for the dentist to know if you are taking these medicines so they can take extra precautions to prevent bleeding, such as stopping the medication temporarily or controlling the bleeding through local measures. They can control the bleeding through various methods, such as mechanical pressure, agents that stop the bleeding, or suturing. The dentist can make a more informed decision with what they want to do with the medication when they have a better knowledge of the type of medication you’re taking, your bleeding risk, and what procedure you’re going in for.1

Dry Mouth

Having a dry mouth can be caused by a variety of different factors, such as a medication’s side effect, having a certain medical condition, or personal habits (mouth breathing and alcohol/tobacco use).

Saliva plays an important role in maintaining your oral health through multiple ways by:

  • Reducing the population of bacteria in the mouth
  • Neutralizing acid caused by bacteria, which damages your teeth
  • Repairing tooth enamel that may have been damaged by acid
  • Washing food particles away2

A lack of saliva can cause dry, cracked lips, bad breath, infections in your mouth, and cavities. Medications that can cause this include medications used to control allergies, asthma, blood pressure, pain, and depression.

Your dentist can help by:

  • Recommending a special gel or rinse to keep your mouth moist
  • Prescribing or applying a fluoride containing toothpaste or mouthwash to prevent cavities3

Other ways to relieve this symptom can include:

  • Chewing sugar-free gum or sucking on sugar-free hard candies to increase the flow of saliva
  • Sucking on ice chips
  • Drinking water with meals to help with chewing and swallowing food
  • Using alcohol-free mouthwash
  • Avoiding carbonated drinks, caffeine, tobacco, and alcohol
  • Using a lanolin-based lip balm to soothe dry lips3

Enlarged Gum Tissue

There are some medications that may increase your risk of getting enlarged gum tissue, which is also known as “gingival overgrowth”. This is usually associated with antiseizure medications (phenytoin), immunosuppressive drugs (cyclosporine), and calcium channel blockers (including nifedipine, verapamil, diltiazem, and amlodipine). If your dentist is aware you are taking these medications, they may encourage you to do professional cleaning more often throughout the year and educate you on how to improve your brushing technique.4

Jaw Pain

There have been some reports of individuals who had difficulty healing or jaw pain after going through invasive dental procedures or even a tooth extraction. This can be due to bone death caused by a lack of blood supply (osteonecrosis). The common factor in these individuals were that they were taking a medication from the bisphosphonate class. Bisphosphonates are usually used to prevent bone weakening or destruction and are commonly prescribed to treat osteoporosis. Examples include risedronate (Actonel), zoledronate (Zometa), alendronate (Fosamax), and ibandronate (Boniva).

Over 90% of cases were in patients receiving an IV form of the drug. The risk is thought to be less than 1% of patients receiving an IV form, but they were at least ten times more likely to be affected than those who took the oral form. If you are on this medication, your dentist can discuss ways to minimize the risk of needing invasive procedures, such as tooth extractions and surgery. They may consider more conservative treatments, such as a root canal procedure. They can provide preventative advice regarding whether you need professional cleaning more often, how to observe any changes in your mouth, and how to be more careful with taking care of your teeth and gums.5

The following may increase your risk of developing jaw pain:

  • Older age (greater than 65 years)
  • Treatment with chronic corticosteroids
  • Long-term use of bisphosphonates
  • Gum infection that damages the gum and can destroy the jawbone (periodontitis)6

Signs to watch out for:

  • Gum wounds that heal very slowly or do not heal for six weeks or more after a procedure
  • Exposed bone
  • ”Roughness” on gum tissue
  • Pain if the open wound becomes infected
    • Pus or swelling
    • Numbness, especially in the lower jaw, if the infection lasts long enough5

Current treatment options include:

  • Antiseptic rinses to help prevent the growth of bacteria
  • Antibiotics
  • Cleaning/removal of dead bone from the affected area
  • Possible referral to a specialist or a surgeon for further evaluation5

Updating Your Dentist Regarding Medications

These are just a few of the reasons of why it is important to inform your dentist regarding what medications, over-the-counters, and herbal supplements you take. Your dentist can take extra precaution when you come in and educate you as to the best way to maintain your oral health when they are aware of what medications may be affecting it. The next time you go in, bring an updated medication list so your dentist is on the same page as to what you are taking at home.

References:

  1. Anticoagulant and Antiplatelet Medications and Dental Procedures. https://www.ada.org/en/member-center/oral-health-topics/anticoagulant-antiplatelet-medications-and-dental-. Accessed October 31, 2018.
  2. Department of Health & Human Services. Teeth and drug use. Better Health Channel. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/teeth-and-drug-use. Published June 30, 2014. Accessed November 1, 2018.
  3. Managing dry mouth. The Journal of the American Dental Association , Volume 146 , Issue 2 , A40
  4. Staff SBI. Gingival Enlargement. The American Academy of Oral Medicine. http://www.aaom.com/index.php?option=com_content&view=article&id=132:gingival-enlargement&catid=22:patient-condition-information&Itemid=120. Accessed November 2, 2018.
  5. Staff SBI. Bisphosphonate Therapy. The American Academy of Oral Medicine. http://www.aaom.com/index.php?option=com_content&view=article&id=78:bisphosphonate-. Accessed November 2, 2018.
  6. Dental management of patients receiving oral bisphosphonate therapy. The Journal of the American Dental Association. 2006;137(8):1144-1150. doi:10.14219/jada.archive.2006.0355.

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