food allergies and medicine -scriptsave wellrx blog image

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

Nearly 20% of Americans have self reported an allergy to a medication and roughly 4% of the nation suffers from some form of food allergy.1 While it would seem obvious to avoid something if you’re allergic to it, you’d first have to know you’re allergic. When it comes to medications this can be challenging.

There are different grades to an allergic reaction. It could be as mild as some pesky itching or a cough; a more serious fever, rash or painful blisters; or very serious blood irregularities, difficulty breathing or death.2,3 Allergic reactions can occur within many different classes of medications such as antibiotics, antidepressants, anesthetics, narcotics, nonsteroidal anti-inflammatory drugs (NSAIDs), among others.1

Excipients – Crucial for Drug Delivery

When you take medication, there is more than just an active drug inside the tablet, capsule, spray or syrup; these additional “inert” products are called excipients4. Excipients play a variety of roles in medications. They are used to stabilize the active drug, bind the active drug(s), increase the solubility, enhance or delay absorption (such as enteric coated tablets), and provide flavor or sweetness.4 Some excipients come from foods that people have an allergy to. The most common food allergies in the United States are milk, egg, peanut, soy, fish, and gluten.5 The Food Allergen Labeling and Consumer Protection Act (FALCPA) was enacted to inform patients if a major allergen was in their food, even in trace amounts. This carries over to medications, however, this information comes and stays with the original bottle, it will not be transferred to the prescription label. These food and drug allergies are why the pharmacy will ask for your allergy information when creating your profile and before dispensing any medications. Different manufacturers use different excipients in their preparations, so you may be allergic to one brand and okay to take a different brand. If you would like to know if an allergen is in your prescription, ask your pharmacist.

Milk: Milk allergy, sometimes called lactose intolerance causes discomfort in the digestive tract whenever dairy products are consumed. There are other enzymes in milk that people may be allergic to such as casein. Lactose is used as a stabilizer in some asthma inhalers and as a filler (excipient) in some tablets. Other milk products can be found in TUMS smoothies, as well as some vaccines, so be sure to ask your doctor or pharmacist to avoid an allergic reaction.5,6

Egg: Those with an egg allergy should be cautious of vaccines that use egg as a stabilizer and certain hospital drugs for intravenous use as some patients have had an anaphylactic reaction. The CDC has said that the Flu vaccine is safe, even in people with an egg allergy but there are egg-free versions of the vaccine available. IV Benadryl and the sedative propofol are two medications that contain egg. Again, make sure any health care professional that considers you a patient knows your allergy history as it is important for your safety.5,6

Peanut: Peanut is a well-recognized allergy alert and as such is not found in many medications. The package inserts for progesterone capsules and valproic acid capsules have peanut as an ingredient. Dimercaprol lists peanut oil and there is peanut oil in some asthma inhalers and the topical medication fluocinolone.6  There are alternatives to any of these medications for anyone with a peanut allergy that would also need one of these medicines.

Soy: Soy can be listed as soy or as one of its derivatives – lecithin. Again, it can be found in some inhalers and propofol5. Some over the counter products I’ve discovered that have soy are Advil liquid-gels, TUMS smoothies, and black cohosh (an herb sometimes used to treat perimenopause and menopause symptoms). Be sure to read the ingredient list when choosing an over the counter medication or ask your pharmacist if you are unsure if an allergen is in a product.

Fish: Fish products can be found in some (not all) multi-vitamins and supplements, which highlights the importance of reading labels. A reversal agent for the anti-coagulant heparin called protamine contains some derived fish products. NPH insulin also contains some fish oil, so diabetic patients with a fish allergy needing a short acting insulin could choose a different insulin.3,5 There are case reports of patients with a fish allergy trying fish oil and not experiencing a reaction, if you would like to try the fish oil test then ask your doctor.

Dyes: One final excipient that causes a reaction in some patients is medical dye. Most specifically FD&C Blue 1, Blue 2, Red 4, and FD&C Yellow 5. These colors can be used in many different medications, your doctor or pharmacist would need to check to ensure these dyes aren’t in any of your medications7.

This is not a complete list of possible allergens or medications that may contain allergens. If you have ever experienced a reaction to a food, medicine, or dye be sure to inform your primary care doctor, pharmacist, and any specialists that you see. Document your reaction so that you can remember what happened if a health professional asks you about your allergy. Questions about possible allergens can be answered by your prescriber, pharmacist, poison control center, or manufacturer of your medication so never hesitate to call and ask. Any patient that has ever experienced an anaphylactic reaction should wear a bracelet advertising the allergy.

 

References

  1. Macy E, Ho NJ. Multiple drug intolerance syndrome: Prevalence, clinical characteristics, and management. Ann Allergy Asthma Immunol2012; 108:88–93
  2. Stevenson, DD. Sanchez-Borges M. Szczeklik, A. Classification of allergic and pseudoallergic reactions to drugs that inhibit cyclooxygenase enzymes. Ann Allergy Asthma Immunology 2001; 87:177
  3. Demoly P, Adkinson NR, Brockow K, et al. International Consensus on Drug Allergy. Allergy 69:420-437, 2014
  4. Lesney, Mark S. More than just the sugar in the pillToday’s Chemist at Work. 10(1): 30–6, 2001
  5. Kelso JM, Davis C. Food Allergy Management. Immunology and Allergy Clinics of North America 2018; 38:53-64
  6. Kelso JM. Potential food allergens in medications. Journal of Allergy and Clinical Immunology. Jun 2013; 133(6):1509-18
  7. Swerlick RA, Campbell CF. Medication dyes as a source of drug allergy. Journal of Drugs in Dermatology. Jan 2013; 12(1):99-102

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blockchain technology and healthcare - scriptsave wellrx blog image

by Sterling Harpst, 2019 PharmD Candidate

There are many news stories about the digital currency Bitcoin, and some have heard of the technology behind it: blockchain. However, most people are probably unaware of the impact this technology could have on our society, especially within the field of healthcare. Demand for blockchain, is exploding, so let’s look at its potential applications to consider from a patient perspective.

What is Blockchain Technology?

The blockchain is a permanent and public database that shows all transactions that have ever taken place on it.

Think of it as a single spreadsheet that can be simultaneously accessed and edited by a network of computers all around the world. Each time a participant on the network enters a new transaction, the change is reflected on all spreadsheets in real time. What makes this unique is its decentralized nature. In contrast to traditional networks in which the spreadsheet is owned by a single company (i.e. a bank), the blockchain stores the original information in millions of locations at the same time, with no single owner. This ensures all information stored on the blockchain is public and verifiable. It also greatly increases the protection of data, preventing hackers from corrupting a central location that houses every file on the network.1

When a digital transaction or “block” is initiated, it can only be finalized on the spreadsheet if there is public consensus among other participants on the network. This consensus requires multiple decisions regarding whether the information being transferred from one party to another is accurate and decisions are then compared to one another. Once a threshold consensus has been reached, the data is time-stamped and permanently linked to the previous transaction, forming a chain of information that is impossible to alter.2 The blockchain “spreadsheet” can only be distributed to other participants in the network, rather than copied, which eliminates the possibility of altering data and allows for an unbiased and trustworthy source of transaction information. Therefore, this type of network eliminates the need for a middleman to perform these services.

Although this new type of system can be difficult to comprehend, it has the potential to change nearly every aspect of business. In the same way that e-mails can be sent without fully understanding the underlying technology, the blockchain can be used by anyone. This still begs the question for patients – how will it affect me?

How the Blockchain Will Impact Healthcare

Electronic Health Record (EHR)

One of the most significant problems with the healthcare system today is the lack of information sharing. As a patient, many individuals find it hard to understand why one doctor can access their entire medical history, while another has only incomplete notes regarding once yearly office visits. The middleman, in this instance, is the electronic health record company. These entities protect the information that is stored on their software to incentivize other businesses to adopt or pay for the ability to communicate with their program. This can leave patients with partial, mismatching records that hinder the doctor’s ability to provide the best care. Many companies, however, are now proposing the use of a blockchain to solve this problem.

As described earlier, the blockchain allows for a digital “spreadsheet” to be shared across computers with access to the same network. The spreadsheet in this instance, would represent the patient’s electronic health record (EHR). This blockchain network would be personally controlled by the patient, who could then grant access to doctors or other healthcare professionals as necessary. Patients would even have the ability to grant access to only certain parts of the health record, leaving out personal information that doesn’t pertain to the specialist they may be seeing. Once an appointment has concluded, the patient can then subsequently revoke privileges to see the information, if they so choose. Examples of companies pursuing this type of blockchain solution for EHR include Iryo, Patientory, Guardtime, Coral Health, Medicalchain, and more.3

Pharmacogenomics

In the new and growing fields of pharmacogenomics and genetic testing, current industry business models have prompted some to seek another use for the blockchain. 23andMe and AncestryDNA are a few of the most well-known genetic testing companies in the direct-to-consumer market today. By selling patients an opportunity to receive a genetic test through the mail, the need for prescriptions or consultation by a healthcare professional has become something of the past. What few patients know is, a significant portion of their revenue comes from selling the genetic information to pharmaceutical manufacturing companies for the purpose of conducting research. Pharma companies pay billions of dollars each year to obtain this information and use it to direct their future drug development efforts. Unfortunately, patients do not see any kickback revenue as a result.

This practice has prompted companies such as EncrypGen, Nebula Genomics and others to offer a unique answer to this problem. In their models, the “spreadsheet” would be the results of a genetic test. In the same way mentioned prior, patients could both allow and revoke access privileges for Pharma companies to this information. Instead of Pharma companies acting as doctors to use the test results to make clinical decisions, they would instead pay the patients directly for their data.3 This would incentivize patients to not only further research efforts but receive payment at the same time.

The Future of Blockchain in Healthcare

A new generation of healthcare technology companies have launched efforts to create an information structure that performs each of these functions and many more using the blockchain. From prevention of drug counterfeiting to managing data loss in natural disasters, startups are appearing across the country to fix problems that have plagued the healthcare system for decades. Many think this technology is coming to our businesses and personal lives very soon, while others believe it is far from being fully integrated. Either way, with the potential to revolutionize several different areas in healthcare and beyond, the blockchain is a technology worth paying attention to.

 

REFERENCES:

  1. Elliott C, Rosic A, Lind, et al. What is Blockchain Technology? A Step-by-Step Guide For Beginners. Blockgeeks. https://blockgeeks.com/guides/what-is-blockchain-technology/. Published June 22, 2018. Accessed June 25, 2018.
  2. Mearian L. What is blockchain? The most disruptive tech in decades. Computerworld. https://www.computerworld.com/article/3191077/security/what-is-blockchain-the-most-disruptive-tech-in-decades.html. Published May 31, 2018. Accessed June 25, 2018.
  3. Top 12 Companies Bringing Blockchain To Healthcare. The Medical Futurist. http://medicalfuturist.com/top-12-companies-bringing-blockchain-to-healthcare/. Published April 4, 2018. Accessed June 28, 2018.

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by Eli Kengerlinski, 2019 PharmD Candidate
University of Florida College of Pharmacy

Over the years, insulin prices have increased in accordance with newly developed insulins that have come to market. Traditional insulins, short and intermediate acting, as compared to newer rapid and long acting insulins, are less expensive in market value.1 Biosimilar traditional insulins with expired patents (some since 2000) may be a better option for some patients, as their market price has significantly dropped over the years. However, many patients are still having trouble affording their monthly Lantus or Humalog due to their high copays.

Why is insulin important?

Insulin plays an important role in managing patients with Diabetes Mellitus (DM). Patients with Type 1 DM have limited ability to produce endogenous insulin due to their pancreas’s inability to properly function. Patients with Type 2 DM can also have increased dependence on insulin therapy use as their disease state progresses. It is crucial for certain diabetic patient populations to have insulin at hand as they cannot control their sugar levels with just oral medications (eg. Metformin) that have no effect on insulin production. Type 1 DM population, there’s a greater need for basal (intermediate or long acting) as well as mealtime (rapid or short acting) insulin.

What options do you have?

Lifestyle modifications towards a healthier diet and exercise can be the most important changes any diabetic can make, and help ensure proper management of your condition. Monitoring your daily sugar levels, managing your weight via carb counting or following the plate method2, as well as exercising 30 minutes a day, five times a week, are all great habits to ensure effective DM management.

From January 2014 to July 2018, short and intermediate acting insulins have dropped in price equaling less than half of rapid and long acting insulins in the market today.1 Even if newer insulins offer better sugar control, their high prices make it difficult for patient access. For these specific patient populations, traditional insulins should be considered to ensure patient adherence to DM therapy and prevent patients using less of their insulin. If you’re having trouble paying for your insulin, then ask your provider if short and intermediate acting insulins would be right for you. Also contact your insurance company to see if you qualify for additional programs (eg. Medicare, Medicaid).

Furthermore, ask your provider if there are generic alternatives to your rapid or long acting insulin. For example, Admelog costs 12 to 15% less than Humalog while Basaglar costs about 15% less than Lantus on a per insulin unit basis.3 Therefore, it is important to ask for biosimilar generics that have the same active ingredient as they are usually cheaper.

Another affordable alternative to ensure access to insulin would be switching patients on high cost insulin pens to vials. Even though pens are more convenient and patient friendly, vials should be considered, especially if you’re having trouble affording your insulin. However, do ensure that you are instructed on how to properly inject your insulin.

If you’re still having trouble affording your insulin, ask your local pharmacist for a manufacturer savings card. If you need help with diabetic medications, visit www.wellrx.com for substantial prescription savings at pharmacies throughout the U.S. and Puerto Rico.

REFERENCES:

  1. Eisenberg Center at Oregon Health & Science University. Premixed Insulin Analogues: A Comparison With Other Treatments for Type 2 Diabetes. 2009 Mar 25. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007-. [Table], Price of Insulin. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45287/table/clininsulin.tu1/
  2. Lara Hamilton. “How to Create Your Plate.” Diabetes Forecast, Nov. 2015, diabetesforecast.org/2015/adm/diabetes-plate-method/how-to-create-your-plate.html
  3. “Sanofi Launches Follow-On Insulin Lispro, Admelog.” The Center for Biosimilars Staff, 9 Apr. 2018, www.centerforbiosimilars.com/news/sanofi-launches-followon-insulin-lispro-admelog.

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why children need to play - scriptsave wellrx blog image

by Pattiya Wattananimitgul

When you think of a child’s development, you might think of good education, nutritious food, and a caring family. Play is likely not on the top of your list if it’s on your list at all, but it should be. In this post, playing means active activities that would engage children’s bodies and minds in imaginative and creative ways and not passive activities, like sitting in front of the screen playing computer or video games. Some examples of healthy, active activities are pretend plays, hide-and-seek, and board games. In this day and age, fast-paced lifestyle, family structure changes, and increased focus on academics are contributing to less free time for children to play.1 Some parents might think playing is useless or a waste of time. However, scientific studies show that play is crucial in children’s development.2 Here are some reasons why children need to play:

Strengthen “cognitive, physical, and emotional well-being of children”

Play is crucial to the development of the brain because it lets children use their creativity and imagination. By playing, they are able to make decisions, solve problems, and think for themselves. It allows them to explore the world around them, overcome their fears, and develop skills to deal with future challenges.1  Play also helps release stress, which help fortify children’s emotional well-being and reduce the risk of developing behavioral health problems.2 All these combined also lead to better academic outcomes.

Improve teamwork and social skills

Play allows children to work in groups, share, negotiate, boost confidence, solve problems, and learn how to respond to people’s feelings.1 It helps them develop social interaction skills and get along better with others.

Reduce obesity

Research shows that there is a link between decline in active outdoor play and increase in childhood obesity.2 About 18.5% of children and adolescents in the United States are obese, which increased more than three times the percentage from the 1970s when plays was more common.3,4  Obesity leads to complications such as high blood pressure and diabetes. According to Alliance for Children, doctors are warning that children today may be the first generation in two centuries to have a shorter duration of life than their parents. Active play increase children’s physical activities and therefore decrease childhood obesity epidemic.2

Discover their interests

Play allows children to explore in many different areas and discover interests without giving them any unrealistic expectations or pressure to be outstanding in each area. This would ultimately lead them to find their own passions they would like to pursue in the future.1

Open up opportunities for parents to engage with their children

Play would help build stronger bond with your children and better relationship with them. This would also give you opportunities to learn how to communicate with your children more effectively and give them nurturing guidance.1

By letting your children play and letting them be kids, it would strongly benefit them in the long run and help them become happy, healthy, and successful adults. Lastly, your pharmacist is a great resource to any questions you might have or to learn more about your children’s health and well-being.

 

References

  1. Ginsburg, K. R. (2007). The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bonds. Pediatrics, 119(1), 182-191. doi:10.1542/peds.2006-2697
  2. Miller, E., & Almon, J. (2009). Crisis in the Kindergarten: Why Children Need to Play in School. College Park, MD: Alliance for Childhood.
  3. Childhood Obesity Facts. (2018, June 13). Retrieved August 10, 2018, from https://www.cdc.gov/obesity/data/childhood.html
  4. Prevalence of Overweight and Obesity Among Children and Adolescents: United States, 1963–1965 Through 2011–2012. (2014, September 19). Retrieved August 10, 2018, from https://www.cdc.gov/nchs/data/hestat/obesity_child_11_12/obesity_child_11_12.htm

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By Pawel F. Kojs, PharmD Candidate Class of 2019,
University of Arizona College of Pharmacy

Morning sickness or nausea and vomiting in pregnancy (NVP) occurs in 70-80% of pregnant women.  In the United States, roughly 4 million women are affected each year.  This is more common in women that live in Western countries.1 A small percentage of women are affected each year with the more extreme form of morning sickness called hyperemesis gravidarum (HG).1

To help with this condition, there are many remedies to consider with your provider.

How can diet help with morning sickness?

With respect to diet, it is best to avoid large meals and eat smaller meals more often throughout the day.  Eating more protein and less fat is advised as well.2

Even though it’s difficult, eating foods that do not have a high flavor profile and ones that are low in fat helps reduce the time it takes for food to leave the stomach.  This in turn helps with reducing the amount of symptoms one would have with morning sickness.2

Which options can help me with morning Sickness?

There are different options to help treat morning sickness. Avoid smells, foods, tastes, and smells that trigger that nauseous feeling. Talk to your healthcare provider before taking any new prescription or over-the-counter (OTC) medications, and nutritional/herbal supplements.

Prescription Options

Disclaimer: Always consult with your provider before taking any medication during pregnancy.

OTC Options

These options for pregnancy related nausea and vomiting are commonly used. The types of medications are available at your neighborhood pharmacy, but it is recommended to monitor for drowsiness or sedation.

Disclaimer: Always consult with your provider before taking any medication during pregnancy.

Prenatal Supplements

It is advisable to talk to a doctor regarding getting a proper prenatal supplementation. You and your provider can discuss how much folic acid you should take. US Department of Health & Human Services Office of Women’s Health (DHHS) recommends taking at least 400 – 800 micrograms of folic acid daily, starting at least three months before conception.3 Prenatal supplements should be taken on an empty stomach. If you experience stomach upset, try taking it before bed with a light snack.

References:


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immunization changes for 2018 - scriptsave wellrx blog image

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

With flu season right around the corner, what better time to talk about vaccines than right now?  We talk and hear about vaccines a lot, but what exactly is a vaccine, and which vaccine is right for you?

What is a vaccine?

In the simplest terms, a vaccine is medicine created from weakened or dead disease-causing germs given to you to help prevent you from getting sick or prepare your body in case you are infected.1 Vaccines can be created using different strategies, depending on who the vaccine is intended for and what disease is trying to be prevented.  There are live, inactivated, recombinant and toxoid vaccines; each serves a different purpose and treats a different germ.1 The way they work is to expose you to a small and safe amount of the germ so your body will recognize it in the future by creating antibodies.  Antibodies are what allow your body to fight off infections or you experience a much milder version of the illness.2   You may sometimes see terminology like “trivalent” or “quadrivalent” when you’re looking at different flu vaccines.3 Trivalent vaccines contain three different strains of virus whereas quadrivalent vaccines contain four different strains of virus.  There also “high-dose” flu vaccine formulations, these formulations contain extra amount of virus material to help people create more antibodies.1

Live vaccines

Live vaccines are also called sometimes called “attenuated” – which is a fancy term for “weakened”. Some examples of live vaccines you or children may have received would be measles, mumps, rubella (MMR), chickenpox or even smallpox.  Live vaccines take the entire virus and weaken it so that it can’t get you as sick as the regular beefed-up virus.  Imagine you have two runners getting ready to run a marathon, but one of the runners has 20-pound boots on, who will win the race?  It’s going to be much harder for the runner with boots to cross the finish line, this is essentially what attenuating viruses do.  Live vaccines do come with some risks, especially to people with weaker immune systems such as someone that had an organ transplant or someone with cancer.

Inactivated vaccines

Vaccines that inactivate the virus also use the entire virus but instead of being weakened like a live vaccine, it is completely dead.  Inactivated vaccines are the typical flu shots, polio and rabies.  Because these germs are completely dead you will not get sick, but this means you will also not be immune and need more frequent shots.3 This is one reason for an annual flu shot.

Recombinant vaccines

Recombinant is technical term that basically means mixed up, it would be like switching some letters around in the alphabet to be CBADEFG instead of ABCDEFG, it’s still the alphabet but not in the exact order it used to be.  These vaccines use only very specific pieces of the germ, a “target”, which will create a strong response in the person receiving the shot.  The bonus is that the vaccine does not have the entire germ, so you won’t get sick and they can be used on more people than live or inactivated vaccines – a big plus for patients with weaker immune systems.  Some recombinant vaccines currently used are for Hepatitis B, meningitis, shingles and whooping cough.

What changed for this year?

Now that you know about all the different kinds of vaccines we can talk about the new changes for this year.  Besides the World Health Organization (WHO) and the Centers for Disease Control (CDC) there is also another government body called The Advisory Committee on Immunization Practices (ACIP) that provides recommendations for what immunizations are needed and when.  Previous flu seasons did not have very good coverage against H1N1 so live viruses were not recommended for children.  That has changed this year, ACIP has recommended that eligible patients receive the FluMist intranasal spray, a live attenuated vaccine, this is good news for parents and kids as there is no needle and no shot.4 The recombinant flu shot called Flublok is recommended for pregnant women. For the older population there has been a change to the zoster vaccination recommendation.  ACIP recommends the recombinant Shingrix vaccine for prevention of shingles in adults over the age of 50.4 Shingrix is a two-dose vaccine just like the previous shingles vaccination Zostavax but has been found to be more effective than Zostavax, most especially in patients over the age of 80.5 The final changed recommendation is in regard to the live MMR vaccine.  Traditionally it has been a two-dose vaccine and that covered you for life.  With recent measles outbreaks, patients living in an area with an outbreak are recommended to receive a third dose of MMR.5

What vaccine is right for you?

The CDC releases an immunization schedule for all patient populations and revises it as new evidence comes to light.  The recommendations from ACIP have allowed the CDC to release a newly revised immunization schedule effective for 2018.  Based on your age and your health you may get different versions of vaccines or vaccinated at different times in your life than other people.  Your provider or pharmacist would be happy to let you know which vaccines are right for you and when, since some vaccines are age-specific.  It is especially important to let health professionals treating you know your health status and social history such as if you smoke tobacco or drink alcohol, if you’ve recently been sick or had a fever, what kind of environment you work in, if you’ll be around newborns or elderly people, your HIV status or if you have liver problems or blood factor issues as well as any allergies.  If you travel outside of the US, especially to an area that requires you to use antivirals, let your prescriber know as this may affect your vaccinations.  Some countries also require special immunizations before you may be allowed to enter, be sure to check these recommendations on the CDC website.

The importance of getting vaccinated

Diseases like polio, measles, whooping cough, flu can be prevented with vaccines.  Without vaccines people that caught these viruses could be paralyzed, blinded, lose their hearing, or even die.  In 2015 there were 710,000 people hospitalized for flu and over 56,000 of them died.  There are some patients that can not be vaccinated and depend on others to be vaccinated so they do not get sick.  This is called “herd immunity,” the more people that are vaccinated, the healthier everyone will be.  So don’t wait, get vaccinated today!

 

References

  1. www.vaccines.gov/basics
  2. www.newsinhealth.gov/nih/2016/07/safeguarding-our-health
  3. Felicilda-Reynaldo RF, “Types of flu vaccines for yearly immunization.” MedSurg Nursing, July-Aug. 2014, p. 256
  4. Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices United States 2018-2019 influenza season. MMWR Morb Mortal Wkly Rep 2018.
  5. Kim DK, Riley LE, Hunter P. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older – United States, 2018. MMWR Morb Mortal Wkly Rep 2018; 67:158.

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does sunscreen cause cancer - scriptsave wellrx blog image

by Pattiya Wattananimitgul

According to the Centers of Disease Control and Prevention (CDC), approximately 5 million Americans are treated with skin cancer each year.1 Overexposure of ultraviolet (UV) rays from the sun is proven to be a major cause of skin cancer.2 In fact, approximately 90% of all skin cancers are associated with exposure to the sun’s harmful rays.3 One way to protect your skin from the harmful UV rays is wearing a sunscreen. However, you may have heard that ingredients in sunscreens can cause cancer, and not just skin cancer but also breast, prostate, and other types of cancer.4 But is it true? Does sunscreen, which is supposed to protect us from skin cancer, actually lead to cancer and other health problems?

Oxybenzone

Oxybenzone is a common active ingredient in sunscreens that absorbs the UVA and UVB radiation and then dissipates it as heat.5 Oxybenzone penetrates through the skin, and then gets metabolized and excreted through urine and feces.6 Some studies suggest that oxybenzone may have an impact on the endocrine system, disrupting hormone levels and potentially causing hormone-related cancer. These studies were actually done on rats. A human study suggested that oxybenzone, even at a high concentration, does not cause hormone disruption. The conclusion is that oxybenzone is an FDA-approved chemical to protect your skin from the sun’s radiation, and currently there is not enough evidence to prove or suggest that oxybenzone causes hormone disruption and cancer in humans.3,7,8

Retinyl Palmitate

Retinyl palmitate is another ingredient commonly added to sunscreens as a skin conditioner. It is a form of vitamin A, known to help slow down premature skin aging. There is some concern, based on a small number of studies, that the free radicals generated from retinyl palmitate may cause changes to our cells and cause skin cancer. However, no studies suggested that these changes are cancerous or increase cancer risks.3,7,8 In fact, a form of vitamin A called retinoids has been used for decades to help protect people with high risk of developing skin cancers from getting skin cancer, according to the American Academy of Dermatology.9

Zinc Oxide and Titanium Dioxide

Zinc oxide and titanium dioxide are nanoparticles that physically protect your skin from UVA and UVB radiation. Some studies indicated that these active ingredients can be absorbed in the skin and cause cells damage. However, according to current studies, these nanoparticles stay on the skin’s surface and do not penetrate the skin when applied.3

Protect Yourself from UV Rays

The main takeaway is that you should always wear sunscreen when going outside, even when it’s cloudy. The known benefits of regular sunscreen use outweigh the unproven risks of potential toxicity. The type of sunscreen you use is up to you, whether it is chemical or physical. However, make sure the ingredient protects both UVA and UVB radiation (broad-spectrum) with SPF of at least 30. Below is a chart by the Skin Cancer Foundation of US Food and Drug Administration (FDA)-approved active ingredients that can be found in sunscreen and their UV action spectrum.3 When using sunscreen, make sure to cover all the exposed skin and reapply the sunscreen every two hours, or right after swimming or sweating. Other ways to protect yourself from the harmful UV rays are9:

  • Seeking shade between 10 a.m. to 2 p.m., when the sun’s rays are strongest
  • Wearing protective clothing such as lightweight long sleeve shirt, pants, broad-brimmed hat, and UV-protection sunglasses
  • Avoiding tanning beds

active ingredients in sunscreen - scriptsave wellrx blog image

Warwick, M. L., MD, MB, & Wang, S. Q., MD. (2011, November 11). Suncreens: Safe and Effective?
Retrieved August 6, 2018, from https://www.skincancer.org/prevention/sun-protection/sunscreen/sunscreens-safe-and-effective

Resources

  1. Cancer Prevention and Control. (2015, September 03). Retrieved August 6, 2018, from https://www.cdc.gov/cancer/dcpc/research/articles/sunscreen-use.htm
  2. The Facts About Sunscreen. (2018, January 11). Retrieved August 6, 2018, from https://www.melanoma.org/understand-melanoma/preventing-melanoma/facts-about-sunscreen
  3. Warwick, M. L., MD, MB, & Wang, S. Q., MD. (2011, November 11). Suncreens: Safe and Effective? Retrieved August 6, 2018, from https://www.skincancer.org/prevention/sun-protection/sunscreen/sunscreens-safe-and-effective
  4. Do Sunscreens Cause Cancer? (2018, June 12). Retrieved August 6, 2018, from https://sciencebasedmedicine.org/do-sunscreens-cause-cancer/
  5. How does sunscreen work? (2017, August 14). Retrieved August 6, 2018, from http://www.loc.gov/rr/scitech/mysteries/sunscreen.html
  6. Jiang, R., Roberts, M. S., Collins, D. M., & Benson, H. A. E. (1999). Absorption of sunscreens across human skin: an evaluation of commercial products for children and adults. British Journal of Clinical Pharmacology, 48(4), 635–637. http://doi.org/10.1046/j.1365-2125.1999.00056.x
  7. Janjua, N. R., Mogensen, B., Andersson, A., Petersen, J. H., Henriksen, M., Skakkebæk, N. E., & Wulf, H. C. (2004). Systemic Absorption of the Sunscreens Benzophenone-3, Octyl-Methoxycinnamate, and 3-(4-Methyl-Benzylidene) Camphor After Whole-Body Topical Application and Reproductive Hormone Levels in Humans. Journal of Investigative Dermatology,123(1), 57-61. doi:10.1111/j.0022-202x.2004.22725.x
  8. Can the chemicals in sunscreen cause cancer – Canadian Cancer Society. (n.d.). Retrieved August 6, 2018, from http://www.cancer.ca/en/prevention-and-screening/reduce-cancer-risk/make-healthy-choices/be-sun-safe/can-the-chemicals-in-sunscreen-cause-cancer/?region=on
  9. Is sunscreen safe? (n.d.). Retrieved August 6, 2018, from https://www.aad.org/public/spot-skin-cancer/learn-about-skin-cancer/prevent/is-sunsceen-safe

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medications can increase your fall risk - scriptsave wellrx blog image

by Roxanna Orsini
PharmD Candidate Class of 2019, University of Arizona

Falls Happen More Often Than You Think

Every year there are millions of falls occurring in the older population, aged 65 and older.2 About 1 out of 4 older people fall each year, with less than half reporting it to their doctor.2 Your chances of a recurrent fall doubles after your first fall. The emergency department (ED) treats about 3 million older individuals for fall injuries each year.2 The most common injuries seen in the ED after a fall includes fractures, superficial injuries, and head injuries.(2,3) Patients have reported a reduction in their quality of life up to 9 months after being admitted in the ED for a fall.3

After a fall you may develop a fear of falling. This can cause negative health effects including:3

  • Recurrent falls
  • Reduced physical activity
  • Restriction or avoidance of social activities
  • Depression/anxiety

Are You at Risk for a Fall?

Here are a few questions to help you determine if you are at risk of a fall:5

  • Do you rush to use the bathroom?
  • Do you take a medication to help you sleep or improve your mood?
  • Do you take a medication that sometimes makes you feel light-headed or more tired than usual?
  • Do you use or have been advised to use a cane or walker?
  • Have you lost some feeling in your feet?
  • Do you feel unsteady when walking at times?
  • Have you had a previous fall?

Answering yes to any of these questions should warrant a conversation with your doctor about getting screened for your risk of falling.

There are certain chronic medical conditions that can contribute to your chances of a fall such as arthritis, dementia, stroke, cataracts, Parkinson’s disease, and urinary incontinence.1 Some of the medications used for these health conditions can increase your risk of a fall. However, falls can be caused by almost any medication that effects your brain or blood circulation.

Some Medications Can Increase the Risk of a Fall

A few medications that can increase your risk of a fall include:3

Most of these medications can decrease your alertness, cause fatigue, dizziness, and drop your blood pressure when you stand up (also referred to as postural hypotension).1

Postural hypotension occurs in about 30% of older adults and may experience one of these symptoms within 1 minute to several minutes of standing up:4

  • Lightheadedness
  • Blurred vision
  • Headache
  • Fatigue
  • Weakness

If you are taking any of these medications, experiencing any of these symptoms or taking more than 6 medications, talk to your doctor about your risk for a fall.4 Your doctor may need to reduce or change your medication to help reduce your symptoms and fall risk, never make any changes to your medication without consulting your doctor first.

Balance, medications, and home safety should be addressed in everyone at high risk.4 To help maintain the highest level of mobility and reduce your chances of falling or risk of injury, follow up with your doctor. Your doctor can provide tips and recommend exercises designed to prevent falls and help avoid unnecessary trips to the Emergency Department.

 

References:

  1. Berg, R. and Cassells, J. (1992). Falls in Older Persons: Risk Factors and Prevention. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK235613/ [Accessed 18 Jul. 2018].
  2. gov. (2018). Important Facts about Falls | Home and Recreational Safety | CDC Injury Center. [online] Available at: https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html [Accessed 20 Jul. 2018].
  3. de Jong, M., Van der Elst, M. and Hartholt, K. (2013). Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies. Therapeutic Advances in Drug Safety, 4(4), pp.147-154.
  4. Phelan, E., Mahoney, J., Voit, J. and Stevens, J. (2015). Assessment and Management of Fall Risk in Primary Care Settings. Medical Clinics of North America, 99(2), pp.281-293.
  5. Sri‐on, J., Tirrell, G., Kamsom, A., Marill, K., Shankar, K. and Liu, S. (2018). A High‐yield Fall Risk and Adverse Events Screening Questions From the Stopping Elderly Accidents, Death, and Injuries (STEADI) Guideline for Older Emergency Department Fall Patients. Academic Emergency Medicine.

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imprtance of iodine - scriptsave wellrx blog image

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

What is Iodine and why is it important?

You may be wondering, “Why do I need iodine in my salt or other food?” Iodine is an essential element our bodies need that we cannot produce on our own, and therefore need to get it from food sources1. Iodine is needed to produce the thyroid hormone, which is important for bodily functions related to metabolism and how our cells use the energy they are given1. Iodine is found in foods such as cheese, milk, eggs, ice cream, saltwater fish, iodized table salt and some multivitamins1. Most people get their daily intake of iodine from iodized table salt1. There is, however, a large population of people who have heart disease or high blood pressure, who are asked by their doctors to not consume as much salt as others.

Who should reduce their salt intake and by how much?

iodized salt - scriptsave wellrx blog image

Heart disease and high blood pressure afflict a large percent of the U.S. population today. The American Heart Association’s (AHA) Heart disease and Stroke Statistics of 2018 estimates that 31.1% of the world’s population has high blood pressure, and they predict that by 2035, more than 45% of the US population will have some form of cardiovascular disease2. It is because of these abnormally high numbers that the AHA has diet and lifestyle recommendations for being “heart healthy,” that they recommend to everyone, not just people who have heart disease or high blood pressure.

One such recommendation is to reduce the amount of sodium consumed each day. Sodium can cause water retention in your body, increasing blood pressure and making your heart work harder than it needs to3. The average American consumes more than 2,400 milligrams of sodium per day. The AHA recommends having less than 1,500 milligrams per day3. For reference, 1 teaspoon is about 2,300 mg of salt. The AHA reports that the body really only needs about 500 milligrams per day, so eating a heart healthy diet will still get you enough sodium to meet the daily requirements3.

How do I get enough Iodine on a low sodium diet?

So, what can you do to make sure you get enough iodine daily, while eating a heart healthy diet?  It is simple. The body needs 150 micrograms of iodine per day1. For reference, a teaspoon of iodized salt contains about 400 micrograms of iodine1. If you wanted to cut out salt in your diet and be under 1500 milligrams of salt per day, that is still at least 260 micrograms of iodine per day, which is greater than the 150 micrograms a day that your body needs. Keep in mind that the majority of people in the US are getting such large amounts of sodium through salty snacks, processed meats, and the typical “unhealthy foods” that the AHA is trying to help people avoid. Make sure that the sodium you do consume is iodized so that you are reaching that 150-microgram daily recommendation.

Overall, there is no need to fear not getting enough iodine while restricting sodium in your diet, as long as you make sure the salt you eat is iodized, and not coming from processed meats, potato chips and other salty snacks. Following the American Heart Association’s recommendations, you should still be getting more than the recommended daily amount of iodine. If you are concerned about the amount of iodine in your diet, there are multivitamins out there that contain 150 micrograms that can be taken daily.  As always, if you have any questions or concerns, your local pharmacist is well equipped to answer your questions and help guide you in the right direction.

 

References

  1. “Iodine Deficiency.” American Thyroid Association, http://thyroid.org/iodine-deficiency/.
  2. Benjamin, Emelia J, et all. “Heart Disease and Stroke Statistics— 2018 Update: A Report From the American Heart Association.” American Heart Association, 2 Mar. 2017, http://circ.ahajournals.org/content/137/12/e67.
  3. “How Much Sodium Should I Eat per Day?” Sodium Breakup, http://sodiumbreakup.heart.org/how_much_sodium_should_i_eat.

If you’re struggling to afford your prescription medications,
visit www.WellRx.com to compare the cash price at pharmacies near you.
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Chances are good that you are spending too much on your prescription medications. Every day we receive phone calls, emails, and comments on Facebook about the staggering prices people pay for the medications they need. People are struggling. We get it. That’s why we launched ScriptSave WellRx – to bring prescription savings to everyone.

How Does It Work? Who Can You Trust? Are Prescription Savings Cards Legit?

There are a lot of companies in the discount prescription space, so how do you know who to trust? How do prescription saving cards work? The short answer is, we negotiate discounts on bulk drug purchases with pharmacy owners at more than 65,000 pharmacies nationwide. The discounts we’ve negotiated are off the cash prices for your medications. More affordable prescriptions bring in more customers who buy more, so it pays off for the pharmacies.

You can feel safe with the resources we share and savings we deliver. ScriptSave WellRx is part of Medical Security Card Company, LLC; bringing some of the most advanced technology, pharmacy expertise and customer service in the industry for the past 25 years.

ScriptSave WellRx in the News

A recent article on prescription costs and savings from The Mighty1 highlights how widely prescription prices can vary between discount companies. Check out their comparison on the medication, Savella:

Savella (Milnacipran)

Savella is a nerve pain and antidepressant medication often used to treat fibromyalgia. Currently, only the brand version is available.

savella pricing scriptsave wellrx prescription savings image

 

How Much Will You Save?

Try our free price comparison tool to see if we can help you save. The ScriptSave WellRx program is FREE to all patients, and the price-check tool is available 24/7, without the need for an account or any personal details. In other words, the program can be used risk-free and with nothing to lose. We even provide free medication management tools, refill reminders and an “Ask a Pharmacist” helpline. We’re doing our best every day to help patients get safe, hassle-free savings.

 

References:

  1. How to Save Money on Your Prescription Drug Costs – The Mighty
    https://themighty.com/2018/08/how-to-save-money-prescription-drug-costs/

Download the free WellRx app from the iOS app store or the Google Play Store,
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If you’re struggling to afford your medications,
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Epidiolex: A new CBD epilepsy drug

by Roxanna Orsini,
PharmD Candidate Class of 2019, University of Arizona

Treatments are available that can successfully control seizures for most people with epilepsy. However, there’s a soon-to-be-released medication, recently approved by the FDA, called Epidiolex.

What is Epidiolex?

Epidiolex (cannabidiol) is a new FDA-approved epilepsy medication that is derived from Cannabis Sativa plant (marijuana). Cannabidiol (CBD) does not create feelings of euphoria or intoxication, the “high” that is often experienced with Cannabis, which comes mainly from the compound tetrahydrocannabinol (THC), which is also found in marijuana.

Which forms of epilepsy does Epidiolex treat?

The FDA approved Epidiolex for treatment of seizures associated with two rare and severe forms of epilepsy, in patients two (2) years and older.5

  • Lennox-Gastaut Syndrome
    • Begins in childhood and continues to adulthood with some changes in presentation with age.3
    • Often characterized by multiple types of seizures (particularly tonic and atonic) and an intellectual disability.
    • An EEG (electroencephalogram) can display a classic pattern of background slowing and spike-wave bursts with frequencies less than 2.5 per second. 2
    • Found in 2-5% of childhood epilepsies.2
  • Dravet Syndrome
    • Begins during the first year of life and is a lifelong disease.3
    • This is a rare genetic epileptic brain disease.
    • Infants will have normal development up until an increase in seizure frequency occurs after the first seizure which is often associated with a fever. 1
    • Most children develop some level of developmental disability.
    • Seizures can be triggered by various factors such as body temperature, emotional stress or excitement, and photosensitivity.1

Coming Soon!

While Epidiolex has been approved for release, the expected time to market is September 2018. A few things to know about the medication before it is released:

Effectiveness

The study for Epidiolex involved 3 randomized, double-blind, placebo controlled clinical trials which included 516 patients who had either Lennox-Gastaut Syndrome or Dravet Syndrome.3 Results showed that patients taking Epidiolex along with other anti-epileptic drugs (AEDs) showed a decrease in seizure frequency when compared to the placebo.3

Precautions

Side effects (3,5) are often something to be aware of before starting a new medication. A few reported side effects to Epidiolex include:

  • Elevated liver enzymes
  • Sedation
  • Lethargy
  • Sleep Disorders
  • Diarrhea
  • Rash
  • Increase in suicidal thoughts
  • Decrease in appetite
  • Abdominal discomfort
  • Abdominal pain

Cost

The company has not release any official information about cost for Epidiolex, however NY Times analysis estimates a cost of $2,500 to $5,000 a month.4 It is possible that this medication may be approved by insurances so make sure to discuss options with your provider.

Future Opportunities

Even though this medication is only currently approved for these two forms of seizures, it does open the door to future possibilities.  Always keep communication open with your healthcare provider so they can help guide you on therapy options as more clinical studies arise with new information.

 

References:

  1. Epilepsy Foundation. (2018). Dravet Syndrome. [online] Available at: https://www.epilepsy.com/learn/types-epilepsy-syndromes/dravet-syndrome [Accessed 11 Jul. 2018].
  2. Epilepsy Foundation. (2018). Lennox-Gastaut Syndrome (LGS). [online] Available at: https://www.epilepsy.com/learn/types-epilepsy-syndromes/lennox-gastaut-syndrome-lgs [Accessed 11 Jul. 2018].
  3. FDA.gov. (2018). FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. [online] Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm611046.htm [Accessed 10 Jul. 2018].
  4. Kaplan, S. (2018). D.A. Panel Recommends Approval of Cannabis-Based Drug for Epilepsy. [online] Nytimes.com. Available at: https://www.nytimes.com/2018/04/19/health/epidiolex-fda-cannabis-marajuana.html [Accessed 5 Jul. 2018].
  5. Micromedexsolutions.com. (2018). Micromedex Products: Please Login. [online] Available at:
    http://www.micromedexsolutions.com/micromedex2/librarian/CS/B42F8E/ND_PR/evidencexpert/ [Accessed 5 Jul. 2018].

 


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Employers and preventive care - blog image - ScriptSave WellRx

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

Every year, employers are paying more to have their employees insured. A study on the annual growth rate of health care costs found that employers are experiencing 5%-to-6% increases in healthcare costs per year.Early estimates suggest employers will spend over $730 billion on health benefits in 2018 alone.

Curbing Healthcare Costs

Growing health care costs can impact both employees and companies:

  • Employees are becoming more concerned because some of the costs are being passed on by the employers.
  • Increasing costs are pushing large employers to be more involved in healthcare, instead of relying on insurers.
  • As companies grow and costs increase, the amount spent on health benefits will follow suit.  

Saving Money While Providing Better Care

Companies are tackling the increases in health care costs by negotiating with healthcare providers without going through a middleman. By skipping the insurer, large employer groups are spending less and creating a direct path to health care services for  their  employees. These new plans are becoming more prevalent in areas such as the Silicon Valley, where large employee populations can be monitored day-to-day in the work environment.

Healthcare providers are being stationed inside the work space for enhanced patient monitoring, and clinics are being built into the work environments to create better access to healthcare services. The new patient-focused  care plans strive to prevent health conditions, rather than treating problems after they appear. Monitoring employees with  routine check-ups generally costs less than rushing them to the hospital for emergency services.

In California, a partnership between a large employer and a hospital offers a plan that requires healthcare providers to track multiple health indicators on a consistent schedule to prevent unexpected healthcare costs.Many employees are reluctant to switch to a plan that further restricts where they can receive health benefits, but employers are providing incentives to lower the costs to employees.

Some of the incentives include lower monthly premiums and copays. Clinics within the workplace often include necessary amenities for healthcare providers to perform general check-ups, physical therapy, and promote an all-inclusive body, mind, and spirit preventative healthcare approach.

What Can We Learn from Large Employers?

Current healthcare plans that support constant monitoring have allowed employers to save money by reducing high-cost services. Many employers are trying to move towards preventing health conditions rather than treating them after they appear. They are also addressing the inherent conflict for providers, where prevention of expensive healthcare costs reduces the number patients taking part in more profitable care such as emergency services. As we watch these new health plans continue to grow we can observe the benefits of constant monitoring and prevention. If employers continue to promote these plans due to improved health outcomes and costs savings, we may want to take a more preventative approach to our own healthcare.

References

  1. Barnes, K., Judy, R., & Isgur, B. (2018, June 15). Medical Cost Trend. Retrieved from PWC: https://www.pwc.com/us/en/health-industries/health-research-institute/behind-the-html
  2. Caspani, M. (2018, June 15). Soaring costs, loss of benefits top Americans’ healthcare worries: Reuters/Ipsos poll. Retrieved from Reuters: https://www.reuters.com/article/us-usa-healthcare-worries/soaring-costs-loss-of-benefits-top-americans-healthcare-worries-reuters-ipsos-poll-idUSKBN1JB1FD
  3. Humer, C. (2018, June 11). Fed up with rising costs, big US firms dig into health care. Retrieved from Reuters: https://www.reuters.com/article/us-usa-healthcare-employers-insight/fed-up-with-rising-costs-big-u-s-firms-dig-into-healthcare-idUSKBN1J70ZZ

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