Pillboard Archive
The Pillboard, written by Rick
Hogle, owner of the Fairfax Pharmacy, will continue to be a regular monthly
feature of the Fairfax News. Each month the
Pillboard information will be posted to this page, with the topics
indexed in the table below. The table also shows which month's issue of the
Fairfax News contains which topics. A year's worth of topics are
archived here.
Just click on the topic of interest to you.
JANUARY
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FEBRUARY
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MARCH
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APR
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MAY
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JUNE
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JULY
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AUGUST
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SEPTEMBER
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OCTOBER
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NOVEMBER
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DECEMBER
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January 2008
TREATING COLD SYMPTOMS IN CHILDREN has become a challenge for parents with the withdrawal of infant cough and cold products. The effectiveness of using combination products containing cough suppressants, antihistamines and nasal decongestants in children under six years of age is difficult to determine objectively from the patients they are being used on. Since the risk of misuse or overdose is significant their use is not recommended without first speaking to the child's healthcare provider. The first treatment for cold symptoms should be adequate hydration with fluids and a room humidifier. For nasal congestion, saline solution and a nasal aspirator work quite well. Products containing acetaminophen or ibuprofen alone are certainly ok to use, but be sure to measure accurately and not to exceed recommended daily doses. Children under 3 months with cold symptoms should see a doctor or those less than 2 years with a fever for more that 24 hours. Infants and adolescents with ear pain should see a pediatrician as well as those with cold symptoms that don't improve in 10 days.
ALBUTEROL METERED DOSE INHALERS will no longer be available in the United States by the end of this year. They are being replaced by the newer versions containing non-fluorocarbon propellants. The new inhalers generally include the letters HFA in their brand or generic name. Some patients believe the new inhalers don't work as well. This may be due to the fact that the propellant delivers the drug with a "softer" spray however the correct amount of drug is dispensed with each spray. Washing the actuator out once a week with warm water will help to prevent clogging and provide the proper dose to the patient.
LEAVING THE LIQUID ANTIBIOTIC ON THE COUNTER OVERNIGHT can be a concern for some parents. Products such as Augmentin (Amoxicillin/Clavulanate) do not keep at room temperature overnight. Cephalexin, Cefzil, Cefaclor and Pediazole can be left at room temp for 24hrs. While Amoxicillin, Azithromycin, Omnicef, Duricef, E.E.S. Liquid may taste better cold; they are good for 10 days at room temp. Biaxin and Cleocin get too thick to dose in the refrigerator and should be kept at room temp. Sulfatrim liquid does not require refrigeration. If you have any questions about the storage of your child's antibiotic ask your pharmacist.
A NEW EUROPEAN BREAKTHROUGH FOR WEIGHT LOSS CALLED AKAVAR 20/50 claims to allow people to eat all they want and still lose weight. This product contains guarana, yerba mate and green tea as sources of caffeine as well as other caffeine containing components. One capsule contains about 100 mg of caffeine, about the same as a cup of fresh brewed coffee. So taking the recommended dose of two capsules twice daily is equal to about 4 cups of coffee a day. Combine this with your regular cola or coffee intake and you could dangerously increase heart rate and blood pressure. There is no proof that caffeine or Akavar use leads to significant weight loss.
February 2008
PATIENTS TAKING VYTORIN ARE CONCERNED about the recently reported ENHANCE study. Vytorin contains simvastatin (Zocor) and ezetimibe (Zetia). The ENHANCE study compared Zocor alone against Vytorin to see if the combination reduced plaque build up more effectively. The study shows no better results from the combination in reducing plaque build up but the two drugs combined are more effective at lowering LDL (bad) cholesterol. These are preliminary reports with only a small amount of data released. There are still ongoing studies to determine if the combination is effective at preventing heart attacks. Right now there is no evidence that the combination is dangerous. Patients should not stop taking either drug without first talking with their physician.
PATIENTS SHOULD PAY ATTENTION TO MEDICAL BENEFITS paid in their name by insurance companies. Criminals are stealing medical information in order to obtain medical payments or care. Protect the information on your Medical Insurance Card, Social Security and Medicare cards and report any lost cards. The real problem might occur if the wrong illness, diagnosis or allergies get attached to a patient record. If you suspect medical identity theft, verify the accuracy of vital medical records with your health care provider.
TAKING ORAL MEDICATIONS WITHOUT WATER OR LAYING DOWN IMMEDIATELY after taking can lead to erosions and even ulcers in the esophagus.
Meds such as tetracyclines, NSAIDS, potassium supplements and bone builders (Fosamax, Actonel, Boniva) are often times implicated when this occurs. Always drink a full glass of water with these medications and in some cases remain upright for at least 30 minutes after taking. Drugs such as oxybutynin and dicyclomine can aggravate the problem since they reduce saliva production. The elderly and Parkinson patients are at increased risk for esophageal erosions due to difficulty swallowing. A liquid or coated tablet may be a better choice for these patients.
STEVIA IS A NATURAL SWEETENER THAT COMES FROM THE LEAF OF A PLANT IN THE DAISY FAMILY. It is much sweeter than sugar and has no calories. Stevia is widely used in Japan and other countries as a sugar alternative and artificial sweetener. It can't be sold in this country as a sugar substitute since food additives have to be proven safe. It is available as a supplement and people are using it as a sweetener. The FDA is concerned about studies that suggest that stevia may be carcinogenic or reduce fertility. Used in small amounts it is probably save however it should not be used excessively and probably not during pregnancy.
March 2008
PATIENTS WITH JOINT PAIN will soon be able to purchase patches and gels containing diclofenac, an NSAID medication used orally to treat inflammation and pain. Voltaren Gel and Flector Patch should be in stores soon and it's hoped that applying this drug topically will reduce the risk of side effects. The gel should be measured accurately on a dosing card and massaged into the affected area. The patch should be applied directly over the sprain or contusion, left on for 12 hrs and kept dry. If skin irritation occurs, discontinue use.
SEVERAL MEDICATIONS CARRY AN ALCOHOL WARNING. Antibiotics such as metronidazole, Tindamax, Cefobid and Cefotan can cause severe reactions when combined with alcohol. Drugs used to treat diabetes such as sulfonylureas may lead to severe hypoglycemia if alcohol is consumed in more than the occasional single drink.
Warfarin metabolism may be inhibited by alcohol resulting in unstable INRs. Soriatane and alcohol leads to a teratogenic compound that remains in the body for years. Avinza, a long acting morphine, releases morphine faster when combined with alcohol and could lead to a fatal overdose. Taking NSAIDS along with chronic alcohol use can increase the risk of GI bleeding. Alcohol can induce the production of toxic metabolites from acetaminophen if exceeding 4 gms (8 extra strength tablets) per day.
ZYRTEC OTC AND ITS GENERIC EQUIVALENT CETIRIZINE are now on pharmacy shelves. It is quite a bit less expensive especially in the generic form. For some patients it works better than Claritin and also faster, usually in 60 minutes as opposed to 3 hours for loratadine. However Zyrtec does cause more drowsiness.
PSEUDOEPHEDRINE BEHIND THE COUNTER may reduce its availability for manufacturing methamphetamine but it has left some people looking for congestion relief. Phenylephrine is the only oral decongestant now on front-end shelves. It works well topically in a nasal spray, however oral doses are poorly absorbed and some studies show it to be no more effective than placebo. Higher doses might work better but increase the risk of side effects. If you find the "PE" products ineffective than try a short-term nasal decongestant spray or request pseudoephedrine at the pharmacy counter..
April 2008
GENETIC TESTING TO PREDICT DRUG HYPERSENSITIVITY may become routine in the future. Genetic testing for Asians is now recommended before starting a commonly used seizure medicine. Human leukocyte antigens (HLA's) are attached to white blood cells and are important in recognizing foreign invaders. They can also cause a reaction to a drug. HLA subtypes are genetically determined and so are more common in families or races. Right now testing is too expensive for routine use but hopefully with time can help prevent severe reactions and hospitalization.
MANY PRESCRIPTION DRUGS AFFECT NUTRIENT LEVELS and while most of the time it is not significant, patients with inadequate diets may need supplementation.
Long-term large doses of aluminum antacids can deplete calcium and phosphates. Aspirin and NSAIDs may cause GI blood loss leading to iron depletion. Carbamazepine, phenobarbital, phenytoin and primidone deplete calcium, vitamin D and K. Corticosteroids use can lower calcium and vitamin D. Digoxin blocks reabsorption of magnesium. H2 blockers such as Pepcid and PPIs like Prilosec reduce vitamin B12 absorption. Hydralazine reduces vitamin B6 levels. Most diuretics lead to potassium loss. Metformin can lower vitamin B12 and folic acid levels by reducing absorption. Orlistat by blocking fat absorption blocks the absorption of the fat-soluble vitamins- beta-carotene and vitamin A, D, E and K. Sulfasalazine decreases folic acid in the body. Close monitoring, adequate dietary intake and supplements when necessary are advisable.
SOME DIABETIC SWEAR THAT CINNAMON helps lower their blood glucose. A recent study to check this out did not bear fruit. An earlier study had suggested some benefit however the results cannot be reproduced and for most diabetics, cinnamon does not affect blood glucose.
PATIENTS CHECKING THEIR OWN BLOOD PRESSURE AT HOME probably obtain a better reflection of their true situation. It avoids "white coat" effect and allows for more readings to obtain an average. A digital monitor that goes around the upper arm is relatively easy to use and correct cuff size is critical. The patient should be seated with back supported and feet flat on floor. The arm should be supported at heart level. Resting for 5 minutes is advisable and 30 minutes after exercise. Nicotine should be avoided for 30 minutes and caffeine for 2 hrs. Take 3 readings around a minute apart and average the 3 together.
May 2008
CAN CALCIUM INCREASE HEART ATTACK RISK? Early studies seem to suggest that a higher risk occurs in older women taking calcium for 5 years. The evidence is not conclusive. Some researchers speculate that the extra calcium lowers magnesium levels or hangs around the arteries, worsening atherosclerosis. There is no reason to panic, and taking another view, it is known that one out of fifty women taking calcium with vitamin D for five years WILL be spared a fracture. Women should try to take 1200 mgs of calcium with vitamin D per day including supplements and dietary intake.
PATIENTS LOOKING FOR A DRUG FREE ALTERNATIVE FOR SINUS CONGESTION are finding relief with neti pots. Also called nose bidets, neti pots look like little teapots. They are filled with a saline solution, either mixed at home or purchased ready made. The solution is instilled into one nostril, through the sinuses and empties out the other nostril. Although awkward at first to learn the technique, once mastered the results can be dramatic and offer relief for allergies, colds, sinusitis and post-nasal drip. Patients making up their own salt solution should be sure to use non-iodized salt as iodine may impair the ability of the nasal cilia to move mucous secretions.
WHETHER CAFFEINE INCREASES THE RISK OF MISCARRIAGE is not settled by two recent studies. One said yes and the other study said no. Looking at the details of both studies, they do agree on one thing-that small amounts of caffeine are probably ok. Pregnant women should limit intake to about 200 mgs per day, which is equal to 12 ozs of coffee. Several other foods contain caffeine including tea, soda and "energy" drinks as well as "energy" foods like Snickers Charged candy bars, Jelly Belly Extreme Sport, Ice Breakers Energy mints and more.
INCREASED USE OF SUNSCREENS, TIME SPENT INSIDE AND A DECREASED ABILITY TO ABSORB VITAMIN D AS PEOPLE AGE has led to an increased incidence of vitamin D deficiency. Living in higher latitudes and darker skin also leads to low vitamin D levels. Testing should probably be done on homebound elderly, patients with renal disease and those with persistent, non-specific musculoskeletal pain.
To prevent deficiency, patients under 50 yrs of age should supplement with 400 to 800 IU/day of cholecalciferol and 800 to 1000 IU/day if over 50 yrs. Clinical deficiency requires treatment at higher doses by a physician.
June 2008
PATIENTS TAKING CALCIUM CHANNEL BLOCKERS may experience skin reactions. Approximately 1% of patients have minor reactions such as rash, photosensitivity and itching soon after starting the medication. A delayed reaction, perhaps 3 months after starting, can include an eczema rash. More severe skin reactions can occur in a few patients in days, weeks or months after beginning the drug. Switching to a different calcium channel blocker may help minor reactions but more severe reactions require stopping the drug and switching to a different cardiovascular drug class entirely.
SCREENING FOR PATIENTS AT RISK FOR FRACTURES FROM OSTEOPOROSIS is critical. There are around 10 million people over 50 years of age who have osteoporosis and many more at risk. Unfortunately a broken bone is the first alert to the problem. Bone density testing is now the recommendation for women 65 and over and men 70 and older. Postmenopausal women and men over 50 should be tested if they have a family history of osteoporosis, drink 3 or more drinks per day, smoke or are underweight. Some drugs can cause osteoporosis such as anti-seizure meds and corticosteroids.
A NEW TOPICAL ESTROGEN SPRAY FOR MENOPAUSAL SYMPTOMS is now available. Evamist contains low dose estradiol in a 21 mcg/spray dose. It joins the other estrogen supplements such as pills, gels, patches, creams and vaginal products used to treat symptoms of menopause. Physicians try to use the lowest dose possible to control hot flashes and avoid adverse reactions. Patients are able to choose the dosage form that best fits their lifestyle.
SOME PATIENTS BELIEVE THAT THE STATINS THEY ARE TAKING TO LOWER CHOLESTROL are causing them memory problems. At this point there is no solid proof that this is true. Loss of memory is the second most reported complaint after muscle pain in patients on statins. Cholesterol is a large component of the central nervous system so some theorist suggest that too much suppression of its production could lead to slow thought and memory. Collected data is conflicting and some even suggests a protective benefit. There are other illnesses and drugs that are known to produce memory loss and the problem should be discussed with a physician. Statins do reduce the risk of stroke and stroke certainly can cause cognitive problems.
A REMINDER THAT FLUSHING UNUSED DRUGS IS NOT THE RECOMMENDED METHOD. Levels of hormones, antibiotics, antidepressants and heart meds are turning up in our drinking water. The amounts are miniscule but over time could affect fish and wildlife and contribute to antibiotic resistance. Crushing tablets or capsules and mixing with kitty litter or coffee grounds then placing in a Ziploc bag and sending to lined landfills is preferred. Certain controlled substances that can't be rendered unpalatable this way are exceptions that should be flushed.
July 2008
PREPARATION FOR A COLONOSCOPY CAN BE MORE TRYING than the actual exam. Oral phospho-soda solutions are most commonly used for bowel cleansing and work quite well at emptying the colon. Patients must be careful to consume at least 8 ounces of clear fluids with each dose as well as additional amounts throughout the preparation day to prevent dehydration. Patients with impaired renal function or electrolyte imbalance should not use oral phospho-soda solutions. Chilling the solution before drinking makes it more palatable. Patients must be careful to avoid red or purple colored liquids as they can interfere with the colonoscopy.
THE FDA IS WORKING HARDER TO GET SAFETY INFO into health care providers hands sooner especially after the Vioxx market withdrawal. "Early communications" to the public and providers alert them to possible problems the FDA is looking into. This results in reports flowing to the FDA of any incidents that may confirm the problem. It also can help to alleviate concerns when the problem does not pan out. An early warning about possible heart problems with Nexium and Prilosec turned out to be unlikely. Chantix warnings became stronger when reports of violent behavior and suicidal thoughts became more numerous. The FDA is currently looking at reports of suicidal thoughts and mood swings on Singulair and similar meds, however this is an "early communication" and the data is still being collected. Patients should not stop taking these medications with first speaking with their prescriber.
WOMEN OFTEN TAKE ORAL CONTRACEPTIVES BEYOND THE AGE OF 35 and are concerned about their safety. They are used to regulate menses, treat perimenopausal symptoms or for birth control. Combo contraceptives quadruple the risk of clots annually. Obesity, smoking, hypertension, diabetes and migraine history in combination with combo contraceptives is especially risky since these women are already at risk for heart attack and stroke. As long as women have a low risk of heart attack or stroke and it is not contraindicated, women can take oral contraceptives up to the age of 55 to prevent pregnancy.
PARENTS ARE CONCERNED WHETHER THEY NEED TO HAVE AN ECG for their child before they are placed on an ADHD medication. This relates to an increased risk of sudden death when stimulants are given to children with congenital heart defects.
The American Heart Association recommends checking family history and a physical exam for all kids prior to starting a stimulant medication and an ECG is suggested if there are concerns about congenital heart defects. If it's available, an ECG is better than a physical exam at detecting potential problems, however it is not required.
August 2008
ELDERLY PATIENTS MAY BE ABLE TO REDUCE THE RISK OF FALLING WITH VITAMIN D. Almost a third of patients over the age of 65 fall down at least once a year with fractures, head injuries or even death occurring in 10% of those falls. Taking vitamin D appears to improve muscle strength and since the elderly generally get less sun, a supplement is a good idea. Taking 800 IU per day is an appropriate dose, as taking less does not appear to have the same benefit. Several drugs can cause dizziness, drowsiness or balance impairment and should be used cautiously in the elderly.
MEDIA REPORTS OF A LINK BETWEEN BONE STRENGTHENING AGENTS AND ATRIL FIBRILLATION are not backed up by most clinical studies. The reports were associated with the injectable drug Reclast and there was some concern that it would also be a side effect from Fosamax, Actonel or Boniva. What seems likely is that women experiencing atrial fib probably had an underlying condition.
THERE IS GROWING EVIDENCE THAT GLUCOSAMINE CAN INTERACT WITH COUMADIN leading to increases in INR's and serious bleeding complications. This is a rare interaction and may occur when taking glucosamine alone or in combination with chondroitin. This interaction does not appear to be a problem with aspirin or Plavix.
Patients should report any unusual or prolonged bleeding or bruising especially after starting the supplement or increasing the dose of Coumadin (warfarin).
PURCHASING MEDICATIONS WHEN TRAVELING IN FOREIGN COUNTRIES CAN BE TRICKY. Medications may have different brand names or sound-a-like names in other countries. Prilosec is Losec in Canada and Zyrtec is Reactine. Simvastatin (Zocor ) has more than ten different names in Mexico and Lipitor has more than thirty in India. In Mexico, Prilosec is called Medral and Medrol in this country is a steroid used to treat inflammation. Albuterol inhalers are call salbutamol in most countries and acetaminophen (Tylenol) is often called paracetamol. Be sure to tell your pharmacist if you are taking any drugs purchased in foreign countries.
September 2008
THE SMOKING CESSATION DRUG CHANTIX HAS BEEN VERY EFFECTIVE AT HELPING SMOKERS QUIT. There are cautions however associated with its use. Patients taking Chantix should report any changes in mood or behavior to their physician and should use caution driving or operating machinery until they know how the drug will affect them. There are some safety groups that suggest a link between Chantix and confusion, dizziness, diabetes, seizures and heart attacks. These links are as yet proven and the benefits of quitting smoking are known. Clinicians are now trying to determine if these effects are actually related to nicotine withdrawal or previous smoking. Until this is determined, pilots, air traffic controllers, bus drivers or truckers should not use Chantix.
AFTER DECEMBER 31, 2008, CHLOROFLUOROCARBON (CFC) ALBUTEROL INHALERS WILL NO LONGER BE AVAILABLE IN THIS COUNTRY. Patients will have to be switched to non-cfc products such as Albuterol HFA or Xopenex HFA. Due to the fact that these inhalers do not dispense the albuterol with as much force as CFC inhalers and taste differently, patients may think they are not working. Patients can rest assured that they are just as effective. The newer inhalers do have a higher price tag however insurance and drug companies are offering some assistance with this.
SEVERAL DRUGS ARE AVAILABLE IN PATCH FORM CAUSING QUESTIONS REGARDING THEIR APPLICATION. Some patients cut patches to titrate doses or save money. This is not a good idea with drugs that are in a reservoir since leakage and over dosage can occur. Matrix patches with drug in the adhesive may avoid leakage however dosages can be inaccurate. There are some patches, such as Lidoderm, where the manufacturer has provided guidance regarding cutting to titrate dose. Taping over the entire patch to hold in place is not recommended since it can increase adsorption. Be sure to place patch only on dry skin and hold in place the required time to enhance adhesion. Heat can also increase absorption of the active ingredient and patients should not expose the patch to sunbathing, saunas, heating pads or electric blankets.
PATIENTS SUFFERING WITH FIBROMYALGIA HAVE A NEW TREATMENT OPTION. Cymbalta has recently been approved to decrease pain and tenderness. Lyrica first received the indication to treat fibromyalgia. Antidepressants are often tried to improve mood and relieve pain. Since sleeping can be difficult, physicians often also order sleeping pills to provide relief in this area. Natural remedies tried include St.Johns wort, SAMe and malic acid plus magnesium. At this point only SAMe appears to have a modest benefit.
October 2008
PATIENTS TAKING QUINOLONES (CIPRO, LEVAQUIN, etc) should be alert to signs of a tendon injury. Rarely these drugs can increase the risk of tendon rupture, usually the Achilles tendon of the heel but also those in the shoulders, arms and hands.
Symptoms of a tendon injury include swelling, pain and the inability to move or put weight on the affected tendon. Patients that suspect this should not try to work through it since this can worsen the problem. They should stop the drug and notify their physician.
The risk is higher in patients over 60 or those taking corticosteroids.
SOME MEN MAY WANT TO CONSIDER TAKING FINASTERIDE (PROSCAR) to prevent prostate cancer. Prostate cancers strike 1 in 6 men and leads to the death of 1 in 35 because it grows so slowly. Taking finasteride reduces risk only by about 6% in men over 55, however those with higher risk factors such as family history, African Americans or those over 50 may want to consider the drug to reduce their risk.
PATIENTS USING A SPACER DEVICE FOR THEIR INHALED MEDICATION may want to soak the device in soapy water for 20 minutes once a month and let air-dry. This will help eliminate the static charge that can develop on the interior surface of the device trapping some of the medication. Infants and toddlers that use a mask with a chamber should keep the mask in place for 3 to 6 breaths of each puff. Patients using an inhaled steroid should be sure to rinse their mouth after each use.
MORE AND MORE INFANTS ARE BEING PRESCRIBED ANTI-REFLUX MEDICATION such as Prevacid. Over half of healthy infants will spit up frequently during the first 4 months after birth. If a baby is gaining weight, not overly fussy and feeding well then reflux is rarely serious. Sometimes smaller more frequent feedings can help out as well as checking for milk allergy, exposure to smoke, colic and constipation. If a baby will not eat, spits up blood, is not gaining weight or has frequent diarrhea then a specialist should be consulted.
IRON SUPPLEMENTS ARE AVAILABLE IN MANY FORMS intended in some cases to avoid side effects. Ferrous sulfate, ferrous gluconate and ferrous fumarate are all iron salts. They each contain different amounts of elemental iron. Their effect and side affects are similar at equivalent doses of the iron content. Carbonyl iron such as Feosol is a time-release product that is designed to improve tolerance and reduce toxicity but at the cost of reduced adsorption. Polysaccaride-iron complex, Niferex, is iron bound to carbohydrates. This is supposed to reduce side effects however this has not been proven. Products that include vitamin C are supposed to increase iron absorption however they need to contain more than 200mgs of vitamin C to each 30mg of elemental iron.
November 2007
THE GOOD NEWS IS THAT ADVANCES IN DIAGNOSIS AND DRUG TREATMENT have reduced mortality from the "silent killers" such as hypertension, high cholesterol and osteoporosis. The bad news is that poor compliance by patient's costs an estimated $100 billions per year due to increased hospital visits and produces about 125,000 deaths per year. Because these chronic illnesses are "silent", patients stop taking half their meds within a year and one in five new prescriptions are never filled. Patient that don't take their medication for heart failure are twice as likely to die or be hospitalized. Patients that don't take their statin drugs for high cholesterol double their risk of heart attack. Asthma patients that don't use their maintenance inhalers correctly are more likely to show up at the emergency room for asthma attacks. If you don't know why you need to take a medication ask your doctor or pharmacist. If you have trouble remembering to take your medication ask your pharmacist for patient aids or perhaps the possibility of a drug that better fits your lifestyle. If it's too expensive-ask about using generics medications. Monitor your blood pressure and blood glucose regularly.
PATIENTS THAT DON'T TOLERATE DRUGS LIKE FOSAMAX, ACTONEL OR BONIVA or can't remember to take them now can get a once a year infusion of Reclast at their doctors' office. The administration takes 15 minutes and reduces spinal fractures by 70% and hip fractures by 41%. A few patients may develop infusion reaction that can be treated with acetaminophen or ibuprofen. Women should still take an adequate amount of calcium and vitamin D as well as perform weight-bearing exercises.
ZYRTEC GOES OFF PATENT IN DECEMBER AND WILL HAVE GENERIC COMPETITION soon after that and it is expected to go over the counter just as Claritin did. And just like Claritin, Zyrtec will have a son of Zyrtec prescription drug called Xyzal. Clarinex is the active component of Claritin and Xyzal if the active part of Zyrtec. It extends the patent life of the drug and allows the manufacturer to squeeze a little more life and money out of the drug.
TAKING A DAILY ASPIRIN WITHOUT SPEAKING WITH YOUR PHYSICIAN is not a good idea and can be downright dangerous. Aspirin therapy does reduce the risk of heart attack and ischemic stroke but increases the risk of hemorrhagic stroke. This is especially true in patients with uncontrolled high blood pressure. Before starting aspirin therapy, patients should consult with their doctor and make sure that the benefit will outweigh any risk. Getting blood pressure under 150/90 or even lower should be their goal.
WHAT IS THE BEST WAY TO CHECK FOR A FEVER? Rectal temps are most reliable and should be used when accuracy is critical. Oral temps for older children that can keep a thermometer under their tongue for 30 seconds. Pacifier thermometers can take up to 6 minutes to read. Ear thermometers are convenient but may be inaccurate due to earwax or improper placement. They should not be used during ear infections. Temporal thermometers scan the forehead with infrared and are less prone to inaccurate readings than ear thermometers. Under the arm temps are least accurate. Rectal, temporal, and ear readings are similar, oral are 1/2 to 1 degree lower and armpit readings are 1 to 11/2 degree lower. Call a doctor for any fever in a child under 3 months, fevers that last longer than 24 hrs in a child under 2 years or with symptoms of diarrhea, sore throat, vomiting or ear pain. .
December 2007
DID YOU EVER WONDER IF A RASH WAS AN ALLERGIC REACTION TO A MEDICATION? A rash caused by an allergic reaction to a drug can occur 1 to 3 weeks after first exposure and in 2 to 3 days for patients previously exposed to a drug. It usually has a sudden onset, starts on the trunk and may spread to the limbs, is itchy and looks somewhat like measles. Most commonly causing drugs are penicillins, cephalosporins, sulfonamides and anticonvulsants, but any medication can cause an allergic reaction. If it occurs the medication should be stopped and the doctor contacted. Oral antihistamines and topical steroids may give some relief. A rash that also has symptoms of fever, joint pain or fatigue should immediately be reported to a physician, as it may be more serious.
EVISTA (raloxifene) AND TAMOXIFEN ARE BOTH NOW BEING USED IN POSTMENOPAUSAL WOMEN TO REDUCE THE RISK OF BREAST CANCER. They reduce the risk by about 50%, however the Evista is less likely than tamoxifen to cause uterine cancer, cataracts or the need for a hysterectomy. They both can increase the chance of blood clots and the prescriber should be consulted if a patient is at an increased risk for blood clots such as during an extended immobility.
FLU SEASON OFTEN PEAKS IN FEBRUARY so it is not too late to get your flu shot. This year up to 20% of Americans with get the flu, two hundred thousand will be hospitalized and thirty six thousand will die from the flu. Flu vaccine does not cause the flu, as it is an inactivated virus, the inhaled vaccine is a live virus but would only present a problem in a severely immuno-compromised patient. Being vaccinated is especially important in patients under 5 yrs and over 50 yrs of age, health care workers, pregnant women, asthma patients, diabetic patients and patients with other chronic conditions. There's plenty of vaccine this year so don't worry about taking someone else's shot.
PEOPLE ARE CONCERNED ABOUT THE RISING INCIDENCE OF "MRSA". Methicillin resistant Staph aureus infections are generally acquired in health care settings but more cases are appearing in community settings. ER visits for skin and soft tissue infections are commonly the result of MRSA. They are usually very treatable by draining of the abscess and/or oral antibiotics. Recurrent infections or those associated with more severe symptoms require more vigorous treatment with stronger IV antibiotics. As with all infections the best prevention is good hygiene including washing hands well, not sharing personal items or towels and cleaning surfaces that frequently contact bare skin.
I'D LIKE TO TAKE THIS OPPORTUNITY, ON BEHALF OF MYSELF AND OUR STAFF, TO THANK YOU FOR YOUR PATRONAGE AND WISH ALL OUR CUSTOMERS AND FRIENDS A PEACEFUL, HAPPY AND HEALTHY HOLIDAY SEASON! RICK
