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Archive for June, 2013

Summer Travel. By Our “Soon To Hit The Road” Student Pharmacist, Nick Trego.

Summer time has arrived and the kids are out of school, which means it is time for the annual summer vacation! Here at Plain City Druggist, we want to make sure you have a blast on your family vacation, so we have some easy tips and advice for making sure that the vacation goes as smoothly as possible. We want to make sure that this family vacation is one you will never forget for all of the right reasons.

Whether you are headed to the beach or a foreign country far, far away, there are many helpful things we can suggest to make preparing for your trip a breeze. Sometimes, the excitement of packing for and looking forward to the vacation can interfere with making sure that you have packed all the essential goods to prevent disaster after you leave home. On the other hand, trying to pack for the entire family and remember to complete all necessary tasks before leaving is not easy. A checklist, especially one for your healthcare, is always helpful to make sure you don’t forget anything.

CDC checklist: http://wwwnc.cdc.gov/travel/page/pack-smart#travelhealthkit

If staying inside the continental United States, whether driving or flying to your ultimate destination, there are a few things to look into. First, knowing the climate of the destination will be very helpful when deciding what exactly to pack. Now, this may seem like common sense, but temperature and weather can affect air quality, allergens in the air, and ultimately the health of many members of your family. Some destinations will be very hot and have low air quality–this could potentially cause problems for people with asthma or chronic obstructive pulmonary disorder (COPD). The hot, low quality air will contain less oxygen than normal and could cause shortness of breath, asthma attacks, or other exacerbations of these conditions. Visiting your local pharmacy for an inhaler and other asthma and COPD medication refills is a must if visiting one of these destinations.

Air allergen presence is another factor to consider when leaving for vacation. The local weather reports of the area which you are visiting will most likely contain any allergy alerts. Since this destination may have different plant and animal species than your family is used to, an allergy exacerbation is possible. In this case, it does not hurt to bring along a common allergy medication such as Claritin or Allegra to prevent allergies from interfering with your vacation.

Common over-the-counter medications such as acetaminophen, ibuprofen, aspirin, or Aleve are always a good idea to tote along on a vacation, as well. These can quickly help take care of minor aches, pains, injuries, swelling, headaches, and fevers.

Sometimes motion sickness can interfere with travel and, if you are prepared with medication, you can quickly fix this problem without a headache.

Link: Common Motion Sickness Medications with doses and reviews (http://www.drugs.com/condition/motion-sickness.html)

Uncomfortably high temperatures can make motion sickness worse, so cooling a nauseous family member down is always a good idea. Packing, dressing, and hydrating appropriately for higher than normal temperatures, while on vacation, is a wonderful preventive measure that will keep your family healthy during summer vacations.

Other products such as antiseptics (alcohol swabs), antibiotic ointment (Neosporin), bandages, sunscreen, antidiarrheal, and antacid medications are useful to prevent unwanted problems or delays in vacations.

Diabetics and people with blood clotting disorders need to take into account that they may be seated for long periods of time during travel, which increases their likelihood of developing a blood clot. Compression stockings and frequent breaks in travel (if driving) are a few good ways to lower the risk of clot formation. Walking around on an aircraft can help to improve circulation, but only do so if allowed by the flight crew and if the patient is very careful due to the potential of a fall during bouts of turbulence. Patients may want to speak with their doctor before traveling to receive other prescription medications that will reduce the likelihood of clot formation.

For those really lucky people traveling out of the country, there are many more aspects to consider when leaving for vacation. The Center for Disease Control (CDC) has developed a website that tells you what precautions you need to take based on the country you enter into their database.

CDC: Out of US Travel Search: http://wwwnc.cdc.gov/travel

Extra precautions for traveling out of the country may include pre, during, and post-vacation treatment with preventative medications, special vaccinations, and other precautionary medications or devices that might be helpful in a specific country.

We here at Plain City Druggist hope you and your family enjoy summer vacation and that the memories last a lifetime. By following the simple precautions listed in this article, you may save yourself a headache or two and insure the health of your family during future trips.

Seasonal Allergies. By Our June Pharmacy Student, Nick Trego.

It’s warm weather again in Ohio and you know what that means: ALLERGY SEASON!

Plants, that had been dormant over the winter, are once again blooming and releasing allergens into the air. These allergens find their way into our bodies and provoke our immune systems to attack foreign particles that are not necessarily harmful, but our bodies perceive them as being so.

Seasonal allergies typically occur in the spring and fall when the seasons are changing and plant life is most active. The blooming of plants in the spring and the shedding of plant material in the fall releases a high number of allergens into the air and increases the likelihood of people experiencing allergy symptoms. Pollen, grass, ragweed and mold are common substances that cause seasonal allergies.

Some ways to avoid exposure to seasonal allergens are to:

1. Stay inside on dry or windy days.

2. Avoid lawn mowing, weed pulling, and other gardening chores that stir up allergens.

3. Remove clothes that were worn outside.

4. Take a shower after being outside to remove allergens from skin.

5. Do not hang laundry outside to dry.

6. Wear a dust mask if you must do outdoor chores.

Many newspapers and television news stations report the pollen and allergen levels on a daily basis, so this is a good way to determine if going outside will aggravate allergies.  Allergy Information:  Allergy Information

There are numerous over-the-counter medications available to ease the burden of seasonal allergies. Avoiding exposure to the allergen is always a first line recommendation, but for some people staying inside all day is not a viable option. Antihistamine medications such as Benadryl (diphenhydramine), chlorpheniramine, Allegra (fexofenadine), Zyrtec (cetirizine), and Claritin (loratadine) can help to combat these seasonal allergies. Benadryl and chlorpheniramine can cause drowsiness, so these may not be the best option for day time allergy relief. Zyrtec, Allegra, and Claritin all work very similarly and will not cause drowsiness. However, it is recommended to switch between these medications if one has been used for a long period of time and seems to be losing its effect on allergy relief.

All of these medications are available behind the pharmacy counter in combination with pseudoephedrine. Pseudoephedrine is a medication that helps to relieve the stuffy nose and congestion that is commonly associated with seasonal allergies. This medication can cause an increase in heart rate and blood pressure–therefore, anyone with high blood pressure or heart problems should consult their doctor before using pseudoephedrine containing products. How to choose the right medication for me?

Nasal saline rinses can also be helpful with allergy and congestion relief, but remember to always use distilled water with saline nasal rinses, as tap water can contain harmful substances that may cause extra complications. These nasal rinses help to lubricate the nasal passages and clear any mucus and allergens from the nasal canals. Nasal sprays are available to decrease congestion, but their use is not recommended beyond three days. These medications cause the blood vessels in the nose to constrict and this provides temporary congestion relief. However, these nasal sprays only act for a very short period of time and as they wear off, the blood vessels open back up and increased congestion occurs.  For this reason, the use of decongestant nasal sprays is not commonly recommended.  Rebound Congestion

One other product that can help make seasonal allergies more bearable is the antihistamine eye drop. Often times, seasonal allergies cause itchy and reddening of the eyes.  The active ingredients in antihistamine eye drops include naphazoline hydrochloride (Naphcon A) and ketotifen fumarate (Zaditor). These medications are available over the counter for allergy symptoms of the eyes.

If any symptoms of seasonal allergies become too much to handle or affect normal daily life to a point that is unacceptable, a physician or allergist should be consulted. There are many prescription medications and treatments that can help relieve allergy symptoms and improve quality of life in many patients.

Insomnia. By Our Worn Out Student Pharmacist, David Brokaw.

Sleep. That blissful third of my life of which I have absolutely no memory. Did you know that our brains secrete neurotransmitters to paralyze our bodies so that we don’t act out our dreams1? The more I think about sleeping, dreaming, and the brain, the more I am fascinated by how we work, brain-wise. But what can we do when our brain isn’t able to follow its own instructions to settle down and get to sleep?

That brings us to my topic for today: insomnia.

Insomnia ranks third behind headaches and the common cold for what ails us. Adults need eight or more hours of sleep a night, but, on average, 6.9 hours is all that we get. And, as we age, this problem becomes more and more common. In 2005, 11% of adults managed insomnia with the help of alcohol, 9% used an over-the-counter sleep aid, and 7% used a prescription medicine for sleep.2

Sometimes, when I get stressed over a big deadline, I have trouble sleeping for a few days. But when the stressful day has passed, my sleep pattern returns to normal. This is transient insomnia.

There are also two other insomnia patterns. Short-term insomnia can last 1-3 weeks. Additionally, there is chronic insomnia, lasting more than 3 weeks. The latter is often a secondary problem of another medical condition, psychiatric disorder, or substance abuse. Problems with sleep could be caused, for example, by sleep apnea, diabetes, heartburn, heart disease, high blood pressure, asthma, chronic pain, anxiety/depression, and stimulant use, like caffeine or smoking. People with medical problems should seek treatment for the underlying medical condition first, which may improve their ability to sleep.

One or more of these strategies could help you wrestle with your particular insomnia demon:

Good sleep hygiene: 1. Avoid large meals later in the evening.

2. Avoid exercise 2-4 hours before bedtime.

3. Dim the lights, lower the volume on the television or radio, and relax.

4. Regulate the temperature in your bedroom to a comfortable level.

5. Avoid caffeine and smoking 4-6 hours before bed.

6. Avoid alcohol, which may help you feel drowsy, but can cause increased nighttime awakenings and bathroom visits.

7. Go to bed at the same time each night and rise at the same time each day.

8. Avoid napping during the day.

Underlying medical condition: Ask your physician if your insomnia could be related to a medical condition or a current medication. Seek treatment if your sleep loss is negatively affecting your day-to-day functioning. Sleep apnea is a common breathing problem and an often underdiagnosed cause of insomnia.

Prescription options: Medications called ‘hypnotics’ are available for short term use for insomnia (e.g., Valium, Ambien, Lunesta, Sonata). They are modestly effective in helping you fall asleep and stay asleep, giving you 10-30 minutes more sleep on average for up to 6 months. However, some of these medications can have addictive qualities and could be harmful if used in the long term. Long term use has been compared to smoking in both the increased risk of mortality and cancer3. As we get older, too, these medications are even more risky if used on a long term basis4. This is a discussion best had with your doctor.

Complementary therapy: Melatonin has limited empirical evidence, but on a 0.3-0.5 mg starting dose one hour before bedtime, this supplement may help you fall asleep in the short-term only (jet-lag). Do not use melatonin in pregnancy.

5-hydroxytryptophan or 5-HTP, for short, is a supplement that should be avoided, because it has no proven efficacy and is potentially harmful. I wouldn’t risk it.

Other herbal products are equally unproven with limited safety data (valerian, kava, chamomile, ginseng, lavender, hops, lemon balm, passionflower.) Acupuncture, tai chi, and light therapy may help, but, again, no studies have confirmed any benefit.

Over-the-counter options: Benadryl (diphenhydramine) is the ingredient in “PM” products, sometimes labeled as “sleep aids”. Benadryl is an antihistamine widely used to induce sleep, but may cause “morning after” effects (hard to get moving, a feeling of being tired) in some individuals. The usual dose is 50 mg, but some people use 25 mg, 30-60 minutes before bedtime. Do not use Benadryl for more than 2-3 consecutive nights without taking ‘time off’ from the medication to re-assess improvement in your sleep pattern. Benadryl, plus a pain reliever (Tylenol PM, Advil PM), can help if insomnia is accompanied by mild pain.

Best option (in my opinion): Daily exercise – it’s good for you and it helps you sleep better, feel better, think better, and live longer!

I think I just put myself to sleep…..

References:

  1. http://www.jneurosci.org/content/32/29/9785.full.pdf+html?sid=8ac6964b-8a2c-4fa7-aec3-cbbc6bc880f2.
  2. 2005 National Sleep Foundation survey.
  3. http://www.huffingtonpost.com/jerry-siegel/are-sleeping-pills-good-f_b_446804.html
  4. http://www.ncbi.nlm.nih.gov/pubmed/22371848

 

Poison Ivy. By Our Student Pharmacist, Nick Trego.

Toxicodendron radicans, also known as poison ivy, is a common nuisance encountered by anyone participating in outdoor activities. Whether you are gardening, hiking, exploring the woods, or working outside, you will likely run across poison ivy at some point in time. This plant is difficult to identify, but knowing how to identify poison ivy will most likely save some suffering. The following link provides some help with the identification of the poison ivy plant: Identification

The poison ivy plant produces an oily resin called Urushiol. Urushiol is the compound that causes allergic reactions in humans. This oil can stay on clothes, gloves, shoes, and any other object (even your pets!) for very long periods of time. It is very important, therefore, to thoroughly wash any object that might have come in contact with the poison ivy plant to prevent further spread of the oil. If the contaminated objects are not washed, the oil can stay on the surface and cause a reaction the next time somebody touches or uses the object. This is why poison ivy is commonly mistaken as being “contagious” or “spreading” on a person without the person being outside or close to the original source.

For more poison ivy myths: Myths

Some common ways to prevent poison ivy are to:

1. Wear long sleeved shirts and pants.

2. Wash clothes, hands, and tools after being outdoors.

3. Apply products that block the spread of poison ivy.

4. Avoiding burning the plants, as the smoke of the burning plant can still cause irritation and an allergic reaction.

At least 50% of people who come in contact with the plant or oil develop an itchy rash that can become quite annoying and painful. It usually takes 12-72 hours after contact with the plant for a rash to develop and the rash can last for up to three weeks. Although the rash does not look pleasant and can cause discomfort, poison ivy is usually a mild condition and will resolve on its own. The rash is a delayed reaction. Therefore, if the rash gets larger from day to day, it is not spreading, but still developing from the initial exposure. Scratching the rash will not spread the poison ivy unless Urushiol oil is still present on the skin. However, scratching is not recommended due to the irritation it causes to the already damaged skin. Scratching also increases the potential for breaking the skin and eventual scarring.

The FDA released this document for poison ivy awareness:  FDA awareness

Identification of the poison ivy rash is important because the area of the rash needs to be washed immediately to remove Urushiol oil from the skin to prevent further spreading.

Common symptoms of poison ivy reactions include redness, itching, swelling, and blisters. Any area of skin believed to be exposed to poison ivy should be washed thoroughly with rubbing alcohol, specialized poison plant washes, degreasing soaps, or detergents. This washing should be done with plenty of water to remove the Urushiol oil from the skin. Then, the exposed person should scrub underneath their fingernails to make sure all the oil is off of their hands.

The poison ivy rash can be treated by soothing the area with a cold compress and applying calamine lotion or hydrocortisone cream to reduce itching. If the skin becomes broken (bleeding occurs), hydrocortisone cream should no longer be used. Oatmeal baths can also be helpful for itch relief. Oral antihistamines, such as Benadryl, can be taken to help reduce the allergic reaction. If the skin becomes broken, the rash covers more than 1/3 of the body, or the rash is on the face or genitals, medical attention should be sought. Oral corticosteroids are often prescribed by doctors in treatment of serious poison ivy reactions.

Treating Sunburn. By Our Student Pharmacist, David Brokaw.

June is one of the most beautiful months of the year in Ohio, and, like most of us, I like to spend as much time as possible outside enjoying the weather. The downside is that every year, without fail, I innocently stay outside all afternoon on the first free sunny day, while totally forgetting that the sun is a giant ball of energy constantly radiating powerful UV light down to Earth. Somehow, being incarcerated indoors all winter long has this incredible amnestic effect on my memory of last year’s sunburn. So again, I learned the hard way about sunburn and the cosmetic appeal (and pain) that comes with a fantastic “farmer’s tan.”

Here are a few things I learned along the way:

Sunburn appears as painful, reddened skin with possible swelling, which is associated with increased blood flow. The worst part of the burn is usually delayed, appearing after 24-48 hours.

Mild sunburn is red, painful, warm to the touch, and may be accompanied by a low grade fever, dizziness, or a headache. The skin may peel after several days as new skin cells are produced from lower layers to regenerate the damaged layer of skin (epidermis).

Moderate sunburns, however, can lead to nausea, fever or chills, and blistering, which may require professional wound care.

Severe sunburns may lead to heat stroke, so patients with fever, confusion, weakness, or convulsions should seek medical attention immediately. Even some of the medications we take can make us burn faster, increasing our photosensitivity, so we should check with our pharmacists if we have a concern.

General treatment for sunburn should start with staying out of the sun and covering up with protective clothing when outside. Cool compresses or a cool bath can help relieve pain. To prevent drying of the skin, a skin cream or ointment can be used to trap moisture. Some choose an aloe vera product to help soothe the skin. Blisters should not be broken open, because they protect the skin underneath, nor should peeling skin be pulled off. Vitamin C plays a major role in wound healing and taking two grams daily could possibly help until the burn is healed.

To treat sunburn symptoms, time heals all wounds–in this case 3-6 days for mild and 2-3 weeks for moderate sunburns. But for pain, we have a couple of options. NSAIDs or non-steroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin, are preferred to help with the redness and swelling especially in the first 24 hours after UV exposure. These drugs are taken differently from each other, so it is important to read the directions on the label for correct dosing and appropriateness for children. Some people cannot take NSAIDs, so Tylenol is an option there. Provided that you are not allergic, topical anesthetics (benzocaine, lidocaine) should only be used on intact skin (not blisters), and should only be used on small areas of skin, no more than 3-4 times a day.

What shouldn’t you use? Products with menthol or camphor, although they smell nice (think Vick’s VapoRub), should not be used because they can actually increase the pain and swelling. Ouch! Also, the use of honey as a home remedy for sunburn is not recommended by burn centers.

Next time I decide to enjoy time in the sun outside with friends, you’d better believe I will have my sunblock and a good pair of sunglasses with me!

[Source: Dlugosz CK. The Practioner’s Quick Reference to Nonprescription Drugs. Washington, D.C.: American Pharmacists Association. 2009. pp 30-41.]