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Archive for March, 2022

Shingles and Shingrix. By Our Student Pharmacist, Justin Yu.


Shingles is a painful rash that develops on one side of the face or body. The rash appears as a single stripe along either the left or the right side of the body. The rash consists of blisters that typically scab over in 7 to 10 days and fully clears up within two to four weeks.

Shingles on the face is quite serious as it can affect the eye and lead to vision loss.

The most common complication of shingles is long-term nerve pain called postherpetic neuralgia. This pain occurs in the areas where the shingles rash was, even after the rash clears up. The neuralgia can last for months or years after the rash goes away. Postherpetic neuralgia pain can be excruciating to the point that it can interfere with daily life and may require long-term prescription pain medications.

Image 1Chickenpox and shingles are related because they are caused by the same pathogen called the varicella-zoster virus. After a person recovers from chickenpox, the virus continues to live inside the body in an inactive state. As a person grows older and their immune system weakens, varicella can eventually reactivate and cause shingles.

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There is an effective vaccine for protection against shingles called Shingrix. The vaccine is easily accessible by visiting your local pharmacy.

If you are 50 years or older, it is recommended to get two doses of Shingrix, separated by two to six months. Those 19 years and older who have weakened immune systems due to a disease state such as cancer or immunosuppressive drugs should also get two doses of Shingrix.

Shingrix is 90% effective at the prevention of shingles. For those who previously received the old shingles vaccine called Zostavax, it is recommended to get the two doses of the Shingrix vaccine. Zostavax, unlike Shingrix, is only 50% effective in preventing shingles. Zostavax gives a 50/50 chance of being protected. Not the best odds.

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If you ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix, currently have shingles, or are a woman who is currently pregnant, it is advised to not get the Shingrix vaccine.

If you had shingles in the past, Shingrix can help prevent future occurrences of the disease. There is no specific length of time that you need to wait after having shingles before you can receive Shingrix, but generally you should make sure the shingles rash has gone away before getting vaccinated.

Like all vaccines, a sore arm with mild or moderate pain is very common after the Shingrix vaccine administration. The following day after the vaccine, some people may feel tired, have muscle pain, experience a headache, shivers, fever, stomach pain, or nausea. These bothersome side effects may hinder a person’s ability to do normal daily activities for a couple days. These side effects might occur after the first or second dose of Shingrix, or both doses. Side effects such muscle pain or fevers, can be combatted with over-the-counter pain medicine such as ibuprofen or acetaminophen.

Insurance coverage regarding Shingrix:

  • Medicare Part D plans cover Shingrix, but there may be a cost to you depending on your plan.
  • Many private health insurance plans cover Shingrix, but there may be a cost involved.
  • Medicare Part B does NOT cover Shingrix.
  • Medicaid may or may not cover Shingrix; contact your insurer to find out.
  • The manufacturer of Shingrix, GlaxoSmithKline, offers vaccine assistance programs to provide vaccines to eligible adults who cannot afford to get the vaccine or who lack health insurance. To get help, go HERE.


Shingles. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054. Published September 17, 2021. Accessed March 25, 2022.

Shingrix shingles vaccination: What everyone should know. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html. Published January 24, 2022. Accessed March 25, 2022.


Medication Safety. By Our Student Pharmacist, Kendra Terry.

With last week being National Poison Prevention Week, I wanted to share some information about medication safety. While medications can be lifesaving and an essential part of maintaining our health, if used inappropriately or incorrectly, they can potentially be harmful.

The Centers for Disease Control and Prevention (CDC) estimates that 125,000 people die each year due to medications being taken incorrectly. Additionally, each year, accidental medication ingestion by children leads to:

  • 60,000 emergency room visits
  • 450,000 calls to poison control

These accidents are why it is very important to make sure medications are stored and disposed of properly!

Below are some medication safety tips and guidance on safe medication storage and disposal.

General Medication Safety Tips

  • Take all medications the way they are prescribed
  • Never take another person’s prescription medication
  • Do not abruptly stop taking any medications or skip doses without talking to your doctor or pharmacist
  • Keep an updated list of all medications you take, both prescription and non-prescription
  • Ask your doctor or pharmacist before starting any over-the-counter medications or supplements. We can check to make sure the medication is appropriate for you and identify any interactions it may have with your other medications.

Drug Storage

In most cases, medications should be stored in a cool, dry place. You should avoid leaving medications in the bathroom due to changes in temperature and humidity. Be sure to read storage information for all of your prescriptions, as some may need to be stored in the refrigerator. Additionally, medications should be kept in a location that is hard for children or pets to access.

Drug Disposal

If you have unused or expired medications, it is best to remove them from your household to prevent accidental or intentional ingestion by others. Most communities have drug disposal boxes at police or fire departments, as well as certain pharmacies. You can find drug disposal boxes in your area at the following website:


Drug Disposal Flier

If you are unable to dispose of medications using a disposal box, there are ways to safely dispose of medications at home. Before disposing of medications, be sure to read the label or package insert to see if any disposal instructions are provided.

Most medications should not be flushed down the toilet, but there are certain exceptions to this. Medications that can be flushed are those that have the potential to be abused and/or can be fatal after one dose if taken inappropriately.

The following medications should be flushed if a drug disposal box is not an option. These include medications that contain:

  • buprenorphine
  • fentanyl
  • hydrocodone
  • oxycodone
  • oxymorphone
  • hydromorphone
  • methadone
  • morphine
  • tapentadol

For other medications, you can mix the drugs in a plastic bag with coffee grounds or cat litter, seal the bag, and throw it in the trash.

Sharps Disposal

If you use any injectable medications, such as insulin, it is very important that you dispose of your used needles appropriately. All needles should immediately be placed in a sharps disposal container after use. These can be purchased at most pharmacies or medical supply stores. If you do not have access to a sharps container, you can dispose of used needles in an empty laundry detergent bottle or other heavy-duty plastic container.

Once your sharps container is approximately 3/4ths full, you should place the lid on the container, seal it with tape, and label the container “DO NOT RECYCLE”. You can throw the container away with household trash, but trash collectors may be reluctant to take the sharps container. You can find locations to take your full sharps container at the following website:

If you ever have any questions about your medications, pharmacists are the experts- so don’t hesitate to ask!


March is National Caffeine Awareness Month. By Our Student Pharmacist, Justin Yu.

Did you know that March is known as National Caffeine Awareness Month?

Caffeine itself is probably the most consumed stimulant in the world. Almost everyone depends on caffeine to increase mental awareness, prevent tiredness/burnout, and improve overall athletic performance.

Though caffeine is very beneficial in providing jolts of energy throughout the day, it is important to be aware of its harmful effects on the body especially when consumed in large amounts.

Some of the short-term adverse effects of caffeine intake include:

  • headache
  • anxiety
  • tremors
  • insomnia

Also keep in mind that caffeine itself can raise blood pressure, so those who are currently taking blood pressure medications may find that the medication therapy is not as effective as before.

Caffeine can also cause acid reflux in the stomach so if you are taking a medication like Pepcid or Prilosec to suppress bothersome stomach acid, stopping/reducing your caffeine intake may help prevent this problem.

Caffeine works in the body by blocking adenosine to provide that alertness we need to get us through that day. Adenosine is a brain chemical that increases after prolonged wakefulness to help increase the likeliness of sleep. During sleep deprivation, adenosine accumulates in the brain to promote the initiation of the sleep cycle. It takes about 30 minutes for caffeine to take effect in your body and it is usually cleared out about 5 to 6 hours later.

Caffeine withdrawals can happen after a day of abruptly stopping your morning coffee. The most common symptom of a withdrawal is a headache. These headaches tend to be very unpleasant throughout the day, so over-the-counter pain medications such as acetaminophen (Tylenol) or ibuprofen (Advil/Motrin) can be taken to help alleviate them.

Over time, this stimulant may provide fewer jolts of energy throughout the day if taken constantly. This means that we can build up a tolerance to caffeine and require even more to feel the same boost as before which can possibly lead to a caffeine overdose.

Some of the signs of caffeine overdoses include:

  • fever
  • muscle twitches
  • diarrhea
  • vomiting
  • irregular heartbeat and palpitations

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It is important to consider your sources of caffeine and how much it takes to derive a benefit from it daily. Typically, an average adult should consume between 300 to 400 milligrams of caffeine per day which is equivalent to about 3 to 4 cups of coffee.

Common sources of caffeine:

  • Sodas
  • Tea
  • Chocolate
  • Energy drinks
  • Coffee

Below is a helpful guide to gauge how much caffeine you are consuming daily:Picture 1Caffeine can be incorporated into other foods especially those that are coffee flavored. For example, caffeine isn’t taken out of the coffee ice cream you may enjoy before bed or that extra-large sweet tea you saved during lunchtime. All of these can be contributors to sleep deprivation. Various drinks and food items add up to the total caffeine intake and contribute to sleepless nights, increased blood pressure, and stomach acid.

As discussed from the previous blog about sleep health, caffeine can negatively affect your quality of sleep when taken too close to bedtime leading to difficulty concentrating, irritability, depressed mood, and daytime drowsiness.

It is advised to avoid consuming caffeine products 4 to 6 hours before your bedtime to avoid issues with restful sleep.


Caffeine. MedlinePlus. https://medlineplus.gov/caffeine.html. Published February 3, 2022. Accessed March 15, 2022.

Caffeine: How much is too much? Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/caffeine/art-20045678. Published March 6, 2020. Accessed March 15, 2022.

Celebrate World Down Syndrome Day on Monday, March 21. By Our Student Pharmacist, Kendra Terry.


March 21 is World Down Syndrome Day. Down syndrome, also known as trisomy 21, is an inherited condition in which a baby is born with an additional 21st chromosome. Having this extra chromosome affects development and can cause some of the characteristic physical traits such as flattened face, almond shape/slanted eyes, and poor muscle tone.

People with Down syndrome can have all or none of these physical characteristics, and many are capable of leading normal, semi-independent lives.

In recent years, people have recognized the abilities of people with Down syndrome and have allowed for a more inclusive society. Just this year, Victoria’s Secret hired its first ever model with Down syndrome. In 2018, Gerber had its first spokes baby with Down syndrome. These are both great steps towards achieving a society in which people with Down syndrome are accepted!

World Down syndrome day is particularly important to me, because one of the most special people in my life has Down syndrome- meet Nicholas!


Nick and his family moved in across the street from me when I was 10 years old and Nick was only 2. My sister and I almost immediately adopted Nick and his two older brothers as our own siblings, and his parents as friends. Despite no longer living across the street from them, we have maintained that relationship and consider them family- spending holidays, vacations, and all important events together.

Although having Down syndrome may be what is first noticeable about Nick to others, I am lucky enough to know that having Down syndrome is only one of the many things that makes Nick unique and special. He loves to smile, swim, swing, take selfies, and play on his iPad. He can be extremely sweet and loving, but he can also drive you crazy by being stubborn, picky, and moody at times.

Seeing the ups and downs Nick and his family have experienced over the last 18 years has had a huge impact on both me and my sister. This is especially true for my sister, who as a result has dedicated her career to helping kids like Nick. She is an occupational therapist who works in schools with children with disabilities. Nick graduated from high school last May, and as an educator for Westerville schools, my sister was able to present him with his diploma.

For World Down syndrome day, I asked Nick’s mom what she wished the world understood about Down syndrome:

“Children born with Down syndrome are not all the same, they are individuals just like typical children. They are not always happy and loving. That’s a stereotype. Anyone who knows my son knows his moods are as typical as many people they may know. I will say that he has kept us on our toes throughout the years. He has made us laugh, cry, and scream. I love him and wouldn’t change the fact that he was born with Down syndrome because without it, he wouldn’t be Nick.”

If you are interested in supporting people with Down syndrome or want to learn more, here are some good resources:

Down syndrome myths and facts


1.) Inclusion means. World Down Syndrome Day. https://www.worlddownsyndromeday.org/inclusion-means. Published March 4, 2022.

2.) Facts about down syndrome. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/birthdefects/downsyndrome.html. Published April 6, 2021.

3.) D_Scribbler. Russ Ewell. Posted by russewell. https://russewell.tumblr.com/.


Updated Pneumococcal Vaccine Recommendations. By Our Student Pharmacist, Kendra Terry.

Although most discussion surrounding vaccines lately has been about COVID-19 vaccines, we can’t forget about the importance of some of the other vaccines we have available. Vaccines that protect us from pneumococcal disease are also very important, and the recommendations for these have recently changed.

Pneumococcal vaccines protect us from infections with pneumococcal bacteria. More specifically, the vaccines prevent infection by the bacteria Streptococcus pneumoniae, or S. pneumoniae. These types of infections most commonly present as pneumonia, but can also cause bacteremia (infection of the blood) and/or meningitis (infection of the membranes that cover the brain and spinal cord).

Pneumonia is the most common presentation of pneumococcal disease among adults. Symptoms usually develop after 1-3 days of infection, often starting as fever and chills. Other common symptoms can include chest pain, productive cough, shortness of breath, tiredness, and weakness. Some people may experience nausea and vomiting, but this is less common. Thanks to antibiotics, most people are able to recover from pneumonia, but older adults and people with certain medical conditions are at a higher risk of developing serious complications, including death.

The best way to protect yourself from infection and serious complications is to get vaccinated against pneumococcal disease. Who should get vaccinated, and which vaccine they should get, can be a confusing picture, especially since these recommendations have recently changed.

Please refer to the image below to answer the first of these questions: WHO should get a pneumococcal vaccine?

PNA vaccine- who should get vaccinated

The next question you may have is: WHICH pneumococcal vaccine should I get?

The answer to this question may be a little more confusing, as two new pneumococcal vaccines have become available in the last year. To make this more clear, I’ve done my best to summarize the answer for you!

There are currently four different vaccines available in the US.  Three of these are “conjugate” vaccines, and one is a “polysaccharide” vaccine. The easiest way to explain the difference between these is to say that the conjugate vaccines protect you from disease longer than polysaccharide vaccines.
Conjugate vaccines:

PCV13 (Prevnar 13): Prevents infection from 13 serotypes of S. pneumoniae

PCV15 (Vaxneuvance®) **NEW**: Prevents infection from 15 serotypes of S. pneumoniae

PCV20 (Prevnar 20) **NEW**: Prevents infection from 20 serotypes of S. pneumoniae

Polysaccharide Vaccine:

PPSV23 (Pneumovax23®): Prevents infection from 23 types of pneumococcal bacteria

Previously, the only vaccines available were Prevnar13 and Pneumovax23. Now that Prevnar20 and Vaxneuvance are available, both are recommended over Prevnar13 for patients who have never received a pneumococcal vaccine. The recommended schedule for those with no history of pneumococcal vaccination is shown in the figure below:

PNA vaccine schedule- previously unvaccinated

Some of you might be wondering: What if I’ve already received a pneumonia vaccine?

The algorithm below should answer this question for you:

PNA vaccine algorithm

The timing/schedule for when to get Pneumovax23 can be even more confusing, and can vary among different groups of people, such as those who have an immunocompromising condition. You should speak with your doctor or pharmacist to determine when you are eligible for each of the vaccines.

In summary, getting vaccinated against pneumococcal disease is an important step we can take to keep ourselves healthy.

I hope I was able to clear up some questions you might have had about the new vaccinations that have become available. If you are ever unsure of which vaccine you should get, your pharmacist is a great resource to help answer any questions you may have!


1.) Gierke R, Wodi AP, Kobayashi M. Pneumococcal disease. The Pink Book. https://www.cdc.gov/vaccines/pubs/pinkbook/pneumo.html. Published August 18, 2021.

2.) About pneumococcal vaccines: For providers. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/pneumo/hcp/about-vaccine.html. Published January 24, 2022.

3.) Pneumococcal vaccination: Who and when to vaccinate. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.html. Published January 24, 2022.

4.) Clinical Resource, Pneumococcal Vaccination in Adults. Pharmacist’s Letter/Prescriber’s Letter. March 2022. [380301]