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Archive for the ‘Plain City Health’ Category

Got Acne? We’ve Got Over the Counter Solutions. By Our Student Pharmacist, Christine Stearns.

Acne Vulgarisor acne is the most common skin disorder and results in the highest dermatological referrals, particularly in adolescents. Fortunately, with the proper nonpharmacologic and pharmacologic therapy, many cases can be resolved without a prescription.

Approximately 60-70% of individuals are affected by acne at some point in their lives. The highest presentation is in adolescents (particularly in young males ages 16-17), which usually subsides by the age of 25. After 25, patients are considered to have developed late onset acne, which affects about 8% of people.

Overall, acne can lead to low self-esteem, a decreased quality of life, and depression. In fact, studies indicate that skin disorders such as acne increased the risk of developing anxiety or depression by more than 60%. So effective treatment is important not only physically for the patient, but from a mental health perspective as well.

Acne pic 1

Acne can present in several different ways and may range in severity. Here is a breakdown of its typical clinical presentation:

  • Mild Acne: less than 10 pustules (pimples) or papules (a raised, tender bump) that mostly occurs on the face
  • Moderate Acne: 10-40 pustules or papules plus comedones (blackheads or whiteheads) that usually affect the face but can involve the chest and back
  • Severe Acne: numerous, painful pustules, papules, comedones and/or nodules (large inflamed bumps) that occur mostly on the face but can affect multiple sections of the body

Most patients experience mild acne, which can be treated with over-the-counter products. If a patient is experiencing what looks like moderate or severe acne, he or she should be referred to a physician, as they will most likely require a prescription medication.

There are many causes for acne, including but not limited to:

  • Increased oil (sebum) production
  • Hormonal fluctuations such as pre-menstruation
  • Inflammation in the skin/damage from trauma such as scrubbing and friction
  • Physical barriers like clothing, casts, and helmets
  • Skin follicles not shedding properly
  • Bacteria growth
  • Medications such as epilepsy drugs, lithium, and steroids
  • Diet (This may influence acne but more evidence is needed in clinical trials. Offenders could include dairy products, chocolate, soft drinks, or higher sugar/carb diets.)
  • Genetics

Because some of these causes are preventable, treatment begins with changes in lifestyle, such as:

  • Limiting washing the area to no more than twice daily
  • Using a mild soap
  • Avoiding harsh scrubs or exfoliants that can lead to extra inflammation
  • Drinking plenty of water (because dehydration can promote skin inflammation)
  • Avoiding occlusive clothing like headbands and hats

Lastly, just giving it time, because in most cases, acne is self limiting.

acne pic 2

Along with nonpharmacologic changes, there are several over-the-counter (OTC) products that can be used to further eliminate acne. These include the following:

Adapalene (or Differin gel) is the first retinoid to be offered over the counter and is considered first line for mild to moderate acne. Adapalene should be used on intact skin (no open sores) and should be applied every day prior to bedtime. Some potential side effects could include sun sensitivity, skin irritation and dryness. With this gel, your acne may actually get worse before it gets better, so it is important to continue using it for at least three months. Most see an improvement by week six.

There are many over-the-counter products that contain benzoyl peroxide, including cleansers, creams, and body washes. This medication works differently than Adapalene because it has antibacterial effects, so the two products can be combined in treatment. Common side effects include dryness and peeling. These products may also discolor fabrics. Benzoyl peroxide comes in different strengths, so it is important to start with a low strength and gradually increase, as tolerated, in order to avoid excessive drying.

Although not first line, salicylic acid can be helpful in the treatment of acne by preventing clogged pores (which may be especially useful for blackheads and whiteheads). Example products include Noxema or Stridex facial pads. Potential side effects include burning, stinging, and dryness.

Acne pic 3

Lastly, topical sulfa products have proven to be beneficial in acne treatment. Sulfur is one of the oldest forms of acne treatment. Similarly to benzoyl peroxide and salicylic acid, sulfur works as a drying agent by reducing oil and bacteria buildup, but may have less severe side effects (so this may be a better choice for sensitive skin).

When determining your OTC acne treatment, combination therapy is often more advantageous than a single product. Along with lifestyle changes, a consistent skin regimen that includes these products is key in eliminating acne, preventing new acne, and avoiding residual scarring.

References:

  1. Foster K. Chapter 38. Acne. In: Coe M, Gailbraith E, Young L, Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 19th Ed. Washington DC: American Pharmacist Association; 2017. https://pharmacylibrary-com.proxy.lib.ohio-state.edu/doi/full/10.21019/9781582122656.ch38. Accessed August 15, 2019.
  2. Ganceviciene R, Grigaitiene J, Lukaviciute L. Quality of life, anxiety prevalence, depression symptomatology and suicidal ideation among acne patients in Lithuania, 2017; 31 (11): 1900-1906. DOI:10.1111.
  3. Treatment of Acne Vulgaris. UptoDate. Wolters Kluwer. Hudson, OH. Available at: https://www-uptodate-com.proxy.lib.ohio-state.edu/contents/treatment-of-acne-vulgaris?search=acne%20vulgaris&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

 

CBD: The Science Behind it and What You Should Know. By Our August Student Pharmacist, Christine Stearns.

SB57

Are CBD products legal?

As of July 30th, it is now legal to grow, manufacture, and sell CBD products in the state of Ohio.

Last week, Governor Mike Dewine signed Senate Bill 57, which decriminalized hemp and hemp cultivation. Prior to the bill, state laws did not differentiate between cannabis oil derived from hemp and cannabis oil derived from marijuana. This new bill will allow Ohio farmers the right to legally grow hemp, others the ability to process it, universities the ability to perform further research with it, and stores the ability to carry and sell it.

In 2018, the Farm Bill was passed, which exempted hemp and its constituents (including cannabidiol) from the Federally Controlled Substance List. However, Ohio’s previous medical marijuana law did not differentiate hemp from marijuana, and this led to confusion from retailers. This new legislation excludes hemp from the State Board of Pharmacy’s definition of marijuana with a few considerations. The product must contain less than 0.3% THC (the main psychoactive component of marijuana), and farmers who wish to grow hemp must be licensed through the Department of Agriculture beginning in 2020.

hemp-vs-marijuana

Will CBD give me a high?

Unfortunately, a lot of confusion and stigma still remain surrounding the difference between cannabinoid products.

Cannabis, or marijuana, consists of the dried leaves, stems, flowers, and seeds from the plants Cannabis Sativa and Cannabis Indica. These plants contain hundreds of compounds called cannabinoids. The most common cannabinoids include tetrahydrocannabinol (THC) and cannabidiol (CBD).

THC is the primary psychoactive chemical in cannabis, which creates the high that is associated with marijuana use.

The second chemical, CBD, does not activate the same receptors that THC does, so it does not produce any psychoactive effects in patients (even at significant doses). CBD can also be extracted from another cannabis plant called Hemp.

Hemp plants are a more fibrous variant of the Cannabis Sativa family and have been historically used in textiles and dietary supplements. Hemp plants contain less than 0.3% THC, so even at high doses, there is no high produced from the extraction. The stalks, stems, leaves, and flowers of the hemp plant naturally contain the highest concentration of CBD and are typically used to make these CBD products.

What are the benefits?

Although it is not completely clear, CBD has demonstrated some beneficial effects on receptors 5HT1a, a serotonin receptor involved in the pathways of antidepressants and anxiolytics, GPR55, a receptor that has become a new target in preventing seizures, and TRPV1, which may play a role in pain sensation.

Because of its mechanism, CBD may be beneficial in treating:

  • anxiety
  • depression
  • inflammation
  • Crohn’s Disease
  • smoking cessation
  • multiple sclerosis
  • rheumatoid arthritis
  • epilepsy
  • pain.*

These products have also shown antioxidant properties and improve mood and sleep.*

What do I need to know before trying CBD?

Before taking any CBD products, it’s important to speak with your doctor to make sure you are a candidate for the supplement. These products may not be suitable for use if you have any liver problems, are pregnant or breastfeeding, or take any of the following medications:

  • Proton pump inhibitors (omeprazole, pantoprazole, esomeprazole, etc.)
  • Benzodiazepines (alprazolam, lorazepam, clobazam, temazepam, etc.) or phenobarbital
  • Valproic acid or carbamazepine
  • Ketoconazole
  • Rifampin
  • Warfarin
  • Antidepressants
  • Narcotics

It is also important to note that just like prescription drugs, dietary supplements can produce unwanted side effects, as well.

Potential side effects of CBD products may include:

  • fatigue
  • sleep disturbances
  • lightheadedness
  • dry mouth
  • decreased appetite

The full effects of CBD products may take up to two weeks.

These products may be more readily absorbed with a meal high in fat, but can be taken with or without food.

CBD products come in many forms, but the most common ones include oils, tinctures, and capsules.

I see CBD products everywhere. Are all of these products created equally?

Because of the potential benefits demonstrated in preclinical testing and clinical trials, various CBD products have become increasingly popular products in supplement shops, whole food stores, and online. With this sudden boom in popularity, there comes a major problem. Because these products are considered dietary supplements, they are not regulated by the FDA as strictly as prescription and OTC medications. The manufacturers are not required to test what is in their products, so they may not contain the ingredients or the amounts of the ingredients that are listed on the labels. This is why it is important to do your research prior to purchase and find a CBD company that employs third party testing and has obtained a certificate of analysis on their products.

Where can I find certified CBD products?

Luckily, your local Plain City Druggist and Happy Druggist Pharmacies have identified a well-known, credible CBD company called Ananda Professional™.  Ananda is a Kentucky-based company that provides the highest quality hemp extract because they test their product at every step of their manufacturing process. Each of their products are pesticide-free, have been accredited through third party testing, and have a certificate of analysis to report the potencies of each ingredient.

We are excited to announce that we have started working with Ananda to provide our patients with safe and effective CBD products. Feel free to ask our pharmacists about CBD the next time you stop by any of our locations!

*All CBD products are considered dietary supplements, therefore, they are required to be in compliance with current good manufacturing practice (cGMP) and properly labeled. Efficacy has not been established.

cbdoil.0

References:

  1. Pisanti S, Malfitano AM, Ciaglia E. Cannabidiol: State of the art and new challenges for therapeutic applications. Pharmacology & Therapeutics.2017;175:133-150. DOI:10.1016/j.pharmthera.2017.02.041.
  2. Wilson-Morkeh H, Al-Abdulla A, Sien L. Important drug interactions exist between cannabidiol oil and commonly prescribed drugs in rheumatology practice. Rheumatology. 2019. DOI: 10.1093/rheumatology/kez304.
  3. Corroon J, Felice J. The Endocannabinoid System and its Modulation by Cannabidiol (CBD).Alternative Therapies in Health and Medicine.2019; 25 (1078-6791):6-14. https://www-ncbi-nlm-nih-gov.proxy.lib.ohio-state.edu/pubmed/31202198. Accessed August, 6, 2019.

World Hepatitis Day is July 28. By Our July Student Pharmacist, Ray Chu.

World-Hepatitis-Day

In observance of World Hepatitis Day, which is July 28 this year, I wanted to spread awareness by answering some common questions about hepatitis.

Some fast trivia: Did you know there are currently five different kinds of hepatitis recognized? Hepatitis A, B, C, D, and E. The most common ones in the US are A, B, and C.

What is hepatitis?

Hepatitis describes inflammation of the liver and most often is referring to viral hepatitis caused by one of the hepatitis viruses. Depending on which virus, a person’s hepatitis will be classified A through E. Due to inflammation, the liver will not work as well. Drugs and toxins will not be filtered out of the body as well as with a normally functioning liver. Also, any activity that would stress or damage a normally functioning liver (such as drinking alcohol or taking certain medications) will affect a liver with hepatitis even more, worsening the condition.

It is estimated that 4.4 million Americans are living with chronic hepatitis. 

Sounds dangerous, should I avoid people who have hepatitis?

Not at all. It is perfectly safe to be around someone with hepatitis. You cannot contract viral hepatitis by casual contact, so you can shake hands with, hug, or even kiss someone with hepatitis safely without danger of infecting yourself. 

How is hepatitis spread and what preventative measures can be taken?

Hepatitis is spread differently depending on which virus we are talking about.

  • Hepatitis A Virus (HAV)
    • HAV is spread person to person by the fecal-oral route, mainly by eating or drinking food or water that has been contaminated by the feces of an infected person.
    • Basic hand washing with soap and water following bowel movements and before handling food and drinks will reduce the incidence of Hepatitis A.
  • Hepatitis B Virus (HBV)
    • HBV is a bloodborne viral infection that is mainly spread through sexual contact with an infected person, mother to child during childbirth, and by contact with the bodily fluids of an infected person.
    • Avoid sharing personal items such as toothbrushes, razors, nail clippers, and needles with an infected person.
  • Hepatitis C Virus (HCV)
    • HCV is spread primarily though contact with an infected person’s blood.
    • To a lesser degree, it can also be spread though sexual contact and childbirth.
    • Much like HBV, avoid sharing personal items with an infected person that may come into contact with infected blood.
  • Hepatitis D Virus (HDV)
    • HDV is also spread through contact with infected blood, but only in people already infected with HBV.
    • If you do not have HBV, you will not contract HDV; therefore, all precautions for HBV will also help lessen the chance of HDV.
  • Hepatitis E Virus (HEV)
    • HEV is a relatively newly recognized disease.
    • It is spread though food or water contaminated with the feces of an infected person.
    • Some data suggests that pigs can carry HEV and, therefore, eating infected pork may transmit the infection.
    • Consuming clean water only and avoiding contaminated foods will lower your chances in getting infected with HEV.

Are there any treatments available for hepatitis?

  • Hepatitis A
    • There is a vaccine available starting as young as 12 months old and is a regimen of three injections over one year. The immunity provided by the vaccine lasts at least 20 years.
    • Full recovery of all HAV infections is expected in 99% of all patients.
    • HAV usually resolves on its own over several weeks.
    • Chronic hepatitis usually does not result from an HAV infection.
  • Hepatitis B
    • There is a vaccine available for HBV starting as young as two months old and is a regimen of three injections over a year and a half. The immunity is expected to last at least 15 years.
    • If infected, 98% of acute HBV infected individuals clear the virus within 6 months without medication intervention.
    • For those that develop chronic hepatitis, antiviral medications are available to suppress the HBV, but will not cure HBV completely.
  • Hepatitis C
    • There are NO vaccines available to protect against HCV at this time.
    • Preventative measures are the first line of defense. Do not share personal hygiene items with an infected person.
    • Antiviral medications are available to suppress HCV proliferation for those who develop a chronic infection.
  • Hepatitis D
    • Protecting yourself against HBV will also protect you against HDV. Receiving the HBV vaccine will also protect you from getting HDV.
    • All of the same precautions for HBV will also protect you from getting HDV.
    • Treatments for HDV are available, but are only beneficial to a small portion of patients.
  • Hepatitis E
    • There are no available vaccines for HEV.
    • HEV usually resolves on its own over several weeks to months.
    • If it does not resolve, immunosuppressive therapies exist to reduce the amount of damage done to the liver.

Want more information?

Please stop into any of our locations to learn more about the vaccines available for hepatitis or even if you just have a couple questions for us regarding the disease.

Some websites where you may find more information are:

https://hepatitisfoundation.org

https://www.who.int/features/qa/76/en/

https://www.cdc.gov/hepatitis/index.htm

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Pet Safety in the Summer Heat. By Our Student Pharmacist, Ray Chu.

hot-asphalt-small

Summer is here in full force! A time for fun in the sun for our whole family, but it’s important that we keep in mind how to ensure that our four-legged family members stay safe in the heat, too.

As the heat rises, like it will this weekend, we know how to keep ourselves cool and we can tell when our children get too hot, but our pets respond differently to the heat and even differently to how they cool down. For example, did you know that a fan would be perfect for us but doesn’t work well to cool down dogs and cats?

This first point is mentioned over and over, but it’s so important that I feel like I have to mention it, as well. Please do not leave your pet in the car, even for a couple minutes. Tragically, pets die every year due to poor judgment by their owners. Cracking the window does not work to keep the car cool enough.

Take a look at the chart at the bottom of this posting to see how hot it can get in your car.

It doesn’t even need to be a hot day for a car to overheat. On a 70-degree day, within 10 minutes, the interior of a car will reach 89 degrees. These temperatures were all tested with the windows cracked.

Once a dog reaches over 107 degrees, they are in serious danger for irreversible organ damage and impending death – and that’s only approximately 10 minutes on an 85-degree day. It will be much hotter than that this weekend.

Many pets love to spend time outside, but on hot days make sure they have plenty of access to shade and cool water to drink. An enclosed doghouse can actually get really hot inside, so it’s best to have shade with lots of airflow like the shade of a large tree or a covered porch. Add ice to the cool water every so often.

We humans can sweat to cool off, but our furry friends cannot. The best way to help them cool themselves internally is to give them cool water to drink. If you like to exercise with your pet, do it in the cooler hours of the day like the early morning or late evening. Take frequent breaks and make sure to bring lots of water with you to let your pet have a drink.

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Speaking of having your pet outside, it is important to make sure that the ground is not too hot for them. Many of our pets will not make a fuss if the ground is too hot for them to walk on, even if it is burning them. Their paws may be tough, but they can still be burned. An easy way to check is to place your own hand on the ground for 10 seconds. If it’s too hot for you, it’s too hot for your pet. On an 86 degree day, asphalt can easily reach 135 degrees. An egg would fry in five minutes in that temperature!

Many of us must leave our pets at home when we leave for work or other activities. When we leave our pets at home, again, we must make sure they have access to plenty of cool water. The house itself can get very hot, as well. Many owners will turn their air conditioning off when they leave the house. This can be very dangerous for our pets since the temperature can quickly rise to dangerous levels for our pets. The problem is compounded when we are not there to replenish their water bowls. If you do not want to have the air conditioning on as low as when you are in the house, consider setting it to a more conservative temperature like 75 degrees when you leave your pets at home.

So I’ve talked about how to keep your pets cool, but how do we recognize when our pets are overheating, or worse yet, having a heat stroke. Some signs to keep an eye out for are:

  • Heavy Panting
  • Glazed eyes
  • Rapid heartbeat
  • Difficulty breathing
  • Excessive thirst
  • Lethargy (or just really slow and tired acting)
  • Fever
  • Dizziness
  • Lack of coordination
  • Salivating a lot
  • Vomiting
  • A tongue that is deep red or purple in color
  • Seizures
  • Unconsciousness

What do we do if we find our pets in heat stroke?

We should immediately move them into the shade, or even better, into an air conditioned room. Apply ice packs or cold towels to their head, neck, and chest. We should also run cool (but not cold!) water over those same areas. Let the pet drink small amounts of cool water and, most importantly, take them directly to a veterinarian.

Here are links to some other good articles on the subject:

https://www.humanesociety.org/sites/default/files/docs/unattended-pets-hot-parked-car.pdf

https://www.free-press-release-center.info/viewrelease.php?rid=00000000000000046214

Car-Temperature-Safety-Chart

 

Travel Safety. By Our Student Pharmacist, Steve McVey.

Small-Car-Big-Trip-200x300

Summer vacation and travel are here!

The summer months can be very relaxing and fun, but travel can be stressful and bring with it unexpected issues. One thing that can make travel even more stressful is having to manage your medications away from home. It is important to know if there are any restrictions on traveling with your medications, how to store them while traveling, and how to take them if you are traveling outside your normal time zone. If you plan to fly, make sure you check the Transportation Security Administration (TSA) website ahead of time to know what the rules are about traveling with your medications (you can search “medications”).

Several helpful tips include:

  • Carry a letter from your physician that includes medical conditions and medications you are taking. Include your physician’s and pharmacy’s phone numbers.
  • Keep your medications with you in your carry-on.
  • Keep your medications in the original, labeled prescription containers if possible.
  • Tell the screener that you have your medications in your bag and alert them if you have diabetic testing supplies with you.
  • These rules can change so always be sure to check before you travel.

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If you are planning to drive, ask your pharmacist about any special storage instructions for your medications. You may need to use cold packs and coolers for refrigerated medications. Plan ahead so you don’t run out of medication. Let your pharmacy know 1-2 weeks ahead of your travel plans. This will allow them time to work through any potential issues in getting your medication or working with your insurance. Your pharmacist can also instruct you on how to take your medications in a different time zone.

If you plan on driving, make sure your vehicle is in good repair. Have a mechanic do a checkup to screen for potential safety issues. Educate yourself on roadside repair and know what to do/who to contact should you have issues you cannot resolve. Map out your refueling plan to keep from running out of gas. If you are traveling to other states, you may want to familiarize yourself with any unique traffic laws.

Study up and educate yourself about your travel destination. Learn what services are available and where to find them. Inquire about any special weather conditions or other unexpected or unique occurrences (i.e. traveling to a location where flash flooding is a possibility, local events that may impact your travel plans, etc.). You may also want to learn about the local culture. Educating yourself will enrich your experiences and keep you safe and healthy during your stay.

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International travel presents a host of other considerations you should review prior to travel. Schedule a visit with your physician about 4-6 weeks in advance to make sure you are healthy and able to travel. Discuss with your physician or pharmacist what immunizations you may need while traveling to that area. Some needed vaccinations may be unexpected, like the current resurgence of measles.

According to the World Health Organization (WHO), in the first two months of 2019 there were over 34,000 confirmed cases of measles in 42 countries in the WHO European region.

You can learn more about staying safe and healthy while traveling at this CDC website.

A few helpful tips about international travel also include:

  • Wash your hands frequently and before eating, drinking, or touching your face. If soap and water are not available, use an alcohol based hand sanitizer.
  • Avoid tap water and other sources of unpurified water (i.e. ice, fountain drinks, etc.). Instead choose bottled products or heated drinks.
  • Be careful of what you eat. Avoid street vendors and never eat undercooked meat or vegetables. Avoid raw fruits and veggies unless you can peel them before eating.
  • Protect yourself from bug bites, animal bites, and sunburn.

Vacations and travel can provide needed rest and relaxation, as well as many great memories. Prepare for your travels well ahead of time to minimize stress and keep yourself healthy as you have fun.

References:

  1. Transportation Security Administration. Department of Homeland Security. https://www.tsa.gov/. Accessed June 27, 2019.
  2. Travel and Your Medicines. Pharmacist Letter. Therapeutic Research Center. https://pharmacist.therapeuticresearch.com/Content/Segments/PRL/2016/Jul/Travel-and-Your-Medicines-9921. Published June 2016. Accessed June 27, 2019.
  3. Staying Healthy While Abroad. Pharmacist Letter. Therapeutic Research Center. https://pharmacist.therapeuticresearch.com/Content/Segments/PRL/2013/May/Staying-Healthy-While-Abroad-5575. Published April 2013. Accessed June 27, 2019.
  4. Traveler’s Health. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel. Accessed June 27, 2019.
  5. Measles- European Region. World Health Organization. https://www.who.int/csr/don/06-may-2019-measles-euro/en/. Updated May 6, 2019. Accessed June 27, 2019.

Photo Sources:

  1. Plane: https://www.inc.com/bill-murphy-jr/best-travel-tips-2018-21-things-experienced-business-travelers-say-to-do-when-you-hit-road.html
  2. Photography/Mountain: https://www.outsideonline.com/2393413/what-to-know-when-traveling-alone
  3. Car: https://backroadramblers.com/how-to-pack-a-small-car-for-a-big-trip/