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The Evolution of Smoking: All You Should Know about E-Cigarettes. By Our Student Pharmacist, Malcolm White.

The war on tobacco started in 1964 with the Surgeon General landmark report titled, Nicotine Effects on Smoking and Health.

Following the report, anti-tobacco campaigns on quitting strategies and legislation helped decrease the use and reduce the appeal of tobacco products. One would say that the war on tobacco was successful. However, in the past few years the use of tobacco has increased. This increase has contributed to the use of electronic nicotine delivery system (ENDS).

ENDS is an e-cigarette, also known as vape pen, e-cigars, vaping devices, mod systems, or pod systems. ENDS products contain a flavor solution that also often contain nicotine to produce an aerosolized mixture. These devices are very appealing and popular among youth and young adults.

Are e-cigarettes safe?

The safety of e-cigarettes is unknown at this point. There are currently multiple studies being conducted to answer this question.

So far, this is what we know about vape products.

First, ENDS do not contain many of the carcinogens found in conventional tobacco products. However, they do contain many chemicals that appear to be equally or even more damaging. These chemicals include volatile organic compounds (VOCs) which can lead to eye, nose, throat irritation, headaches, as well as nausea. There have been a few reports that believe e-cigarettes cause damage to the liver, kidney, and nervous system. Some reports show that e-cigarettes produce formaldehyde, which is a cancer causing substance. There is even evidence that shows flavoring chemicals are linked to serious lung disease.

What long term complications are associated with e-cigarettes?

E-cigarettes were first approved in the United States in 2008. In 2016, the Center for Tobacco Products was given authority to regulate e-cigarettes as tobacco products. Based on this short timeline, the product has not been on the market long enough to observe the long term effects associated with e-cigarettes. Some recent reports have shown e-cigarettes to cause serious lung disease in some people.

Do e-cigarettes deliver a consistent nicotine concentration? 

No, recent findings show that e-cigarettes can deliver high concentrations of nicotine. E-cigarettes which provide inconsistent levels of nicotine delivery pose health concerns for the user. Increasingly, there have been reports of nicotine overdose in users.

Can vape help with quitting tobacco attempts?

A major statement that is used to market e-cigarettes is the thought that they will help smokers quit. There are studies that showed e-cigarettes decrease nicotine consumption while other studies showed little to no evidence to support they assisted with helping individuals quit.

When reviewing the studies on this statement, many studies were flawed because of two factors.

First, the studies enrolled patients who had no intention of quitting.

Second, the e-cigarettes could not be counted on to provide consistent levels of nicotine.

These two factors, therefore, show that there have not been any appropriate studies performed that prove e-cigarettes help with smoking cessation. The U.S. Preventive Services Task Force concludes that the current evidence is insufficient to recommend ENDS for smoking cessation.

My interpretation of the data is that ENDS could potentially, in the future, be used as a device to help smokers quit who are highly motivated to quit.

Worku., D. & Worku, E. report that, in motivated smokers with clinician support, e-cigarettes can provide superior outcomes than traditional nicotine replacement therapy (NRT), but these results need further confirmation.

Currently, I would still recommend smokers use conventional resources (NRT) when it comes to helping them quit.

Smoking Cessation

Clinically, behavior therapy, as well as NRT, is recommended to help an individual stop smoking.

An individual looking to quit smoking should seek out a motivational or coaching program dedicated to helping individuals quit. If one can not be found, regularly scheduled therapy visits can suffice as a replacement. Be wary of programs that charge high fees. Smoking Cessation services are usually free or low cost.

The next step would be to talk to your doctor about prescription or over-the-counter nicotine replacement therapy. NRT products range from patches, to gums, to inhalers.

Both therapies should be used together to help increase your chance of successfully quitting.

Smoking Cessation Resources:

CDC Free quit help:

1-800-QUIT-NOW or 1-800-787-8669

CDC How to Quit Smoking Campaign – offers quit plans, tips from former smokers, and quitSTART app

https://www.cdc.gov/tobacco/campaign/tips/quit-smoking/index.html

Smokefree.gov’s Make Your Quit Plan

https://smokefree.gov/build-your-quit-plan

American Cancer Society’s Great American Smokeout

https://www.cancer.org/healthy/stay-away-from-tobacco/great-american-smokeout.html

NiAnon by Recovery.org

https://www.recovery.org/support-groups/smokers-anonymous

QuitLogix – Offers coaching and an online support community.

https://helpline.quitlogix.org/en-US/Just-Looking

NSW Cancer institute and Quitline Team

Quit Kit and a diary to help you quit smoking

https://www.icanquit.com.au/media/QuitKit/QuitKit.pdf

References:

Nicole van Hoey. Nicotine addiction and the evolution of tobacco products: How can pharmacists counter new trends? America’s Pharmacist. Published April 2, 2020 Accessed August 11, 2020

E-Cigarettes. American Academy of Pediatrics. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Richmond-Center/Pages/Electronic-Nicotine-Delivery-Systems.aspx. Published … Accessed August 11, 2020

The American Cancer Society Medical and Editorial Team. What Do We Know About E-cigarettes? American Cancer Society. https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/e-cigarettes.html.Published November 19, 2019 Accessed August 11, 2020

Jenssen BP, Wilson KM. What is new in electronic-cigarettes research?. Curr Opin Pediatr. 2019;31(2):262-266. doi:10.1097/MOP.0000000000000741

Bhalerao, A., Sivandzade, F., Archie, S.R. et al. Public Health Policies on E-Cigarettes. Curr Cardiol Rep 21, 111(2019). https://doi-org.proxy.lib.ohio-state.edu/10.1007/s11886-019-1204-y 

Farsalinos K. Electronic cigarettes: an aid in smoking cessation, or a new health hazard?. Ther Adv Respir Dis. 2018;12:1753465817744960. doi:10.1177/1753465817744960

Worku, D., & Worku, E. (2019). A narrative review evaluating the safety and efficacy of e-cigarettes as a newly marketed smoking cessation tool. SAGE Open Medicine. https://doi.org/10.1177/2050312119871405

Tobacco Smoking Cessation in Adults, Including Pregnant Persons: Interventions. U.S. Preventive Services Task Force Published June 02, 2020  Accessed. August 14, 2020

 

Picture References: 

E-Cigarette Dangers – 5 facts you need to know. Columbia Doctors Nurse Practitioner Group.https://www.columbianps.org/healthy-life-blog/e-cigarette-dangers-5-facts-you-need-to-know/. Published September 24, 2019 Accessed September 12, 2020 

https://www.columbianps.org/healthy-life-blog/e-cigarette-dangers-5-facts-you-need-to-know/

Curr Opin Pediatr. Author manuscript; available in PMC 2020 Apr 1.Published in final edited form as:Curr Opin Pediatr. 2019 Apr; 31(2): 262–266.doi: 10.1097/MOP.0000000000000741

Components of the e cigarettes components:

Rom, O, Pecorelli, A, Giuseppe, Vet al. Are E-cigarettes a safe and good alternative to cigarette smoking. Ann N Y Acad Sci 2015; 1340: 65–74.

 

Allergy Relief? Sinus up! By Our Student Pharmacist, Cat Mechler.

What are allergies?

Allergies are a result of your body overreacting to foreign objects, that we call allergens. Seasonal allergies are fairly common as there are many allergens that can trigger an allergic reaction, including(1):

  • Pet dander
  • Dust mites
  • Grass
  • Weeds
  • Trees
  • Mold

Symptoms of seasonal allergies are similar to those of a cold and include(1):

  • Itchy/watery eyes
  • Congestion
  • Runny/itchy nose
  • Sneezing
  • Skin rash

Allergy #1

When can I get allergy symptoms?

Typically, allergies can begin as early as the end of February and last until the end of the summer. However, you may experience these symptoms at any time during the year, depending on where you are in the country. The specific allergen that’s triggering your allergies can also affect when you get them.(2)

What can I do to treat them?

The best thing you can do to prevent these symptoms is to avoid the allergen. Monitoring pollen counts, keeping windows and doors shut, and taking a shower after you’ve been outside during allergy season are a few ways to help minimize your risk of experiencing allergy symptoms.(2)

It’s not always possible to completely avoid triggers. There are a variety of options that can be found over the counter (OTC) to help control your allergies. At first, the amount of OTC allergy products can seem overwhelming; however, there are generally 5 different types of products to choose from:

  1. Glucocorticoid nasal sprays are the most effect single treatment to help relieve(3):
    • Congestion
    • Runny/itchy nose
    • Sneezing

These nasal sprays may cause local irritation, including drying or burning of the nose or throat. Another important thing to know is that these medications can take several days to weeks of daily use to see the full effects.

Examples include:

  • budesonide (Rhinocort)
  • fluticasone propionate (Flonase)
  • triamcinolone (Nasacort)

Allergy #2

Be careful not to pick out a nasal decongestant spray, like phenylephrine or oxymetazoline. These are not recommended for the routine treatment of seasonal allergies.

  1. Nasal Saline – Saline spray or irrigation can be beneficial for milder symptoms and offers some relief for:
  • Runny nose
  • Itchy throat
  • Congestion

It’s important to remember if using the nasal saline irrigation to always use distilled, sterilized, or boiled water that has cooled to room temperature to kill any potentially infectious organisms.(4)

Allergy #3

  1. Oral antihistamines – Good option if you’re looking for something to help control mild to moderate symptoms, especially:
    • Itching
    • Sneezing
    • Runny nose

These medications are less effective for congestion in comparison to the glucocorticoid nasal sprays.(5) Additionally, antihistamines often cause sleepiness. First generation antihistamines, including diphenhydramine (Benadryl), are more sedating than others. Typically, second generation oral antihistamines are less sedating and are therefore preferred to help treat allergy symptoms.

Less sedating second generation antihistamines include:

  • cetirizine (Zyrtec)
  • levocetirizine (Xyzal)
  • loratadine (Claritin)
  • fexofenadine (Allegra)

Some other side effects of these medications could include dry eyes and mouth.

Allergy #4

  1. Antihistamine eye drops – Option that offers relief for itchy or red eyes

Refrigeration or using refrigerated artificial tears prior to the antihistamine eye drops may help to reduce burning/stinging sensation upon installation. Other side effects could include increased eye dryness or headache. (6)

Examples include:

  • ketotifen (Alaway or Zaditor)
  • olopatadine (Pataday)

Allergy #5

 

  1. Artificial tears are another option to help with dry eyes that would in turn reduce redness.

Of course, if you’re having trouble picking the product that will work best for you, feel free to ask the pharmacist!

Sometimes OTCs aren’t enough to control your allergies and you might have to go to a doctor who specializes in allergy control. They might suggest immunotherapy or allergy shots. These are very effective in treating your persistent allergy symptoms and may even make you “less allergic” over time.(2)

References:

 

All Your Questions and Concerns About CBD. By Our Student Pharmacist, Malcolm White.

Have you heard about CBD? Recently, CBD has become increasingly popular. You might have seen CBD products advertised at your local grocery and pharmacy. The CBD rage is due to the many potential benefits it has for easing symptoms of insomnia, anxiety, chronic pain, and a host of other health conditions.

What is CBD?

CBD, short for cannabidiol, is a plant-based compound known for its calming effects. CBD comes from hemp and cannabis plants. CBD is made by extracting CBD from the cannabis plant and then diluting it with another type of oil, such as coconut oil or hemp seed oil. CBD is a 100% natural product with no psychoactive effects.

The following information comes from Ananda Professional:

Does CBD get you high?

No, CBD is derived from the cannabis plant and is made up of two main players: CBD and THC. CBD is the non-psychoactive portion of the plant. What that means is you won’t have any effects like euphoria. Therefore, you will not feel “high” in any way when taking CBD.

Will CBD show up on a drug test?

No, a product that contains CBD alone will not trigger a positive drug test. Most drug tests screen for the compound delta-9-tetrahydrocannabinol (THC). You do want to research reputable CBD brands that have third party testing. Below will be a list of reputable places to purchase CBD.

Is CBD legal?

Yes and no. CBD is legal to sell or consume in all 50 states except Idaho, South Dakota, and Nebraska.

It is legal in Ohio.

CBD side effects

The most commonly reported side effects are:

  • fatigue
  • diarrhea
  • changes in appetite

CBD forms

As the hype around CBD increases, consumers are finding a wide variety of ways to consume it. The most common form of CBD products include oils. You could also see popular food brands and restaurants adding CBD to their products.

Common forms include:

  • CBD Oil
  • CBD Gummies
  • CBD Topicals/Lotions/Sprays
  • CBD Capsules
  • CBD Sleep Aids
  • CBD Pet Products
  • CBD Bath Bombs
  • CBD Candy
  • CBD Patches
  • CBD Toothpicks

IMG_1991

What can CBD treat?

CBD has been promoted to manage a wide range of health issues. Many research trials are currently in progress or needed to show scientific evidence that CBD is effective in treating and managing these wide range of health issues. Currently, there is strong scientific evidence in the effectiveness of CBD to treat some severe childhood epilepsy syndromes such as Dravet Syndrome and Lennox- Gastaut Syndrome (LGS), which typically don’t respond to antiseizure medications. CBD is commonly used to address anxiety, and for patients who suffer through the misery of insomnia, studies suggest that CBD may help with both falling asleep and staying asleep.

CBD also helps to treat:

  • Pain and inflammation seizures
  • Anxiety
  • Depression
  • Nausea
  • Migraines
  • Psychosis Mental Disorder

Is CBD good for pain management?

Based on scientific data and requirements, it’s unknown due to the lack of studies conducted. Currently, there is an overwhelming body of convincing preclinical evidence indicating that cannabinoids are effective in treating pain for rodent test subjects. The next steps are to conduct trials using human subjects to show effectiveness in treating challenging chronic pain.

CBD drug interactions with common interactions

Current research shows that CBD is generally safe. However, CBD does have the potential to interact with some medications.

Some medications with moderate interactions include:

  • Plavix: Clopidogrel
  • Valium: Diazepam
  • Lexapro: Escitalopram
  • Prevacid: Lansoprazole
  • Prilosec: Omeprazole

Before trying CBD, it’s crucial to talk to your doctor or local pharmacist about all of the vitamins, supplements, prescriptions, and over-the-counter medications you’re taking. You never know how your body will react to a product. Therefore, when taking CBD for the first time, do so safely under supervision.

Reputable CBD Brands

The following are websites of trusted brands that may be the best place to find CBD oil. These websites provide you with third-party lab reports and all the key product details.

The above products are located and can be purchased at Happy Druggiest on Karl Rd.

CBD for Pets

More people are looking for new ways to help their pets. Many pet owners wonder if CBD is okay for pets. Because mammals, including cats and dogs, all have similar central regulatory systems, CBD can provide relief for them with some health issues including:

  • Arthritis
  • Separation anxiety
  • Nausea and vomiting
  • Noise phobias
  • Hip and joint mobility
  • Everyday health and wellness

For those looking for a natural alternative to provide relief, CBD may support a wholesome wellness regimen.

References:

  1. Iffland K., Grotenhermen F. An update on safety and side effects of cannabidiol: A review of clinical data and relevant animal studies. Cannabis Cannabinoid Res. 2017;2:139–154. doi: 10.1089/can.2016.0034.

  2. VanDolah HJ, Bauer BA, Mauck KF. Clinicians’ Guide to Cannabidiol and Hemp Oils. Mayo Clin Proc. 2019;94(9):1840-1851. doi:10.1016/j.mayocp.2019.01.003

  3. Peter Grinspoon MD. Cannabidiol (CBD) what we know and what we don’t. Harvard Health publishing Harvard Medical School https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476 Published, August 24th, 2018, Accessed August 5th, 2020

  4. John Rampton. CBD Guide: 12 Important Facts You Should Know Right Now. Green Entreprenuer. https://www.greenentrepreneur.com/article/333543 Published May 10th, 2019, Accessed August 5th, 2020

  5. Jennifer Chesak, CBD and Drug Interactions: What You Need to Know. Healthline.https://www.healthline.com/health/cbd-and-drug-interactions-what-you-need-to-knowPublished November 15th, 2019, Accessed August 5th, 2020

  6. Jillian Kubala, 7 Benefits and Uses of CBD Oil (Plus Side Effects). Healthline.https://www.healthline.com/nutrition/cbd-oil-benefits Published February 26th, 2018, Accessed August 5th,2020

  7. Nova Recovery Center, Everything You Need to Know About CBD.https://novarecoverycenter.com/drug-use/what-is-cbd/ Published February 15th 2019, Accessed August 5th 2020

  8. Ananda Professional. A 600mg tincture CBD bottle. Ananda Professionals https://www.anandaprofessional.com/ Accessed August 6th, 2020

Truth About Ticks. By Our Student Pharmacist, Catherine Mechler.

Ticks are small insects that typically live in long grass, trees, shrubs, and leaf piles. They feed off the blood of humans and animals and can sometimes transmit diseases. Ticks prefer warmer months and are most active in April-September, although you can find them anytime throughout the year.(1) It’s therefore important to know how to identify ticks and what to do if you find one!

There are a variety of tick species that are found throughout different regions of the world. You can find more information about the specific tick species that occupy different regions of the U.S. on the Centers for Disease Control and Prevention (CDC) website. In Ohio, we have three types of ticks that are most commonly found:(2)

  • American Dog Tick (Dermacentor variabilis)
  • Blacklegged Tick or Deer Tick (Ixodes scapularis)
  • Lone Star Tick (Amblyomma americanum)

Tick #1

Even within the same species, ticks can range in size from the size of a pin head to the size of a pencil eraser. Their size fluctuates depending on if they’ve eaten recently – the larger the tick, the more blood it has taken in recently.(1) If you or your pet get bitten by a tick, you’ll likely know because you find them embedded in your skin.

What do you do if you get bitten by a tick?

DON’T PANIC! The best thing you can do is remove the tick. Follow these steps from the CDC:

  1. Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible.
  2. Pull upward with steady pressure, being careful not to twist or jerk the tick. If the mouth parts break off, remove mouth parts with tweezers, and if still unable to remove mouth easily, leave it alone and let the skin heal.
  3. Clean the bite area with rubbing alcohol or soap and water.
  4. Dispose of a live tick by putting in rubbing alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet.

Tick #2

There is a wide range of reactions someone could experience if bitten by a tick. Majority of the time, you won’t experience any symptoms or may have a minor allergic reaction that could include:(1)

  • Pain or swelling
  • Rash
  • Burning feeling
  • Blisters

If these symptoms become bothersome or if you experience difficulty breathing, it could be a sign of a severe allergic reaction and you should seek care immediately!

Tick bites may also cause diseases, such as:

  • Lyme disease
  • Rocky Mountain spotted fever
  • Babesiosis
  • Others!

Each of these diseases has their own unique set of symptoms to look out for.

How can you prevent being bitten by a tick?

If you’re going camping or spending a lot of time in the woods or tall grasses, you can use permethrin 0.5% to spray on your clothing and other camping gear.(3) Permethrin should ONLY be applied to clothes and gear. Never apply this to your skin.

Insect repellent is the best way to prevent any unwanted ticks. There are many different products you can use as tick repellent, including some that double as mosquito and tick protection. Products that contain at least 25% DEET are sufficient to repel ticks. Here’s a helpful tool from the Environmental Protection Agency (EPA) that’ll help you choose the right product for you!(4) Wearing a long sleeved shirt and pants and walking in the center of trails are other ways to prevent being bitten from ticks.

After coming inside, you should always check your clothing, gear, and body for any critters. It’s also recommended to shower within two hours after coming inside.(1,3) Ticks love warm, moist places, so be sure to double check:

  • Under arms
  • Behind ears
  • Between legs
  • Behind knees
  • In hair

Tick #3

 

Ticks also love your furry friends. Many pets are on flea and tick medication already, which should prevent them from being bitten, but you will still want to check any pets that have been outside for ticks.(1,3)

Tick #4

To get more information or to answer any questions, feel free to check out this link for the CDC’s website on ticks!

References:

https://www.epa.gov/insect-repellents/find-repellent-right-you

Please Welcome Malcolm White Our Student Pharmacist for the Month of August at Happy Druggist on Karl Road.

 

IMG-1811 3

This month, we are joined at Happy Druggist on Karl Road by Malcolm White, a fourth-year pharmacy student from The Ohio State University’s College of Pharmacy.

Malcolm will graduate in May 2021 and will then take the test to become a registered pharmacist. Malcolm will be with Kristie and the staff on Karl Road throughout August, so please stop by and meet him while he is in the store in Columbus.

Here is what Malcolm tells us about himself:

Hello, my name is Malcolm White. I am a current fourth-year pharmacy student with The Ohio State University. This month, I will be on rotation with Kristie Holliday at Happy Druggist Pharmacy on Karl Rd.

I grew up in Cincinnati, Ohio and moved to Richmond, Kentucky to complete my undergraduate degree at Eastern Kentucky University (EKU). At EKU, I completed my B.A. degree in Chemistry with a minor in Biology. I decided to attend The Ohio State University to complete my PharmD degree.

During high school, I did not put a lot of thought into what I wanted to pursue in college. Once high school was coming to an end and I was thinking about careers I might be interested in, I had the intention of going to college to pursue a degree in business administration. Little did I know, my father had other ideas for me. One night we deliberated on potential careers and weighed the pros and cons of each career. Once the deliberation was over, we concluded that the best career for me to pursue was pharmacy. My father played a major role in influencing my decision in pursuing a career in pharmacy.

When it comes to what I see myself doing in the future as a pharmacist, it is working as a community pharmacist. Community pharmacy is where my current interest is. I have two years experience in community pharmacy working for Kroger. I enjoy the atmosphere and the workflow.

Throughout my time at pharmacy school, I was able to gain experience in hospital pharmacy. This experience helped me understand that I prefer to work in a community setting rather than the hospital. However, after speaking to many colleagues, the majority of them say their main interest changed once they started going on rotations their fourth year, so I am keeping my options open.

Outside of pharmacy school, I enjoy quite a few hobbies. These hobbies include going to the gym, watching YouTube, watching anime, and reading. During the impact of COVID and the closing of gyms, I was in disarray. Now that the gym is back open, I understand how much I enjoy going to the gym. When I am at home I am usually watching all things YouTube. Once the day starts to come to an end, I will start to watch whatever is the current anime. On the weekends I usually enjoy reading. I own two bookcases full of books. The topics range from business, self improvement, investments, mystery drama, and school science books.