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Archive for December, 2020

Forget to Take Your Meds? Here are some Tips that Can Help. By Our Student Pharmacist, Sarwar Ghani.

What is medication adherence?

Medication adherence and medication compliance are two terms that we often hear about in healthcare.

Adherence usually refers to filling a new prescription or refilling prescriptions on time. Compliance means taking the medications regularly as prescribed. The terms, however, are often used interchangeably. To be adherent/compliant means that the patient is taking their medication regularly and as prescribed.

Medication adherence is a very important part of managing chronic conditions.

Why is medication adherence important?

Research has shown that improving medication adherence may have a greater influence on the health of our population than in the discovery of any new therapy. Treatment of a chronic disease requires long term treatment with medications. While these medications are effective to help with the disease progression, adherence is crucial to get their full benefit.

Studies have shown that almost 50% of adults in the US are non-adherent to medication and over 10% of hospital and nursing home admissions are due to non-adherence to medications for chronic conditions such as diabetes and hypertension. An article published in 2018 states that non-adherence can account for up to 50% of treatment failures or around 125,000 deaths and up to 25% of hospitalizations each year in the United States.

A report from the World Health Organization states, “Medicines will not be effective if patients do not follow prescribed treatment, yet in developed countries only 50% of patients who suffer from chronic diseases adhere to treatment recommendations. In developing countries, when taken together with poor access to health care, lack of appropriate diagnosis and limited access to medicines, poor adherence is threatening to render futile any effort to tackle chronic conditions.”

Poor adherence can result in avoidable consequences such as:

  • reduced functional abilities and quality of life
  • unnecessary disease progression
  • additional medical costs
  • increased physician visits

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What is the reason for non-adherence?

A survey conducted in 2019 identified the following as top reasons for medication non-adherence:

  • access to a pharmacy
  • price of medications
  • ability to track refills
  • fear of side effects
  • belief that the medication is not beneficial
  • patient has “too many pills” to take

Adherence is a complex issue. There are a lot of external factors that can impact medication adherence. Ideally, any patient who is adherent to their medication 80% or more is considered to be adherent.

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How to improve medication adherence?

Given the complex nature of the problem, there is no one correct answer to this question. Each patient may be facing a different issue which is preventing them from medication adherence. Following are some options that can be utilized to help with adherence.

  • Talk to your health care provider. If you are worried about side effects or the costs of your medications or if you feel like the frequency of the dosing is challenging for you, discuss your concerns with your doctor or pharmacist. Your healthcare team may be able to provide coupons or switch you to other agents that may be better suited for you.
  • Use reminder tools to help you remember. If you have a lot of pills to take at different times throughout the day or generally forget to take your medication, you would benefit from using a reminder tool. Some commonly used methods are:
    • setting an alarm for each time you need to take a medication.
    • keeping your pill bottles in areas where you are usually at during those times.
    • using a pill box to have your medications sorted by the time of the day.
  • Keep an updated list of medications with the dosing instruction. Most pharmacies now offer medication reconciliation. Utilize this service to obtain an updated list of your medications. You can use the list to make sure you are taking all the medications you are prescribed. Take the list with you to every doctor’s appointment and request the doctor’s office provide you with an updated list if they change anything.
  • Get all you medications at one pharmacy. Using one pharmacy will help with your adherence and also allow the pharmacist to better understand your medication regimen to provide a better service. You can also use the pharmacy’s medication synchronization program so that you make the least possible trips to pick up your medications.

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These are just some options that can be utilized to help with medication adherence. If you are struggling with your medication regimen, it is highly recommended that you share your concerns with your doctor or pharmacist to figure out a reasonable solution to help ease your concerns and also improve the management of your condition.











COVID-19 Vaccine: All Your Questions Answered. By Our Student Pharmacist, Sarwar Ghani.


With the recent progress on the development of a vaccine for COVID-19, the possibility of approved COVID vaccines is a reality. It is normal to have questions regarding the vaccine. With this post we aim to answer some of the frequently asked questions regarding COVID-19 vaccines.

How will the vaccine work?

The COVID-19 vaccines will help our bodies develop immunity to the virus that causes COVID-19 without getting us ill.

At the moment there are three main types of vaccines that are or soon will be undergoing large scale clinical trials in the United States. Although the different types of vaccine will work in different ways to offer protection, all three types will result in the body being left with a supply of memory T-lymphocytes, a type of white blood cell that will trigger an immune response when we get exposed to the virus, and B-lymphocytes, defensive white blood cells that produce antibodies. Usually it takes a few weeks for the body to produce the T and B-lymphocytes after vaccination so it is still possible that a person could be infected with the virus just before or just after vaccination and get sick as the vaccine didn’t have enough time to provide protection.

mRNA vaccine

What are the types of vaccines being studied?

  • mRNA vaccines contain material from the virus that causes COVID-19 to instruct our cells to make a harmless protein that is unique to the virus. Once our immune system recognizes that the protein is from a different organism, it starts building an immune response.
  • Protein subunit vaccines include harmless pieces (proteins) of the virus that cause COVID-19, instead of the entire germ, to trigger the immune response.
  • Vector vaccines–this process involves inserting the genetic material from the COVID-19 virus into a weakened version of a harmless virus to start an immune response to COVID-19 without getting us ill.

Can anyone get the vaccine as soon as it is approved?

With the very high demand and limited current availability of the vaccines it is unlikely that everyone will be able to get the vaccine as soon as it is approved for use. Vaccines are expected to set out for transportation as early as 24 hours after approval. It is expected that vaccines will be available for all adults in US around mid-2021. As per the Center for Disease Control and Prevention’s phased allocation guideline released on 12/01/2020, the vaccine will be made available in phases.

During the writing of this post, the CDC released their plan for phase-1 rollout which has been divided into three categories:

  • Phase-1a includes health care personnel and long-term care facility residents.
  • Phase-1b includes essential workers.
  • Phase-1c includes adults with high risk medication conditions and adults over the age of 65.

This allocation was done using results from a risk analysis and survey polls. Although this is the recommendation by the CDC, each state will have its own plan for rollout.

How much will it cost?

The vaccines will be available for all Americans at no cost to the patient regardless of their insurance status.

Will the vaccine be safe?

Under Operation Warp speed, the federal government has been working to make a Covid-19 vaccine available as soon as possible. This accelerated timeline may raise concerns for some people that safety may be sacrificed in favor of speed. However, as with all vaccines, safety is a top priority.

The Advisory Committee on Immunization Practices (ACIP) is a group of 15 medical and public health experts who are voting members and are responsible for making vaccine recommendations. Even before a vaccine is approved by the Food and Drug Administration (FDA), an ACIP work group will thoroughly review all available scientific information about the vaccine to present the information to the ACIP committee about the vaccine. The ACIP reviews the safety and effectiveness for each vaccine. Normally the process of authorization of a vaccine can take several years, but due to the severe nature of the COVID-19 pandemic, the vaccines, under Operation Warp Speed, are being given Emergency Use Authorization (EUA).

What is an Emergency Use Authorization (EUA)?

In an emergency, like a pandemic, it may not be possible to have all the evidence that the FDA would usually have before approving a drug, device, or a test. During the COVID-19 pandemic, the U.S. FDA has issued many emergency use authorizations for tests, as well as treatments.

During a declared emergency, the FDA can decide if it is worth releasing something for use even without all the evidence that would fully establish its effectiveness and safety under normal circumstances. If there’s evidence that strongly suggests that patients have benefited from a treatment or test, the agency can issue an EUA to make it available. The FDA will take into account the scientific data available on the vaccines and the recommendations made by the ACIP and if it satisfies all the required conditions before providing an EUA. After a vaccine receives an EUA, the FDA and the CDC will continue to monitor the safety of the vaccines to make sure every rare side effect is identified.

What are some of the expected side effects?

Side effects from vaccine are not uncommon. A vaccine as common as the flu shot can cause muscle soreness and fatigue among other symptoms. Some of the adverse reactions from the COVID-19 vaccine include:

  • allergic reaction
  • pain and swelling at the site of injection
  • muscle soreness
  • mild fever
  • headache
  • joint pain

The prevalence of the adverse effects was higher in younger patients and with the second dose compared to the first dose. It should also be noted that in most cases the effects resolved within 24 hours after administration.

If I already had COVID-19 and recovered, do I still need to get the vaccine?

At the moment there is not enough information available to say if or for how long after infection someone is protected from getting COVID-19. Evidence suggests natural immunity from COVID-19 may not last very long, but more studies are needed to better understand this. During the time of writing this post there was no available recommendation from the CDC.


Can I stop wearing masks after I get the vaccine?

The vaccine works with the immune system so that our body is able to fight the virus if we are exposed. Precautions like wearing a mask and staying six feet away help reduce our chance of being exposed to or spreading the virus.

Even after you get vaccinated, it takes a few weeks to build immunity to a disease, so it is possible to get sick with COVID-19 even after being vaccinated. As experts learn more about the protection the COVID-19 vaccine provides under real-life conditions, it is important we use all the tools available to us until there is a change in the recommendations.

If you have any questions or concerns regarding the COVID-19 vaccine, it is recommended that you reach out to your Doctor or your neighborhood Pharmacist.







Salt Therapies. By Our Student Pharmacist, Sandy Saleh.

salt room

Salt therapy is popping up all around the map and it is the process in which humans inhale small particles of salt for many different types of claimed benefits.

Even though salt therapy seems new, it is actually very dated and has been around since the 1800’s. A physician noticed that salt mine workers had less health issues, including less respiratory problems, than workers who had been in other types of mines. Even many years later, when people used to hide in salt caves during WWII, their health improved prompting the spread of salt therapy.

Salt therapy is still confusing in terms of science, but the theory is that when salt particles are inhaled, the particles kill off microorganisms in the lungs to reduce inflammation and decrease mucus. A senior scientific advisor to the American Lung Association suggests that when fine salt particles are inhaled, they fall on the airway linings and draw water into the airway, thinning the mucus and making it easier to breathe, thus making people feel better. The salt particles also can pull out other toxins and bacteria from the body cells in the process.


The treatment essentially involves sitting in a warm room filled with rock salt, with walls that are made of salt and inhaling salty air that’s being pumped into the room by a machine. The room itself usually consists of dim lighting, comfortable seating, and is often very pretty. The surroundings provide a relaxing environment.

People can choose to sit in the salt room anywhere from 30 minutes to a couple of hours, with the most commonly chosen time being one hour. There are many different modified versions of the salt room with some rooms including salt and toys that kids can play in like sand, and salt baths that allow for people to float and feel lightweight. The salt rooms are advertised towards all ages.

Initial recommended therapy, by the salt room therapists, for asthma and COPD includes twice weekly therapy for 6-8 weeks. Some people use salt rooms daily and have no complications. It is always important to discuss any type of new therapy with a doctor.

The claimed benefits of salt therapy include relief of symptoms of skin, respiratory and lifestyle conditions, including:

Many people just use salt therapy as a way to relax in the comfortable quiet rooms and clear the mind as a form of self care. Self care alone is shown to improve health outcomes both mentally and physically.

There is not much evidence showing that salt therapy is harmful. However, since there is no evidence-based findings or guidelines to salt therapy treatment, before starting salt therapy, it should be discussed with a doctor.

Salt rooms can be dehydrating and it is very important to drink plenty of water. There are reports of watery stinging eyes due to the salt. Any patient with eye health concerns should also consult a doctor.

We have a wonderful salt spa right here in Plain City. Sweet Dreams Float and Dry Salt Therapy, 218 West Main Street, offers dry salt therapy, as well as a floatation pod. They also have wonderful gifts for the holidays including salt lamps, aromatherapy dispensers, and essential oils.

Like Sweet Dreams on Facebook HERE and find out more about how to book an appointment.

salt room fancy


All You Need to Know about Green Tea Consumption. By Our Student Pharmacist, Sarwar Ghani.

International Tea Day is celebrated annually on December 15 to highlight the effect of the trade of tea globally on the economy, workers, farmers, and society.

With this day in front of us, let’s look at some of the beneficial effects of green tea.

All teas come from the same plant, Camellia Sinensis, but are prepared using different methods. Green tea, which represents roughly 20% of the world’s tea production, is produced by steaming and frying the leaves and then drying them.

Tea has been utilized for therapeutic purposes in China and Japan for many centuries. While many countries favor black tea, the production process for black tea has a huge impact on its chemical composition. During the process of fermenting the leaves, the bioactive polyphenols are oxidized into pigment which may change their antioxidant properties. What’s more, many people like to consume black tea with milk, which additionally decreases the effectiveness of those bioactive components.

Green tea has been a staple of billions of people all over the world for centuries, yet only recently researchers have begun to examine its true benefits. As of late, the health promoting benefits of green tea and isolated green tea constituents have been under investigation. It should also be noted that adding green tea to the diet may cause other health concerns including adverse reactions with other prescription medication.

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What makes green tea different?

The health-promoting effects of tea are primarily attributed to its polyphenol content, particularly flavanols and flavonols, which represent 30% of fresh leaf dry weight. When we look at the composition of green tea and black tea, it is very similar for the most part. The biggest compositional difference between them lies in their content of phenolic compounds and the oxidized phenolic compounds. While green tea is rich in phenolic compounds (six times more compared to black tea), black tea, due to its production process, has more oxidized phenolic compounds.

Table 1

What do people use it for?

Tea is one of the most popular beverages consumed worldwide. Compared to other types of tea, the most significant effects on human health have been observed with the consumption of green tea. Green tea, as a beverage or dietary supplement, is promoted for a wide variety of conditions including relief from digestive symptoms and headaches and promoting weight loss.

Epigallocatechin-3-gallate (EGCG), which is a component of green tea, has been studied for its protective effects against heart disease and cancer. People have reported using green tea orally for the treatment or prevention of multiple conditions such as:

  • depression
  • certain types of cancer
  • human papilloma virus (HPV)
  • genital warts
  • urinary tract infections
  • hypertension
  • Crohn’s disease
  • ulcerative colitis
  • osteoporosis
  • cardiovascular disease
  • diabetes

Gargling with green tea is also used for the prevention of colds and flu.

Green tea products are also used for some oral conditions. Green tea extract mouthwash is used for postoperative pain associated with tooth extraction. Green tea chewable candies are used for gingivitis. Topically, green tea creams/lotions are used as a treatment for genital warts and to prevent skin damage from ultraviolet radiation and other environmental causes.

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Does it work?

It is evident that there is more study needed to say with confidence that green tea is effective for certain conditions. Using the data from the studies conducted so far, we can group the effectiveness of green tea into three categories:

  • likely effective (there is high level of reliable clinical evidence)
  • possibly effective (there is some clinical evidence supporting its use, but the evidence is limited by quantity, quality or contradictory findings)
  • insufficient evidence to rate effectiveness (not enough scientific evidence)

The following table categorizes the proposed uses for green tea into the three categories:

Likely effective Possibly effective Insufficient evidence to rate effectiveness
Genital warts (FDA approved) Heart disease, High cholesterol, High blood pressure, Cancer (ovarian, endometrial), Parkinson’s disease Cancer (bladder, breast, cervical, colon, rectal, esophageal, stomach, leukemia, liver, lung, multiple myeloma, nasopharyngeal, non-Hodgkin lymphoma, oral) Acne, amyloidosis, athletic performance, Heart disease, common cold, diabetes, fractures, influenza, low blood pressure, mental alertness, heart attack, obesity, osteoporosis, stress, infection of kidney, bladder or urethra, skin wrinkle from sun damage, infertility and fatty liver in people who drink little or no alcohol.

Is it safe to use?

Green tea contains tannins. Tannins can interfere with the absorption of iron, so try not to drink green tea with an iron-rich meal and leave at least one hour before drinking tea after an iron-rich meal.

Green tea is also a source of caffeine, so it is important to take that into consideration when consuming it regularly. Drinking green tea is LIKELY SAFE for most healthy adults when consumed in moderate amounts (about 8 cups per day).

Green tea extract can cause stomach upset and has been reported to cause liver and kidney problems in rare cases, so it is important for patients with liver and kidney disorders to consult their doctors before starting regular consumption of green tea. There is limited clinical evidence that shows green tea has some safety concerns or significant adverse effects when consumed in high doses or for a long time.

Drinking green tea may be safe during pregnancy and while breastfeeding when consumed in amounts up to 6 cups per day (no more than about 300 mg of caffeine). Drinking more than this amount during pregnancy may be unsafe and may increase the risk of negative effects. Consumption of caffeine in amounts over 300 mg daily is associated with a significantly increased risk of miscarriage in some studies. Pregnant women are advised to keep caffeine consumption from all sources below 300 mg daily. This is similar to the amount of caffeine in about 6 cups of green tea.  It is important to consider that green tea may increase the risk of birth defects associated with folic acid deficiency.

Caffeine passes into breast milk and can affect a breastfeeding infant. There is limited evidence that shows that green tea is considered safe in children and adolescents in amounts commonly found in foods and beverages. There has been no significant adverse effect in children and adolescents associated with daily caffeine intake of less than 2.5mg/kg.

Alternative green tea products:

With the increased awareness of healthy living, natural products are becoming more and more integrated into our daily lives every day. Due to the wide array of conditions that green tea extracts are being attributed to helping, there are many different forms of green tea extracts being sold online and in stores. The image below shows some different types of green tea extract products that are available on Amazon.

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Final thoughts

The limited amount of research available on natural products makes it difficult to confidently recommend them for treatment or prevention of any conditions. It is crucial that we inform our doctors about any natural product or supplement that we take. While they may be natural products, they can, just like prescription medications, interact with other medications and cause undesired effects.

Unlike prescription medications, over-the-counter supplement manufacturers don’t have to get approval from the Food and Drug Administration (FDA) prior to putting products on the shelves, so it is important that consumers verify that they are getting what the label claims to be in the product. One way to ensure that is to check that the product has the “USP certified” or “Consumer lab certified” label on it. These organizations test and verify that the products actually contain what they claim on the label in the declared potency and amounts. It is important to note that the certification ensures the component and its quantity, but does not eliminate the potential risk of adverse effects or drug interactions, so it’s important to consult a physician or pharmacist to help make the best possible choice.


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Over-the-Counter Medications to Help Combat Covid-19. By Our Student Pharmacist, Sandy Saleh.

immune system

COVID-19 has taken over the year of 2020. At the beginning of this year, the virus quickly spread and made it to the USA in a matter of weeks. The more we know about COVID-19, the more we realize that prescription drugs will not be able to help with the accompanying sickness.

COVID-19 is a virus. It is much harder to make medications to kill viruses than it is to make medications, such as antibiotics, to fight bacterial infections. The difficulty in fighting a virus is due to the fact that viruses invade our actual body cells while bacteria are freestanding and multiple on their own. Creating a drug that targets the virus without targeting body cells and causing damage is very difficult. We do have some antivirals for viral infections such as cold sores, but those antivirals only keep the cold sore virus from spreading. This is why many people have recurring cold sores and have to take the medications long term or every time a cold sore pops up. The virus stays in the body.

Most viral illnesses rely on your body to recognize the virus and fight the virus on its own. The flu is an example of a virus that usually goes away on its own due to a person’s immune system. People with weaker immune systems sometimes have more trouble fighting illnesses and have more complications from viruses.

The Food and Drug Administration (FDA) currently has only one drug that is approved to help with COVID-19. Remdesivir is an antiviral reserved for people who get super sick and it seems to help lower the risk of dying from the virus and possibly shortens hospital stays. Remdesivir is an expensive injectable drug and is not available to the general public.

Vaccines are used to prevent people from getting a virus and are probably not helpful for people actively infected.

vitaminsThe best way to combat COVID-19 is with over-the-counter (OTC) products that you can find at your local pharmacy. Since the human body does have the ability to fight off viruses, it is important that we take care of our bodies and keep up with its needs.

Our bodies need vitamins, which we can’t make on our own and vitamins play a huge role in our immune systems. Vitamins A, D, C and E support the immune system and help fight off infections. Vitamin C and D have been shown to shorten the length and severity of viral infections and other illnesses especially if a person is deficient in those vitamins.

Zinc is a mineral that is recommended to take at the first signs of illness because it helps the body make proteins that help the immune system.

Daily multi-vitamins are often recommended to take whether we are sick or healthy. Even though our bodies need vitamins, talk to a doctor or pharmacist about any supplements before you begin them.

Other options to help with COVID are OTC products to manage symptoms while your body fights off the virus. Many people with COVID develop a cough. Some people like using dextromethorphan for coughs, although cough drops may be best to minimize other side effects like drowsiness.

Acetaminophen or ibuprofen can help with headaches and body aches. Talk to a pharmacist for the best personal option for any existing conditions or medications you have. There was early talk about ibuprofen worsening COVID, but there is no evidence to support this claim. Make sure to follow package directions and read all warnings for all medications.

For stomach and diarrhea issues, it is best to allow these symptoms to run their course and to stay hydrated. If you can’t keep liquids down or become dizzy, contact a provider.


Just remember, pharmacists are the best for information on OTC medications and are easily reachable by phone while isolating for COVID. Pharmacists can review current symptoms and make sure that any OTC products you want to use do not interact with current medications and are safe for use.