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The Pharmacist Answers Podcast

Have a question for the pharmacist? Get your answers here! Clear explanations about complicated medical topics that anyone can understand. Disclaimer: The information contained in this blog and related podcast are not to be taken as medical advice, they are for informational and educational purposes only. If you resemble anything that is mentioned in this blog or related podcast, contact your doctor. The information contained in this blog and related podcasts is the opinion of the author and does not relfect the views of her employer, Walgreens. If you want to know what Walgreens thinks, ask Walgreens!
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Now displaying: July, 2015
Jul 27, 2015

Drink water - lots of water.  Eight 8 oz glasses of water a day - at least. 

 

Your body is mostly water.  If you end up in a deficit, heat sickness or heat stroke may ensue. 

 

Drink room temperature water to be able to drink more and absorb more.  Here’s a website that explains different situations in which you should drink water at different temperatures. 

http://www.healthyandnaturalworld.com/drinking-cold-or-warm-water/

 

If you feel thirsty, you’re already at a deficit and needs to be corrected ASAP. 

 

Make sure kids are drinking water and staying hydrated.  And your pets too! 

 

Temperature Reference

Water freezes at 32o F (0o F)

Refrigerated water is between 35-45o F (1-7o F)

Room temperature is between 68-78o F (20-25 o F)

Body temperature is 98.6o F (37o F)

Your hot water heater is probably set somewhere between 110-140o F (43-60o F)

 

Water boils at 212o F (100o F)

Jul 20, 2015

Stomach acid causes  heartburn.

 

Long-term reflux problems leads to a GERD diagnosis. 

 

Stomach acid has a pH of 2.  

 

Low pH = acid; High pH = base 

 

Stomach acid is Hydrochloric acid (HCl) 

 

The molecules of the acid like to spend their time joining together and breaking apart.  So by attaching to something else instead of each other is how it can be dangerous but also how it helps digest food quickly. 

 

Your stomach is designed to hold this strong acid safely. 

 

There are pumps in the cells of the lining of your stomach that produce the acid. 

 

Proton pumps work kind of like a water wheel - they move protons from inside the cell to outside to the stomach cavity. 

 

Hydrogen atoms are made up of 1 proton (positive charge) and 1 electron (negative charge).  So if you take the electron away from hydrogen, you are left with a proton with a positive charge. 

 

That is why there is a class of medications for reflux called Proton Pump Inhibitors (PPI).  These medications turn off these pumps so they pump less protons into the stomach. 

 

Another process that helps create acid in the stomach relies on histamines. 

 

They are not quite the same as the histamines that you hear about in relation to allergies.  But there is a particular type of histamine that is only in your stomach. 

 

The medications for the histamine process are called Histamine 2 Receptor Blocker (H2RB). 

 

H2RB’s work faster than PPI’s.  Just like you can take an antihistamine and it block histamines causing allergies in just a dose or two, H2RB’s can work as fast as one or two doses.  That is why they are advertised to treat heartburn after you eat or to help prevent heartburn before you eat. 

 

PPI’s take up to 2 weeks to reach maximum effect. 

 

The third option for heartburn are your antacids.  They are bases that go into your stomach acid and help neutralize it. 

 

Atnacids: Tums, Rolaids, Maalox, Mylanta - fastest 

 

H2RB’s: Pepcid, Zantac, Tagamet  - all have generics, all OTC 

Tagamet can have drug-drug interactions with other prescription medications, so caution is advised.

 

PPI’s: Prilosec, Prevacid, Nexium - some generic, newly OTC - slowest 

 

The downside to having reflux medications available OTC and people having the opportunity to self-treat is if there are any cellular changes in your esophagus. 

 

Your esophagus is not designed to be in contact with that level of acid.  As those cells are injured, they eventually change and can become cancer. 

 

Fun tidbit:  Just like the cells of your skin are epithelial cells and their job is to keep the inside things in and the outside things out.  Your digestive tract is also lined with epithelial cells.  So technically the food you eat doesn’t go inside your body, it just moves through this tract that is “outside turned in”. 

 

@steve_tessler question:  After he eats, he coughs for 30 minutes, and sometimes sneezes.  Is this considered GERD?  Cannot eat nuts or seeds due to diverticulosis.  If he sits and rests it doesn’t get so bad, but if he has to be active right after a meal, it is. 

 

 

Recommendation:  try a H2RB morning and night and see if it contains the acid after meals.  The next option could be a slight food allergy, possibly gluten, so cutting out certain foods would be necessary. 

Jul 18, 2015

Stool softener (Colace = Docuasate).  It’s job is to go into your digestive tract and attract water to soften things up.

 

Laxative (Dulcolax = Bisocodyl) = intestines tickler.  Increases peristalsis (natural, rhythmic wave-like movement of your intestinal muscles). 

 

Constipation can be caused by either that rhythm slowing down or stuff being so hard that the natural rhythm can't move it fast enough. 

 

Stool softeners make things softer so the natural motion can move it out, laxatives make the natural wave motion wave faster. 

 

The downside to a stool softener is that it might not work fast enough for some people. 

 

 

The downside to laxatives is that they might cause cramping and pain, and actually lead to diarrhea. 

Jul 18, 2015

All of the cells in your body depend on different forms of sugars to make energy (mostly glucose though). 

 

Insulin works like a key to unlock the doors of the cells and let the sugar in to be used. 

 

Adults can get newly diagnosed with Type 1 Diabetes too.

 

Type 1 Diabetes: Pancreas (insulin factory) quits working or becomes dysfunctional. 

 

Type 2 Diabetes: the key holes and the doors are broken or jammed and the insulin “key” won’t fit in them as well or at all anymore 

 

In Type 1, you have to import insulin (aka injections), because you can’t make your own insulin anymore, ever. 

 

Insulin pump (outside pancreas) gives a continuous flow of insulin and can sense sugar levels.  Tries to operate as much like a natural pancreas would. 

 

In Type 2, the medications are being developed to encourage your body to use your natural insulin as best and as long as possible. 

 

There’s lots of ways to get in a door if they key won’t work, thus there’s lots of different medications to help Type 2. 

 

 

Shout out to Rachel Mayo (@rachelcmayo) for her inspiration for this topic and for her strength and courage to not be scared of #T1D. 

Jul 16, 2015

Excedrin Migraine = Acetaminophen (APAP), Aspirin (ASA), Caffeine

 

Studies have been done regarding deaths caused by APAP overdose, and they are finding that kids and adults are dying from having too much medicine with just a little bit extra over the recommended dose. [This American Life did a whole episode on Tylenol overdose stories http://www.thisamericanlife.org/radio-archives/episode/505/use-only-as-directed

 

APAP is processed by enzymes in your liver. They are like little boats that carry drugs from one place to the other and cause them to make changes so it can do it’s job when it gets to the other side.  So, APAP rides in it’s own little boat, and the body then uses it to reduce pain or fever. 

 

The problem is, if there’s more APAP than boats, other things start happening to it, and it becomes very toxic.  It not only damages liver, it can damage the DNA of your body.  The only way to get it back in order and bind it back up, is for you to receive other pharmaceuticals in a hospital. 

Most likely, if someone has had too much APAP, it takes about 4 days for them to experience any symptoms, and therefore, it’s probably too late for them to receive help. 

 

Please don’t take more APAP than recommended. 

 

They changed the maximum dose allowed from 4000mg per day to 3000 mg per day. 

 

 

Extra strength APAP: 500 mg/ tab (1-2 tabs q 6 h)  —> 500 x 2 = 1000 mg —> 3 doses in a day (6 tablets) 

 

Non-steroidal anti-inflammatory drugs (NSAIDs): Aspirin, Ibuprofen (Advil or Motrin), Naproxen (Aleve) 

 

The Side effects of NSAIDs are much more instantaneous, so if you take too much, you will know right away and can back off.

 

A lot of prescription pain medications contain APAP too. 

 

 

Maximum Doses

APAP: 3000mg in 24 h

Aspirin: 6500 mg in 24h 

Ibuprofen: 3200mg in 24h 

 

Naproxen: 1250 mg in 24 h 

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