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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: December, 2015
Dec 31, 2015

Measuring - Episode 28

Medication for kids are usually in liquid form and require some kind of device to accurately measure the dose.

1 teaspoon = 5 ml

1 tablespoon = 3 teaspoons = 15 ml

1 fl oz = 30 ml

Milliliters = ml = cc = cubic centimeters --> all the same

Kitchen spoons and cooking teaspoons are not accurately calibrated to measure medication.

Example

100 mg/5 ml = 20 mg/ml

Incorrect spoon #1:  4 ml < 5 ml (80 mg < 100 mg)

Incorrect spoon #2: 3.5 ml < 5 ml (75 mg < 100 mg)

Incorrect spoon #3: 6 ml > 5 ml (120 mg > 100 mg)

The cups that come with liquid OTC medications are calibrated accurately to measure medication.

Restaurant spoons are HUGE sometimes.

Maximum error when testing kitchen spoons is a 40% error (meaning it could be 40% below or 40% above the standard of 5 ml in a teaspoon).  For a 500 mg/5ml medication - a 40% error is equal to 200 mg too much or 200 mg too few.  That could mean the difference in not being treated adequately and leading to complications (i.e. infection resistance) or being over-treated and experiencing side effects.

It's a different story if you're taking an adult dose (i.e tablet, capsule - which is already pre-measured) and putting it into something more palatable.

A factoid about the history of pharmacy: the only way pharmacists got medicine to people was by mixing it up and making the pills themselves.  The process of taking bulk ingredients and making specialized forms of medications is called compounding.

A factoid about brand to generic conversion: generics are only allowed to have a 5% variation from the brand name, and some companies are even more strict on themselves and follow a 3% error standard.

3% << 40%!!

"Radio Martini" Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0 http://creativecommons.org/licenses/by/3.0/

Dec 31, 2015

A headache is an ambiguous side effect because there are so many different things that can cause headaches.  Hormones are a big culprit of this.  Blood pressure medications can too.

A factoid about blood pressure:  for someone with chronic high blood pressure, the higher pressure becomes the body's new "normal".  Once medication starts to bring it down, even though the pressures are within a normal range, the body will experience symptoms of low blood pressure.

2 lies people tell about allergies:

  1. No allergies - so then they take something they are allergic to and have an emergency
  2. Allergic to "everything" - because they experienced mild or moderate side effects.  Or in the case of pain pill seekers, they're "allergic" to the weak pain meds to get the doctor to prescribe stronger ones.

Irritability, nervousness, jitteriness, or moodiness can be a side effect of amphetamines (used for ADD) or cold medicines (i.e. pseudoephedrine).

A factoid about ADD/ADHD:  the focus and attention area of the brain are underactive, so a stimulant helps it be more active so improve focus.

The biggest complaint people have from any stimulant is the inability to sleep at night.  Just need to make sure it's taken early enough in the day so it wears off in time for bed.

Joint and bone pain - in this case, we rarely want you to keep taking the medication if these side effects happen.  For example, cholesterol medications (i.e. statins, and fibrates) and quinolone antibiotics (Levaquin, Cipro, Avelox).  The quinolones have a rare but serious side effect of tendon rupture; it is painful and permanent.

Tendons: the connective tissue that anchors muscles to the bones.

Osteoporosis medications can lead to bone pain - since their job is to cause changes in the way the bones are built and rebuilt, it's not uncommon to feel something.  But usually temporary. 

 

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"Radio Martini" Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Dec 28, 2015

3 drug intolerances that involve skin

  1. Itching and rash - even though they are a big sign of allergies, they also can be typical side effects of medications
    1. Narcotics - in hospitals, they give diphenhydramine (Benadryl) to calm an itching side effect
    2. Sulfa antibiotics and tetracyclines - sun hypersensitivity.  Not a sunburn, though.  May require pain reliever to get comfortable.
  2. Flushing - redness and hotness of the skin
    1. Niacin - used for cholesterol reduction.  Flushing is reduced by taking 81 mg of aspirin 30 minutes before taking niacin
    2. Hormones - natural or in medication (birth control or hormone replacement).  Can be reduced or eased by taking before bed or taking with food
    3. IV contrast - as the medication spreads through the body.
  3. Dryness - especially of skin surfaces that require moisture (i.e. mucous membranes)
    1. Antihistamines and cold medications - dry eyes, dry nose
    2. Overactive bladder medications - dry eyes, dry mouth, constipation
    3. IBS meds that control diarrhea - constipation

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"Radio Martini" Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

 

Dec 14, 2015

Medication allergies - especially the dangerous, life-threatening kind - affect your entire body, multiple organ systems, and put you at serious risk of death.  They also require immediate medical attention.

Symptoms include:

  • Serious swelling
  • Not being able to breathe or swallow
  • Significant speeding or slowing of your heart rate or breathing
  • Blood leaking out of blood vessels into other regions of your body

Intolerances are usually related to regular side effects of the medications, but are so bad that you can't tolerate it.

At no time should you be asked to keep taking something that makes you feel worse than death.  And in most cases, avoid it at all costs.

Other times, the discomfort can be short-lived or fixed by altering how the medication is used.

Main point:  Intolerances to medication side effects are not true allergies (even though a lot of people will group them together when giving a medical history to a doctor or pharmacy).

  • Nausea can be caused by 
    1. Pain medications (narcotics)
    2. Antibiotics
    3. Any large, powdery elephant-sized tablet
    4. Multivitamins

Nausea is a side effect of almost everything that you swallow.  It's too vague and nondescript to be an allergy.  It is usually due to the increase in acid production by the stomach when it is trying to break down and dissolve the medication.

The main way to avoid nausea is to take the medication with food - and in some cases, a decent amount of food.

Some widespread advice is to take medications with milk because milk is a base to counteract the stomach acid.  Unfortunately, the calcium in milk and cause certain antibiotics to not work.  Also, some medications require acid to be activated, so making the stomach more basic, reduces the effectiveness of them.

Certain injectable medications for Type 2 Diabetes have a main side effect of nausea or indigestion.  With these medications, the patients are encouraged to keep taking them.  The logic behind this:  in most cases, someone with Type 2 Diabetes will be overweight.  And they may have been resistant to the lifestyle changes (i.e. diet and exercise) that would help improve their weight, thus also improving the diabetes outcomes.  So, if they take a medication that causes nausea thus reducing their appetite, it helps them limit their food intake, and the final results will most likely be weight loss.

  • Diarrhea can be caused by
    1. Antibiotics - they kill the bad bacteria that are making you sick, but also your good bacteria
      1. Take probiotics or eat live culture yogurt (the more diverse the better)
    2. Certain cholesterol medications - particularly, the ones that help trap up the fat in your intestines so it's not absorbed and add it to your waste that is about to exit.  Fat is an oil... oil is slippery... poo that is slippery.... you get the idea.
      1. The less fat you eat, the less slippery things will be.
    3. Metformin - causes diarrhea in the beginning while the body is adjusting to it.  Diarrhea that lasts a month sounds like forever, but is really not compared to the amount of time (aka the rest of your life) that someone may have to take this medication for Type 2 Diabetes.
      1. The best way to control this is to start this medication low and slow.

The best way to counteract long-term diarrhea issues from medications is to use bulking fiber.  They help absorb extra water and add solid substance to stool so it's firmer.

Dec 7, 2015

Who needs help falling asleep?  *raises hand*

WARNING: Do not mix any sleep aids with alcohol - compounded drowsiness, depressed breathing or depressed heart rate

  1.  Melatonin - the chemical your brain makes when it's dark.  Electronic light can interfere with your natural production of melatonin after the sun goes down.
  2. Valerian Root - claims to promote calming and relaxation
  3. 1st Generation Antihistamines - Diphenhydramine (Benadryl) or Doxylamine (Unisom; also in NyQuil).  They have natural drowsy side effect, so using for the purpose of that side effect is a common practice.
  4. Rozerem - stimulates melatonin production in your brain
  5. Hypnotics - Ambien (zolpidem), Lunesta (eszopiclone). They seduce your brain to sleep in an unnatural way, thus they have high risk side effects (vivid dreams, sleep driving/walking/eating) and a high risk of dependence.  The side effects are due to the fact that the medications may get you to a deeper level of sleep before the rest of your body is prepared.  Your body has a natural paralysis process to ensure you don't act out dreams in the REM cycle, but if your brain reaches REM before your body is paralyzed, you may do crazy things!
  6. Benzodiazepines - generic names end in -lam or -pam.  Also have a risk of dependence and side effects (mainly "hangover" effect).
  7. Tricyclic Antidepressants - a symptom of depression is sleeping too much, but insomnia can be a symptom of depression.  Also, insomnia can make you feel depressed - it's a vicious cycle.  In small doses, they work to help rebalance the brain chemicals and reset the sleep-wake cycle.

Use as natural a solution as possible that is effective.  Physiological and neurological issues can lead to chronic insomnia that is not corrected by the most natural solutions, thus pharmaceuticals are needed - and that's nothing to be ashamed of!

Sunlight stimulates your eyes and tells your brain to make serotonin.  When the light is gone, and that stimulation stops, serotonin stops and melatonin replaces it.  This is how we functioned and planned our days back in the "old days".

Summertime brings on long days and lots of sunlight.  Thus we may not sleep as long because the long daylight hours keep us awake.  But this can also be the issue in the winter and for people who experience SAD (Seasonal Affective Disorder) - the shorter daylight doesn't allow sufficient serotonin to be produced and we actually feel sad.

Analyzing your sleep patterns and knowing your options will allow you to have a productive conversation with your doctor - different medications are used depending on if you have trouble falling asleep or waking up halfway through sleep or both.

*Melatonin in nursing:  your natural melatonin gets in breast milk and is thought to help baby's sleep cycle (especially early on when baby's sleep-wake cycle may be backwards because that's how they rolled in the womb).  Thus, if your natural melatonin gets into breast milk, then supplemented melatonin will get there too.  The rationale is that if you're not sleeping (despite the exhaustion of having a new baby), then you may not be making enough natural melatonin.  If you're going to take melatonin while breastfeeding, LOW dose is key to ensure the excess isn't deposited in the breast milk to pass on to baby - 3 mg seems to be the highest recommended, and I agree.  PLEASE do your own research and discuss it with a medical professional you trust rather than just taking my word for it!*

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"Radio Martini" Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Dec 1, 2015

Sleep Hygiene: how conducive your night time and bedtime habits are for restful sleep on a regular basis

 

Your body performs important processes while you sleep.

 

Risk of disease is increased when you don’t get enough sleep.  Heart disease, diabetes, and stroke, just to name a few.

 

4 areas of sleep hygiene

- environment

     - dark (all of our light-emiting toys are bad for our sleep) - your body makes serotonin stimulated by light, and then melatonin when the light is gone.

     - cool - kind of like hibernation, gotta get past REM sleep because REM sleep is not restful sleep

 

- habits

     - no naps - recovery processes can be inefficient

     - exercise (vigorous exercise during the day; slow & calming exercise late at night)

     - getting adequate natural light - so your brain isn’t confused about which chemical it needs to make

     - consistent routine - your brain likes predictable patterns

 

- what you consume

     - stimulants - caffeine, nicotine

     - alcohol - initially makes you sleepy, but can disrupt sleep when the liver finishes processing it into sugar

     - large meals - can cause indigestion which can disrupt sleep

     - drastic dietary changes - fluctuating amounts of sugar in the blood stream or digestive discomfort

 

- mindset

     - bed is for sleep - not a place for work or studying or eating

     - avoid emotional stress - positive (i.e. excitement) or negative (i.e. anger)

 

CPAP machine - helps in sleep apnea, which is wear the body doesn’t get enough oxygen during sleep.  Oxygen is needed for all sorts of processes.  If the body can’t get the oxygen, then it probably isn’t using the nutrients and energy sources available, and it can lead to feeling awful, even after a night of sleep.

 

Nothing good comes from a lack of sleep.

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