Diabetes: When A Low Sugar Reading Is Too Low

By: Brittney Knass, PharmD Candidate, University of Pittsburgh 2016

Low blood sugar can be extremely scary for patients with diabetes or their caregivers because it can be very dangerous when it happens. Low blood sugar is defined by a blood glucose reading of less than 70, but symptoms of low blood sugar can still occur at levels greater than 70. Patients need to treat low blood sugar anytime they have symptoms of low blood sugar or anytime their level drops below 70. Levels less than 70 can be extremely dangerous because it can cause unconsciousness or even coma.

Some typical symptoms of low blood sugar include:

  • Shakiness
  • Sweating, chills
  • Confusion
  • Fast heartbeat
  • Lightheadedness or dizziness
  • Headache
  • Weakness or tiredness
  • Hunger or nausea
  • Tingling or numbness of the lips or tongue

Low blood sugar must be treated with something that will increase blood sugar levels quickly. It is recommended to treat an episode with 15-20 grams of glucose. Some examples of this include:

  • 4oz or half a cup of juice or regular soda (not diet)
  • 1 tablespoon of sugar, honey, or jelly
  • 2-3 pieces of hard candy
  • Glucose tablets or a gel tube can also be used according to the package instructions

Foods that do not raise blood sugar levels quickly include:

  • Chocolate
  • Peanut butter
  • Cheese
  • Crackers/bread
  • Sandwich

However, a half sandwich, peanut butter crackers, or small snack should  be eaten after an episode of low blood sugar has resolved to help keep the level stable above 70, if it is not time for the next meal. It is important for patients with diabetes to eat a consistent diet to help prevent episodes of low blood sugar.

Some medications may increase a diabetic’s risk of having a low blood sugar episode. Some of the medications include:

  • Insulin
  • Glyburide (Diabeta)
  • Glimepiride (Amaryl)
  • Glipizide (Glucotrol)
  • Repaglinide (Prandin)

These medications, especially insulins, are frequently used in diabetic patients. Just because they have a risk of causing low blood sugar does not mean they should be avoided or are unsafe. In fact they are very good at lowering blood sugar levels which means they are good at doing what they’re supposed to do. However, if you or someone you know takes these medications and has frequent episodes of low blood sugar readings, it may be a good idea to talk to their doctor or pharmacist.

Your local pharmacist is always an easily accessible resource to help answer any of your diabetic questions or concerns!

Multiple Sclerosis

By: Rebecca Miller Wise, MEd, PharmD, CGP, Director of Admissions and Asst. Professor of Pharmacy Practice, Lake Erie College of Osteopathic Medicine, School of Pharmacy

Multiple Sclerosis (MS) is a disease where the protective coverings of your nerves (known as myelin sheaths) are destroyed. The cause of MS is not completely known but researchers believe a combination of genetics plus triggers such as viruses or other environmental factors such as smoking or lack of sunlight may cause the immune system to attack its own body. Therefore it is considered to be an “auto-immune” disorder.

MS is usually first diagnosed between age 20 and 45. Childhood and late middle-age diagnoses of MS are rare. MS affects twice as many women as men, and people of Northern European decent are particularly at risk, but fortunately, 85% to 90% of patients with MS are expected to live just as long as their peers.

Every patient has a different journey through this disease so yours will be as unique as you are.

The most common Signs and symptoms of all forms of MS include (but are not limited to):

  • Loss of body control (usually arms and hands and/or legs and feet
  • Spasticity in the legs
  • Numbness, tingling or pins & needles sensations
  • Double vision
  • Bladder dysfunction
  • Constipation

The movement problems can dramatically affect your quality of life, so you may require assistance performing daily tasks.  Don’t be afraid to ask for help. Walking aids and driving ads can be valuable tools to help you be mobile and live a fuller life.

 There is currently no cure for MS. The drugs that are available are designed to shorten the lengths of attacks, decrease how often attacks occur, and provide relief to symptoms.  Thus far, there is very little research on how health care professionals can best treat older people with MS. New studies will provide a better understanding of this disease in the elderly and allow physicians and pharmacists to better select treatments to target the specific needs of MS patients as they age.  Different types of medicines are available to treat MS, but remember that there may be a lot of trial-and-error to determine what is the best fit for your unique set of issues.

Corticosteroids (IV methylprednisolone and oral prednisone)

  • for acute relapses and to shorten the duration of MS attacks

Beta Interferons (Avonex, Betaseron, Rebif, Extavia)

  • Reduce relapses by 33% and reduces inflammatory lesions by 50% to 80%

Glatiramer Acetate (Copaxone)

  • Mimics myelin and acts as a decoy
  • Recommended for patients who cannot tolerate beta interferons

Mitoxantrone (Novantrone)

  • Suppresses the parts of your immune system that can attack myelin

Natalizumab (Tysabri)

  • Prevent leukocytes from adhering to their receptors on myelins thus preventing attacks

Fingolimod (Gilenya), first orally administered drug for MS

  • Blocks the migration of lymphocytes from lymph nodes into the CNS

Dalfampridine (Ampyra)

  • Oral drug designed to improve walking in patients with MS
  • Blocks potassium channels on the surface of nerve fibers to improve conduction

Most MS patients also use other medications for symptom relief or alternative therapies.  These Symptomatic Treatments include muscle relaxers, anti-anxiety meds, and drugs for depression, bladder incontinence, fatigue, etc. depending on what you experience. Alternative Therapies include acupuncture, physical therapy, cold therapy, meditation, yoga, cannabis (regulations on medical use in PA still pending), and some herbals like cranberry, vitamin D, and fish oil.  All of these have varying results in different people.  Never start any of these without a complete discussion with your doctor and pharmacist.

In summary, MS is a condition that is unpredictable and varies from person to person but is always debilitating.  However, you can slow progression and manage symptoms with proper diet, exercise, and medication therapy management.  The best way to have a full life is to employ a good health care team that includes a physician, pharmacist, physical therapist, and dietitian, as well as anyone else specifically trained in how to help you address the unique health problems you face.

Diabetes: What You Need to Know About High Sugar Levels

By: Brittney Knass, PharmD Candidate, University of Pittsburgh 2016

Over 1 in 9 Americans have diabetes (in fact, Pennsylvanians are above the national average). By age 65, 1 in 4 develop diabetes – making it something you need to know about.

The Different Types of Diabetes:

There are two different types of diabetes, type 1 and type 2. Type 1 diabetes is typically diagnosed in childhood or young adulthood. In type 1 diabetic patients, their bodies are unable to produce insulin. When we eat, the glucose from our food goes into our bloodstream, and insulin takes this glucose from the bloodstream to our cells. It is so important for glucose to get to our cells because it is used as their source of energy and is necessary for our survival. Since patients with type 1 diabetes do not make insulin, they are treated with insulin injections.

In type 2 diabetes, patients are unable to properly use the insulin their body makes and they develop what is called insulin resistance. Patients with type 2 diabetes can be treated with medications that help their body make more insulin, help increase their body’s sensitivity to insulin, or they may also need insulin injections.

Elevated Blood Sugar:

Patients with diabetes have elevated blood glucose levels because the sugar from the foods they eat is unable to get to their cells for use. High blood sugar levels can be dangerous when left untreated for long periods of time because it affects the body’s cardiovascular, nervous, and immune system.

Patients who have high blood sugar levels that are untreated are at risk of developing:

  • High blood pressure
  • Vision problems
  • Wounds and cuts that do not heal properly
  • Strokes
  • Nerve pain or eventual loss of feeling (most commonly begins in the feet)
  • A slowed digestive system, which can make eating undesirable and painful

Some symptoms of high blood sugar are:

  • Increased thirst
  • Increased urination
  • Feeling very hungry
  • Extreme tiredness
  • Blurry vision

Blood sugar levels are typically treated with medications or insulin therapy to help keep the morning, or fasting blood glucose, level less than 130 and random blood glucose levels less than 180. An A1c value is also monitored by getting a lab blood draw and many patients have a goal A1c of less than 7%. It is important for diabetics to maintain their blood glucose levels near their goal levels because it helps reduce their risk of developing the feared complications of diabetes. It is important for patients with diabetes to talk with their doctor about specific blood glucose goals because they vary slightly from patient to patient.

Stay tuned for another blog post covering what you need to know about low blood sugar in diabetes! But if you have any questions about diabetic supplies or medications, or need help managing blood sugar levels, your local pharmacist is always available to help!

 

 

Don’t Get Burned This Summer!

By: Christine Trusky, PharmD

Basking in the rays of the summer sun and achieving that golden tan is not all that it is cracked up to be.  Skin cancer is the most commonly diagnosed cancer in the United States.  It may be wiser to stay on the safe side and protect yourself by avoiding those rays from the summer sun.  Despite the efforts to increase awareness, and to decrease risk factors such as inadequate sun protection and intentional tanning, skin cancer rates (including melanoma) have continued to rise in the United States and worldwide. The two most common types of skin cancer are basal and squamous cell carcinomas. These types of cancer are highly curable, but can be costly and physically disfiguring. While, the third most common type of skin cancer, called melanoma, is more dangerous and is responsible for the most deaths.

The most preventable cause of skin cancer is ultra-violet (UV) light which comes from the sun or indoor tanning beds. UV rays can damage your skin in as little as 15 minutes. The National Weather Service and the Environmental Protection Agency developed the UV Index to forecast the risk of overexposure to UV rays. The UV Index lets you know how much caution you should take when working, playing, or exercising outdoors. This index predicts exposure levels on a scale of 1 to 15, where the higher the number, the higher the risk of exposure.

Follow these recommendations to help decrease your exposure:

Shade

  • Seek shade under an umbrella, tree, or other shelter before you need relief from the sun.
  • You should also wear sunscreen or wear protective clothing when you’re outside, even if you’re in the shade.

Clothing

  • Long sleeved shirts and long pants or skirts provide protection from UV rays
  • Tightly woven fabrics offer the most protection
  • A dry t-shirt offers more protection than a wet t-shirt
  • Dark colors offer more protection than light colors
  • A typical t-shirt has an SPF rating less than 15, so use other types of protection as well

Hat

  • Wear a hat with a brim all the way around that shades your face, ears, and the back of your neck
  • Tightly woven fabrics are best
  • Avoid straw hats with holes that let sunlight through
  • If wearing a baseball cap, protect your ears and the back of your neck with clothing that covers those areas, or by using sunscreen with at least SPF 15

Sunglasses

  • Protect your eyes from UV rays and reduce the risk of cataracts
  • Protect the tender skin around your eyes
  • Sunglasses that block both UVA and UVB rays offer the best protection

Sunscreen

  • Apply broad spectrum sunscreen with at least SPF 15 before going outside, even if it is slightly cloudy or cool
  • Apply a thick layer to all parts of exposed skin
  • Sunscreen works best in combination with the other listed options to prevent UV exposure.

Specifically, sunscreens work by absorbing, reflecting, or scattering sunlight. They contain chemicals that interact with the skin to protect it from UV rays. All sunscreens are not equal.  All products do not have the same ingredients. If you have a reaction to one product, tell your doctor, and try another product. Sunscreens have a sun protection factor (SPF) that rates their effectiveness in blocking UV rays. Choose one with at least SPF 15. Sunscreen wears off, so it is important to reply if you are out in the sun for more than two hours. Also reapply after swimming, sweating, or toweling off. Be sure to check your sunscreens expiration date to ensure that its ingredients are still active. Some makeup and lip balms contain the same chemicals used in sunscreen. If they do not have at least SPF 15 add on the suggestions above to ensure full protection.

Be sure to keep these helpful tips in mind to protect yourself from the sun this summer!

Naloxone

By: Zach Hicks, PharmD Candidate, University of Pittsburgh 2016

According to the Centers for Disease Control and Prevention, 44 people die from an opioid related overdose in the United States every day.  Furthermore, this rising public health crisis affects 1 in 4 Pennsylvania families!  Lawmakers from all over the country have been working hard to develop policies and regulations to combat the growing opioid epidemic in a timely and effective manner.  In October 2015, a standing order was issued that allows for the dispensing of naloxone without a prescription in Pennsylvania.

Naloxone – an opioid antagonist – binds to opioid “pain” receptors and can reverse or block the effects of opioids such as heroin and oxycodone.  Opioids have the potential to fatally suppress the respiratory system.  Naloxone reverses these effects, and quickly restores normal respiration to the person whose breathing has slowed or stopped.  Emergency rescue personnel typically have access to naloxone, but unfortunately are not always able to arrive in time to administer the life-saving medication.  By allowing any individual in Pennsylvania to obtain naloxone at a pharmacy without a prescription, the standing order increases access of the drug to any member of the community including family and friends of a person at risk of an opioid related overdose.

The Pennsylvania Naloxone standing order allows for the purchase of naloxone in two formulations: pre-filled syringes for nasal administration, or an auto-injector device for intramuscular administration.  It is always important to be counseled by a pharmacist.  If you are worried about a potential overdose for yourself or are a loved one/caregiver for somebody at risk, you can go to your local pharmacy and request this life-saving medication.  At this time, you will be counseled on how to identify signs of an opioid overdose, calling 911, proper administration of the naloxone, and rescue breathing.

Naloxone is a life-saving drug that can be used on the frontlines to fight against the opioid overdose epidemic within our communities.  It is important to raise awareness of the increased naloxone access – primarily to at-risk individuals and their loved ones.

Over the Counter Medications: What To Do When You Are Pregnant Or Breastfeeding

By: Brittney Knass, PharmD Candidate, University of Pittsburgh 2016

Women, during pregnancy or lactation you may experience a flood of different emotions, but fear of harming your baby due to over the counter medication use should not be one of them. Unfortunately, our bodies are not always in perfect health during this time and you may experience a variety of different symptoms from the common cold, to nausea, heartburn, pain or constipation. There are many dietary and lifestyle changes you can make to help relieve some of your symptoms, but when you decide a medication is necessary how will you know which one is the safest?

Here is a list of common symptoms you may experience while pregnant or breast feeding and some tips for safely managing them:

Pain/fever

  • Apply ice or heat to the painful area
  • Use topical pain relieving creams or gels
  • Tylenol (acetaminophen) can be used safely but should be used for the shortest time period possible
  • Anti-inflammatories (Ex: Advil or ibuprofen, Aleve or naproxen) SHOULD NOT be used at all during the third trimester, but can be used during breastfeeding

Constipation

  • Increase your intake of dietary fiber, which can be found in many foods such as: oatmeal, whole grains, fruits, green leafy vegetables, nuts or prunes/prune juice
  • Increase the amount of water you drink
  • Bulk forming laxatives like Metamucil, FiberCon, or Citrucel may be used when needed

Diarrhea

  • Drink lots of fluids to help prevent dehydration (recommended that you drink 1 cup (8oz) of fluids for each loose stool that you have)
  • Eating bananas, toast, rice, or applesauce may help decrease your number of episodes of diarrhea

Heartburn/Acid Reflux

  • Try to avoid foods that worsen your symptoms (commonly: spicy foods, chocolate, coffee, tomato based foods, citrus fruits, garlic and onions)
  • Try to avoid eating before lying down or try sleeping with your head slightly elevated
  • Antacids (Ex: Tums or calcium carbonate products) may be used as needed

Nausea/Vomiting

  • Try eating small, frequent meals that contain bland foods
  • Ginger or ginger ale may help relieve symptoms
  • Vitamin B-6 (pyridoxine) 25mg every 6-8 hours has been shown to provide some relief of symptoms
  • Antihistamines like doxylamine 25mg daily or dimenhydrinate 50mg every 4-6 hours may be used in pregnancy
    • It is always good to double check with your pharmacist about the safest dose of these medications for you!
    • These medications should be avoided in breastfeeding due to the potential to cause drowsiness in your baby and may decrease your milk production

Common Cold

  • Rest and drink lots of fluids
  • Drink hot tea or use a humidifier
  • Nasal saline is the recommended product to help relieve sinus congestion
  • Decongestants should be avoided in lactation because they may decrease milk production

If you are experiencing any symptoms that you are not sure how to properly manage you can always talk to your pharmacist. They know all of the over the counter products that can be safely used in pregnancy and lactation and can help you choose the best treatment option for your symptoms!

Blood Pressure: “The Silent Killer”

By: Neil Turco, PharmD Candidate, University of Pittsburgh 2016

High blood pressure, also known as hypertension, is a very common chronic disease. The CDC estimates that 1 out of every 3 adult Americans (70 million people) has high blood pressure, yet only half of those people have it under control. This disease is known as “The Silent Killer” since there are no symptoms, though some patients with very high blood pressure may experience headaches or vision changes. The only way to know if you have high blood pressure is to get your blood pressure checked. The consequences of uncontrolled high blood pressure include heart disease and stroke.

So what is blood pressure, and what is high blood pressure? Blood pressure is the pressure of the blood as it flows through your vessels. Having high blood pressure makes it harder for blood to be pumped in your body, so your heart has to work harder, and can become worn out over time. A normal blood pressure is less than 120/80 mmHg, and high blood pressure is greater than 140/90 mmHg.

What causes high blood pressure? For most patients, the cause is unknown, and is a combination of genetic and environmental factors. Risk factors include older age, obesity, family history of high blood pressure, smoking, physical inactivity, and others. Some medications can contribute to high blood pressure.  A common cause is NSAIDs, which are over-the-counter medications used to treat pain and inflammation. Decongestants such as pseudoephedrine can also elevate blood pressure. Talk to your pharmacist about your medications and blood pressure.

How do we treat high blood pressure? If a healthy diet, exercise, and avoiding smoking are not enough to keep your blood pressure in range, then blood pressure medications can help to lower your blood pressure. These medications work in different ways, but include diuretics (“water pills”) such as furosemide or hydrochlorothiazide (abbreviated HCTZ or HCT) that remove fluid to lower the pressure, ACE-inhibitors such as lisinopril or enalapril that work in the kidney to lower blood pressure, calcium channel blockers such as amlodipine or diltiazem that widen the blood vessels, and others. Most patients will require more than one blood pressure medication to achieve good blood pressure control (since the body has multiple ways of controlling blood pressure). Physicians and pharmacists select blood pressure medicines based on your other medical conditions.  Side effects of blood pressure medications vary, but if your blood pressure is low, you can feel dizzy or lightheaded.

If you have been diagnosed with high blood pressure, your doctor will set a blood pressure goal for you. Your blood pressure goal depends on factors such as your age and some disease states including diabetes and chronic kidney disease. Talk to your doctor to see what your blood pressure should be.

Have further questions about blood pressure or blood pressure medicines? Stop in to a pharmacy to have your blood pressure checked and talk with the pharmacist.

Shingles

By: Rebecca Miller Wise, MEd, PharmD, CGP, Director of Admissions and Asst. Professor of Pharmacy Practice, Lake Erie College of Osteopathic Medicine, School of Pharmacy

Shingles – this name comes from the French word for belt, and is use to describe this condition because of the typical band of rash around the trunk of the body.

It is caused by the varicella-zoster virus. This is the same virus that causes chickenpox. After you have had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles. While the doctor can often diagnose shingles based on the telltale signs and symptoms alone, he can also take samples from you and test for the varicella-zoster virus if necessary.

The symptoms of shingles include: Pain, burning, itching, numbness or tingling that is sensitive to touch.  A red rash often begins a few days after the pain, commonly developing as stripes of blisters that wrap around your upper body. It can even occur around the eye, neck, or face. Fluid-filled blisters may occur and break open and crust over. Some people may also experience a fever, headache, sensitivity to light, and tiredness.

Although not a life-threatening condition, shingles can be very painful. Vaccines can help reduce the risk of shingles, while early treatment can help shorten a shingles infection and lessen the chance of complications. Shingles is quite contagious toward people who have never had chicken-pox or a chicken-pox vaccine (generally infants and children).  However, it is not contagious otherwise. This means that if you have shingles, you will not “spread” the disease to most people.  Additionally, the virus is contained in the liquid of the blisters so it is not contagious once any blisters have crusted over.  However, to be safe, you should cover the sores and wash hands often with plenty of soap and water.

If you think you might have shingles, see the doctor if: you have a rash or blemish that is acutely painful, widespread, or around the eye because it may lead to permanent issues; or you or someone around you has a weakened immune system. The doctor may order some prescription medications to help treat the symptoms of shingles.

To speed healing and reduce the risk of problems, you may be given an antiviral such as: Acyclovir (Zovirax), Valacyclovir (Valtrex), or Famciclovir (Famvir).  For these medications, the common side effects are weakness, nausea, vomiting, rash, headache, and nose or throat infection. These are also associated with agitation, dizziness, and abdominal pain.

For severe pain and symptomatic relief, the doctor may also prescribe or suggest:

  • Capsaicin or Silvadene cream: which may cause a burning and itching and should be applied with gloves with hand washing after use.
  • Solarcaine: numbing agent with lidocaine
  • Hydrocortisone cream: may cause itching and pigment change.
  • Gabapentin (Neurontin) or amitriptyline: prescription treatments for neuropathic pain

Some lifestyle remedies would be to reduce stress as much as possible and to take a cool bath or use a wet compress on your blisters to help relieve the pain and itching.

The shingles vaccine (Zostavax) is recommended for persons 60 years or older by the CDC but can be given to anyone over the age of 50; consult your doctor and/or pharmacist to determine what is best for you.  The vaccine only prevents shingles, and so cannot be used to treat and will not always prevent shingles from occurring. It will, however, reduce the severity of an episode – both with a shorter duration, and with milder symptoms.

You cannot have the vaccine if you have an immune compromised condition such as HIV, leukemia, lymphoma or other active cancers, using chemotherapy or other immune suppressing therapy, or have tuberculosis.

For this vaccine, the common side effects from the vaccine will be redness, warmth, swelling, and pain around the site of injection. Other side effects associated with the vaccine are flu like symptoms, headache, and upper respiratory tract infection.

Make sure to talk to your doctor and/or pharmacist about your other medications including, over the counter, and herbal supplements to ensure there will be no drug interactions.

Did you know your pharmacist is not considered a “healthcare provider?”

By: Rachel von Vital, Pharm D Candidate, Temple University School of Pharmacy Class of 2017

It may surprise you to hear that your local pharmacist is not be considered a “healthcare provider,” when it comes to the federal Medicare and Medicaid based programs.  That pharmacist who dispenses your vital medications and gives your annual flu shot is not recognized as a healthcare provider under federal law.  With the recent momentum surrounding the term “Provider Status,” however, pharmacists may soon gain the recognition they deserve.

What is Provider Status?

The term resurfaced when H.R. 592/S. 314, known as The Pharmacy and Medically Underserved Areas Enhancement Act, was introduced into Congress in 2015. This act is an amendment to the Medicare Bill which if passed, would enable Medicare Part B recipients in medically underserved areas to utilize their local pharmacist as a resource for healthcare services. In other words, it would enable pharmacists to finally be considered providers within federal Medicare and Medicaid programs.

With this new amendment implemented, patients in areas with limited access to healthcare could go to their corner community pharmacy and receive medication management services, a broad term used to encompass many services that may be provided by pharmacists but for which compensation as a provider is not available. Some of these services include a thorough review of patients’ medications, disease management coaching and support, administration of immunizations, and health and wellness services such as smoking cessation counseling and nutritional planning. Pharmacists would also be able to provide and screenings for common disease states such as diabetes, asthma, and cardiovascular disease and potentially be paid under Medicare Part B.

How does this bill affect me?

Health care spending in the US has dramatically increased over the past decade, burdening our economy and our pockets. Much of this debt is related to poor disease management and lack of preventative health measures. Take note of these statistics:

  • The US spends almost $300 billion dollars annually on medication problems, including problems related to patients not taking their medications appropriately, or at all
  • Chronic disease states account for $1.7 trillion of healthcare expenditure
  • 45% of Americans suffer from at least one chronic disease state
  • Almost 50% of the people who are prescribed medications for chronic disease states do not take their medication correctly

Health care expenditure accounts for an enormous part of our nation’s debt but many of these costs can easily be reduced by providing preventative care. Limited access to sufficient healthcare services like patient education, in combination with the decreasing number of Primary Care Providers has resulted in countless patients finding themselves alone in their road to recovery. There is one solution, however, that would simultaneously decrease the nation’s healthcare burden and improve patient health outcomes. That is the increased involvement and utilization of pharmacists in healthcare.

Pharmacists are perfectly suited to serve as the link between patients and the healthcare system. Pharmacists are Doctors of Pharmacy, trained in various aspects of pharmaceutical science including pharmacology, medicinal chemistry, and drug therapy with much of their curriculum focusing on the management of chronic diseases. With the required clinical training and certifications in specialty areas, pharmacists possess valuable expertise in medication therapy management. In 47 out of 50 states, including Pennsylvania, pharmacists are authorized to enter into collaborative practice agreements with prescribers, allowing them to exercise their clinical training by making direct interventions to patient medication regimens, improving patient outcomes and reducing healthcare costs.

Studies show that when pharmacists are involved in the management of their patient’s own health, health outcomes improve. Take for example the Asheville Project, launched in 1997 by the City of Asheville, North Carolina. The purpose of this project was to provide education and attention to city employees suffering from chronic disease states such as diabetes, hypertension, and high cholesterol. Employees with these conditions received intensive education about their diseases from the Mission- St. Joseph’s Diabetes and Health Education Center. They were also appointed a community pharmacist, who made certain that they were taking their medications correctly to ensure optimal outcomes. The results of the project showed that through education and the patient care services provided by pharmacists, patients experienced improved blood sugar levels, fewer sick days, lower total healthcare costs, and increased patient satisfaction.

With the passing of H.R. 592/S.314, services and outcomes such as these could be made possible for the millions of Medicare Part B recipients suffering from chronic diseases. By recognizing pharmacists as integral members of the healthcare team, patient health improves, healthcare costs are reduced, and society benefits.  Everyone wins when pharmacists are recognized as healthcare providers in Medicare.

What can you do to help?

There are several ways in which you can support the passing of this bill. You can:

  • Pledge your support by joining the campaign at pharmacistsprovidecare.com and signing the petition
  • Take action by contacting your federal congressmen. You can send prewritten electronic letters directly to your congressman at pharmacistsprovidecare.com.
  • Tell your friends, family, anyone with whom you interact. The more the public is aware of this issue, the more support we can get from our representatives in Congress!

Remember, healthcare affects all of us. Help your nation become happier and healthier with pharmacists by your side.

References:

  1. http://www.pharmacistsprovidecare.com/facts
  2. http://www.pharmacist.com/medication-therapy-management-services
  3. http://www.aphafoundation.org/asheville-project

What’s all the Buzz about Zika?

By Michelle Myers, PharmD Candidate, University of Pittsburgh School of Pharmacy Class of 2016

One afternoon in mid-January, sitting across from my grandmother at one of our favorite lunch spots in Pittsburgh, I heard the first rumblings of the Zika virus. There was that comfortable silence that comes only when you’re both happily chewing your first bite of food and then “So, they’ve taught you all about that Zika virus haven’t they?” By “they” she meant my pharmacy school. You see, my grandmother, who I’m proud to say is turning eighty in April, has a love for the news and day-time TV that is matched only by her excitement to share both with me, her oldest granddaughter and soon-to-be pharmacist. So naturally, I was not surprised when the latest health news story pulled up a seat at our table. What did surprise me, though, was my response: “No, I haven’t heard. What’s the Zika virus?” She smiled at the opportunity to teach me a thing or two. I thought back to my infectious disease class and recounted every virus, every bug, every infection I’d ever learned: no Zika. So I wondered about this Zika virus – what it was, where it came from – and how its story came to join us for lunch in Pittsburgh, Pennsylvania.

There’s a good reason why I never learned about the Zika virus. Prior to May 2015, Zika was limited to Africa, Southeast Asia, and the Pacific Islands. In recent years, there have been outbreaks in Pacific Yap (2007) and French Polynesia (2013), but never in the Americas. However, while the virus was evading US media spotlight, it was also traveling.

The Zika virus is an infection carried by the Aedes mosquito. There are several different species of Aedes, but the two responsible for the Zika epidemic in Brazil are Aedes aegypti (“yellow fever mosquito”) and Aedes albopictus (“Asian tiger mosquito”). These are the same mosquitoes that carry yellow fever, dengue and chikungunya viruses. The yellow fever mosquito lives near people in urban areas, both inside and outside. The Asian tiger mosquito lives in forested areas and gardens, and has been dubbed the most invasive mosquito species in the world. Both species of Aedes prefer tropical and subtropical regions, and lay their eggs in shallow water-holding containers such as flowerpots, plants, tree holes, toilets and used tires. So nearly 5,000 suspected cases, 28 South American countries, and three US territories later (Puerto Rico, US Virgin Islands and American Samoa), what brought these mosquitoes to Brazil? Trade – primarily tire trade.

Both species of Aedes mosquito can be found in the continental United States, although their distribution is largely limited to the southeast and small sections of the southwest. As of March 9, 2016 however, there has not been a single “local” case of Zika virus contracted from a mosquito in the US. In other words, to our knowledge, the mosquitoes here in the States are not infected with the Zika virus. With the exception of US territories, where there have been 173 Zika cases from locally infected mosquitoes, US residents have only become infected during travel to tropical regions (Mexico, the Caribbean, Central and South America, and the Pacific Islands). To date, there have been 193 travel-associated cases in the US.

There are three main ways to become infected with the Zika virus. The first is to be bitten by an infected Aedes mosquito. Peak biting time is at dawn and dusk.  The second way to become infected is through sexual contact with an infected male partner, of which the number of cases continues to increase.  Symptoms develop a few days after being bitten and are surprisingly mild, including slight fever and rash, conjunctivitis (pink eye), muscle or joint pain, and general fatigue or feeling unwell. Symptoms usually last one week or less, which is about as long as the virus remains in your blood. In rare cases, infection with Zika virus has been linked to Guillain Barré syndrome, an autoimmune condition by which the immune system attacks the nerves.

“Oh it’s just terrible! Mothers are passing it on to their newborn babies.” Unfortunately, my grandmother was right. A Zika virus infection in a normal, healthy adult is rather unimpressive; in fact, in 80% of cases people don’t even know they have it. The problem is that serious complications arise when a mother becomes infected during pregnancy and transmits the virus via shared blood to her unborn child, our third and final route of Zika infection. On November 28, 2015, the Ministry of Health of Brazil announced that as cases of microcephaly (a birth defect of the brain) in newborn babies had been increasing in northeast Brazil, so were cases of Zika virus infection. It has not been one hundred percent confirmed that Zika virus causes this rare birth defect, but researchers are currently investigating.

During pregnancy, a baby’s head grows to make room for the growing brain. In cases of microcephaly, the brain stops growing, therefore the baby’s head stops growing, resulting in a smaller than normal head circumference at birth. Complications of microcephaly include seizures, developmental delay, intellectual disability, movement or balance problems, feeding problems, hearing loss and vision problems. According to recent research, an unborn child is at greatest risk for microcephaly when the mother is infected with Zika virus during the first trimester of pregnancy. Once the virus is cleared from the mother’s bloodstream, which as we discussed takes about one week, the virus should not affect future pregnancies.

There is not currently a vaccine for Zika virus. Therefore, the best and only way to prevent Zika virus infection is to avoid travel to tropical and subtropical regions while you (or your partner) are pregnant or trying to become pregnant. For others traveling to these regions, you should take extra precautions to prevent mosquito bites: (1) use insect repellent that contains DEET, picaridin, oil of lemon eucalyptus (OLE), para-methane-diol (PMD) or IR3535 for longer-lasting protection, and follow product directions for applying and regularly reapplying, (2) wear long-sleeved pants, shirts and hats, especially during the hours of dawn and dusk, (3) stay or sleep in screened-in, air conditioned rooms, using a bed net if exposed to outdoors, and (4) apply permethrin-containing insect repellent to clothing, shoes, bed nets and tents (but not directly to skin) to continue to repel mosquitoes even after several washings.

If you think you have been infected by the Zika virus, seek medical attention from your doctor and be sure to let him or her know of any recent travel. There is a blood test coordinated by the PA Department of Health that can be used to confirm whether you have been infected with Zika virus. However, results may take time, as samples must be routed to the Centers for Disease Control and Prevention (CDC). As of March 7, 2016, there have been six blood-test confirmed travel cases of Zika virus in the state of PA and there are currently 211 blood tests pending.

I walked my grandmother up the stairs of the two-story home where she has lived for fifty years. “See you next Tuesday!” I called as she kicked up her feet at the kitchen table and flipped to the 5 o’clock news on her little white TV next to the sink. As I closed the front door and smiled to myself, I wondered about the next big news story my grandmother would hear, and how next time I would be better prepared.