Guide To Over-The-Counter Cough Relief

Man Coughing
By: Christopher Petersen, University of Iowa College of Pharmacy, 2018 PharmD. Candidate

A cough is an important reflex for your body’s natural way to get mucus and other foreign material out of the lungs. Cough is the most common symptom for which people seek medical care and Americans spend more money annually on over-the-counter (OTC) cough and cold products than any other category of OTC products.

Selecting The Appropriate OTC Cough Medication:

With so many OTC cough medications; choosing the drug that is best for you depends on the nature and cause of the cough. There are typically two different kinds of coughs; one is described as wet because with this type of cough mucus is coughed up. Clear mucus is often indicative of bronchitis where colored mucus may suggest a bacterial infection. The other kind of a cough is described as dry or hacking. Dry coughs may be associated with viral infections, acid reflux, heart disease, and can be a potential side effect from other medications.

Wet Cough Recommendations: Guaifenesin

Brand: Mucinex, Robitussin Mucus + Chest Congestion

Guaifenesin is a protussive (expectorant) that works by changing the texture of the mucus in the lungs and it increases the amount of mucus removed by coughing.

Dry Cough Recommendations: Dextromethorphan

Brand: DayQuil Cough, Delysm 12 Hour Cough, Robitussin Long-Acting Cough Gels

Dextromethorphan is an antitussive (cough suppressant). These work to control or stop the cough by decreasing the likelihood of coughing. Stopping a wet cough may lead to a bacterial infection since the bacteria remains in the lungs.

Nonproductive Cough Recommendations: (First-Generation Antihistamines)

Brand: Benadryl (diphenhydramine), Chlor-Trimeton (chlorpheniramine)

Many people do not think to use antihistamines for cough relief. Antihistamines are relatively low cost medications that work by increasing the tolerance for not coughing. They are most often used for deceasing coughs associated with a runny nose or allergies. Mucus running down the back of the throat from the nose is often the cause the cough. The drying effects of antihistamines decrease the mucus in the nose and therefore it is less likely for one to cough.

Combination Products: Dextromethorphan and Guaifenesin

Brand: Robitussin Cough + Chest Congestion DM, Mucinex-DM, DayQuil Mucus Control

Recommendations for dextromethorphan and guaifenesin in combination are debated among medical professionals. Some say that using dextromethorphan will suppress the cough and therefore one will not cough up the mucus. This may get rid of the beneficial effects of guaifenesin. Others say that dextromethorphan will decrease the urge to cough and therefore reduce the amount of coughing; when one does cough the guaifenesin will work to increase the amount of mucus coughed up.

Multi-Symptom Combination Products:

Brand: (DayQuil/NyQuil, Robitussin Multi-Symptom Cold, Tylenol Cold + Flu, Mucinex Multi-Symptom Cold & Fever, Advil Cold & Flu, Alka-Seltzer Plus Flu)

 These products often contain similar active ingredients including an analgesic (pain medication), cough suppressant, nasal decongestant, and an antihistamine. These products have been marketed very well and may seem convenient. Combination products can potentially lead to drug interactions, side effects, and may worsen certain medical conditions. More active ingredients in a product means that you have more potential for side effects. It is recommended to select the product with only the ingredients that are necessary to treat your symptoms. Ask your pharmacist what product may be best for you if you are unsure of what the ingredients in a product.

Dosage Formulations: Liquid, Tablet, Capsule etc.

Cough products are available in a variety of dosage formulations and all have similar effects. It is generally recommended that you select the dosage formulation that is most convenient for you. Ask your pharmacist if the product you are looking for is available in the dosage form that you prefer.

What Else Can I Do?

Drinking water soothes the throat, loosen mucus, and helps prevent dehydration. Using cough drops may reduce coughing by relieving throat irritation. Humidifiers increase the moisture in the air, which may decrease airway irritation. Humidifiers work well for babies and young children (< 6 years of age) as cough medications have not been proven to be effective in this population. Mucus in the nose may be the cause of the cough in babies and a nasal bulb may be used to clear their mucus.

When To Seek Further Medical Attention:

  1. Cough that lasts longer than 7 days or keeps coming back
  2. Children < 4 years old
  3. Cough that produces colored mucus or blood
  4. Cough that may be a side effect of a certain class of medication (angiotensin converting enzyme inhibitors: lisinopril, enalapril, benazepril, captopril)
  5. Cough that is accompanied by a fever >102
  6. Cough associated with a chronic medical condition, such as COPD, asthma, heart failure, or chronic bronchitis
  7. Cough that worsens as a cold or flu resolves
  8. Cough associated with breathing in dust or particles
Tietze, K. J. (2015). Chapter 12: Cough. In Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 18th Edition. Washington, District of Columbia: American Pharmacists Association. doi:10.21019/9781582122250.ch12

Ask Your Pharmacist: Should I take Advil or Tylenol for pain?


Pain is one of the most common symptoms that people seek to relieve by self-treating with over-the-counter (OTC) products. Pain is also a symptom that causes many people seek further medical attention. You may ask yourself, should I go to the doctor or can I take an over-the-counter pain medication?

Before you decide to take medication to relieve your pain, check this list to determine if going to the doctor for further evaluation is appropriate.

Seek Medical Attention If You:

  1. Have severe pain (pain of ≥6/10 on the pain scale)
  2. Have pain that lasts 10 days or more
  3. Have pain that continues despite 7 days of the use of a topical (cream, ointment, gel) pain reliever
  4. Notice an increased intensity or change in character of the pain
  5. Have pelvic or abdominal pain (other than menstrual pain or cramps)
  6. Also have nausea, vomiting, fever, or other signs of infection or disorder
  7. Have a visually deformed joint, abnormal movement, weakness in any limb, numbness or suspected fracture
  8. Are pregnant
  9. Are looking to treat pain in someone <2 years of age


There are only a few brands, but many generic OTC pain relievers. The following is a chart to help you determine which products have the same active ingredients. Ask your pharmacist what generic pain reliever is equivalent to the brand that you are familiar with and if that product is appropriate for you.

Brand ($$$) Generic ($)
Tylenol Acetaminophen
Advil, Motrin Ibuprofen
Aleve Naproxen

Acetaminophen is the most commonly used pain reliever in the world. It may be a good choice to treat headaches, arthritis pain, and fever. Acetaminophen is typically safe for healthy individuals when taken in small to moderate doses. In large doses acetaminophen can lead to liver failure or death.

Ibuprofen and naproxen are medications from the same class that are used to treat pain and swelling/inflammation. For example, menstrual cramps, headaches, toothaches, backaches, arthritis, muscle sprains, and gout are all short-term medical conditions that are associated with pain and swelling that can be reduced by ibuprofen and naproxen.

Ibuprofen and naproxen should be used for the shortest amount of time and at lowest dose possible to provide pain relief. Long-term use may lead to heart issues, high blood pressure, stomach/ intestinal bleeding and kidney damage.

Many people think that these pain medications are completely so they commonly used without recognizing the potential risks. Generally, they are safe to use, but not for everyone. You should consult your pharmacist when selecting an over-the-counter pain medication if you are taking one of the following medications or if you have one of the following medical conditions in order to avoid drug interactions or complications to your medical condition.

When to Avoid Ibuprofen or Naproxen:
Medical Condition Also Taking
·      High Blood Pressure
·      Kidney Disease
·      Heart Failure
·      After a Heart Attack
·      Stomach Ulcers
·      Asthma
·      Over 65 years of age
·   ACE inhibitors: (lisinopril, enalapril, benazepril)
·   ARB: (losartan, olmesartan)
·   Beta Blockers: (metoprolol, bisoprolol, carvedilol, atenolol)
·   Diuretics: (hydrochlorothiazide [HCTZ], chlorithalidone, triamterene)
·   Anticoagulants: (warfarin, Xarelto, Eliquis, Pradaxa, Saavaysa)
·   phenytoin
·   alendronate
·   digoxin
·   methotrexateAny other prescription NSAID: (meloxicam, piroxicam, diclofenac, celecoxib) Use caution if you also taking aspirin
When to Avoid Acetaminophen:
Medical Condition Also Taking

·      Liver Disease
·      Alcoholism

·   warfarin
·   ≥3 alcoholic drinks/day
·   Other medications containing acetaminophen:
Ø  Common ingredient in OTC sleep aids and cough/cold products
Ø  Ingredient in many prescription pain medications (opioids)
Any other medication containing acetaminophen – the maximum total daily dose of acetaminophen from all medications is 4000 mg 
   *The list of medical conditions and medications above is not a complete list. You should talk to your pharmacist about other any questions or concerns regarding this list.*




E-cigarettes – What You Need to Know

by: Cole McKenzie, University of Iowa College of Pharmacy, Class of 2018

E-cigarettes entered the market in the United States back in 2006 and their use has dramatically increased over the years.  The many uncertainties question e-cigarettes safety and whether they help tobacco users stop smoking. There is question about long-term health effects as well as public health concerns about the effects e-cigarettes are having on smoking prevalence and access for adolescents.

What is an e-cigarette?

An e-cigarette consist of a refillable cartridge containing a liquid, an atomizer (vaporization chamber with a heating element), and a battery. When a user inhales an e-cigarette the atomizer heats the liquid which creates a vapor that duplicates tobacco smoke, but is not. As a result of how e-cigarettes work, “vaping” is a common term used to describe when an individual uses an e-cig.


©2017 UpToDate® E-cigarette

So what’s the problem with e-cigarettes?

Currently, the United States FDA is not regulating them, so consumers of e-cigarettes are unaware of what exactly they are inhaling. The main components found in the liquid of e-cigs are nicotine, propylene glycol or glycerol, and flavoring. Chemical analysis of products available in the US has shown inconsistency with the manufacturer’s package labeling. Some products said to be nicotine-free have been found to contain nicotine, whereas others that have claimed to have a specified amount ended up containing higher concentrations. Toxic metals such as tin, lead, nickel, and chromium have also been found in e-cigarette liquids.

Another area of public concern is that unlike conventional cigarettes, e-cigs are able to be sold with different flavorings. With over 7,000 flavors available it should come as no surprise that it appears e-cigarettes are attracting the youth, many of which who are not already smoking. Data and surveys predict that from 2011 to 2014, e-cigarette use in high school students has increased from 1.5 to 13.4 percent.

Surveys have shown that a majority of e-cigarette users are made up of current conventional smokers of cigarettes. This majority of users view e-cigarettes as a tool to help them quit conventional cigarettes or reduce their use. At this point e-cigarettes are still too new to the market to determine if they could be a useful tool for people trying to quit conventional cigarette smoking. There are also the additional health concerns of inhaling e-cigarette’s contents and their alarming rise of use among the adolescent population. It will be interesting to see whether e-cigarettes will continue to expand and whether congress will begin to push for more regulations.

National Immunization Month


August is National Immunization Awareness Month (NIAM). NIAM was established to highlight the importance of vaccination for people of all ages. Additionally, it was put in place to encourage people to ensure that they are up to date on the vaccines that are appropriate for their age. Vaccination is vitally important as it has helped eradicate and lower the severity of many diseases that once were a serious threat.

What is a vaccine?

The first vaccine was developed by Edward Jenner when he was able to help provide protection against smallpox by inoculating people with the cowpox virus. Since then, many more vaccines have been able to be developed, and as a result, many diseases have been eradicated. A vaccine is able to pass what is called active immunity to an individual, and they will be able to avoid contracting a disease. Some vaccines have dead forms of the virus or bacteria and others have low concentrations of the active virus. While most vaccines are given as shots, other vaccines have been made to be a flu mist or even as a solution that patients can drink.

Do vaccines cause autism?

No! In 1998, Andrew Wakefield published a study that established a link between MMR and autism, which received a lot of publicity and caused a lot of widespread concern. The study was poorly done, and a lot of other aspects of the published study were incorrectly attempted. The journal that published the article retracted the article, and Wakefield and all other involved with the study were guilty of several ethical violations. Since then, CDC has issued multiple statements stating that there is no link between vaccines and autism.

How do I figure out what vaccines I need?

First, obtain a record of your immunizations from your doctor. Additionally, the state usually keeps track of the immunizations that you have received as well through a program that pharmacies and providers can access. Once you have this information, you can discuss options that are appropriate for you with a pharmacist or other healthcare provider. The CDC has recommended schedules available online (see first link listed under additional resources).

What if I don’t see a doctor regularly? Where else can I receive vaccines?

Pharmacists are now able to administer all vaccines to patients over the age of 18 without a prescription. It may be a good idea to double check with your pharmacy to see if they have the vaccine you need in stock.

Additional Resources:

2017 Vaccine Schedules for Adults and Children:

CDC Vaccine Website:

National Immunization Awareness Month Page:


Obstructive Sleep Apnea: An Overview

By: Quinton Franklin, University of Iowa College of Pharmacy, Class of 2018.

Obstructive sleep apnea, otherwise known as OSA, is the most common sleep related breathing disorder with an estimated 26% of adults aged 30-70 having obstructive sleep apnea. Despite the large prevalence, an estimated 80% of moderate or severe OSA cases go undiagnosed. OSA can also have a large impact on your health, causing fatigue, impaired concentration, daytime sleepiness, increased blood pressure, severe gastric reflux, depression and irritability, brain damage, and even sudden death. Given the high prevalence, frequently missed diagnosis, and consequences of untreated OSA, it is important to be educated on OSA and how it is treated.

What is Obstructive sleep apnea?

Obstructive sleep apnea is a sleep disorder where the airway is completely blocked leading to a cessation of breathing. In OSA, loud snoring can be caused due to the increased effort needed to make air pass through the blocked airway and into the lungs. Complete airway obstruction can be due to the structure of the face, leading to components of the mouth such as the tongue, palate, and tonsils completely blocking the airway. The risk of OSA is increased in men, obesity, increasing age, abnormalities of the face and upper airway and those with a family history of OSA.


How do I know if I have obstructive sleep apnea?

Unfortunately, OSA does not have an easy and specific diagnostic test. If you suspect that you have OSA, or have symptoms such as waking in the night, excessive snoring or cessation of breathing reported by a partner, daytime sleepiness, wake to excessively dry mouth. or other signs of poor sleep, It is important to let your healthcare provider know. Depending on their decision you may be asked to participate in a sleep study, where you will be monitored overnight to check for the presence and frequency of blocked breathing during your sleep.

How is Obstructive sleep apnea treated?

Thankfully obstructive sleep apnea is easily treatable through a variety of methods. OSA can be treated through weight loss if needed, modifications to sleep posture, decreased sedative use, or by way of a continuous positive airway pressure device or CPAP.

What is a CPAP?

A CPAP helps to keep the airway open by way of pressure gradients, increasing the amount of air delivered to the lungs. For best results, it is important to find a CPAP mask that fits snug onto your face, and that is not too loose or tight and to use your CPAP daily. In addition, it is important to keep your CPAP clean and properly maintained, as dirty CPAP machines decrease effectiveness and can cause bacterial infection.


Here at NuCara we employ several respiratory therapists to help you select a CPAP device, mask, supplies, and give further instructions and tips on how to use your device. For more information, look to our website

Understanding Depression

Woman Suffering From Depression Sitting On Bed In Pajamas

By: Merrill Montgomery, University of Iowa College of Pharmacy, Class of 2018

In 2015, 6.7% of adults in the US suffered from at least one episode of depression that lasted for two or more weeks, and that interfered with their ability to work, attend school, or otherwise function normally.  Despite how common depression is in the US population, for many years it was poorly understood even by researchers and health professionals.  The more scientists and researchers learn about the human brain, the more they begin to understand that depression, like many other disorders, stems from irregularities in both the amount of the important messenger chemicals that our brain cells release, as well as irregularities in how our brain cells, called neurons, process these messages.


Meet Serotonin

One neurotransmitter that’s very important for mood is called serotonin. There are many others but for now, we’ll just focus on serotonin. When good things happen, your brain cells release lots of serotonin. When other cells “hear” these chemical messages, it creates the feelings of joy and well-being we associate with being happy, having fun, and generally enjoying life.


When sad things happen, the levels of serotonin in the synapses fall and we feel sad.  In a healthy brain, there’s always enough serotonin floating around that, on any given day, you feel okay. In a healthy brain, the levels of serotonin are only low in response to sad things happening, and the levels can easily recover so that a person feels “okay” or “happy”. What happens in depression?

When you’re depressed, something goes wrong and your brain cells either stop making the amount of serotonin that your brain needs to feel “normal” and/or your brain cells stop being able to “hear” serotonin well enough to respond appropriately.

This lack of serotonin (or inability of your brain to respond correctly to serotonin) means that people who are depressed always feel like something is wrong, even when life is okay (or even good).  They lack the chemicals they need to enjoy even their favorite things.

No matter how much a depressed person knows, logically, that they have nothing to be sad about, their brain keeps telling their body that something bad or sad has happened or that they have nothing to be happy about.  Just like people with diabetes don’t make the necessary chemicals to use sugar (insulin), people with depression don’t make the chemicals needed to feel happy.

Depression is treatable

Depression medications work to both increase the levels of your brain’s “happy” chemical messengers and enhance your brain cells’ ability to “hear” the happy messages.  Here are some important tips for treating your depression:

Be Patient: Your brain’s whole system of sending and receiving chemical messages is very complicated and delicate, and it’s important to make changes gradually.

Keep Taking Your Medication: Your depression medication isn’t going to start working overnight. It sometimes takes two weeks to start feeling even a little bit better, and it takes 8-12 weeks for the medication to reach full effect.

Stay Hopeful:  Every brain is different, and not every medication works for every person. Sometimes it takes trying a couple of different things or even combining a couple of different medications before you find the magic combination that will restore the balance in your brain.

Your NuCara pharmacists are always happy to help you optimize your treatment in whatever ways we can!


Hammer Medical Supply Looks to the Future with NuCara


Two long-standing leaders in Iowa’s home medical equipment & supply industry are planning to become one.  NuCara Pharmacy & Home Medical, headquartered in Conrad, Iowa, has entered into an agreement to acquire Hammer Medical Supply this week.

With retirement on the horizon, the owners Rick, Kurt, Mark Johnson and Terry Flatt began searching for the right partners that would build upon the success of their company and provide continued opportunities for their long-term employees.

“It was important to us to find a company that shared the same values, objectives, and level of care as Hammer and we found that in NuCara,” says Kurt Johnson.

Both companies have a rich history in providing exceptional service throughout Iowa for over 40 years.  NuCara entered into the home medical equipment and supply business back in 1981 and Hammer Medical Supply in 1976.  Hammer President Rick Johnson, commented “I’m thrilled that this partnership has come to fruition and happy that our loyal patients will be able to count on receiving the same care they have come to expect and deserve.”

“We’ve always enjoyed a friendly business relationship with the Johnsons, sharing the same commitment to patient satisfaction. So when we heard the Hammer Medical Supply business was looking for a new partner, there was no doubt we were interested,” says T.J. Johnsrud, R.Ph., President & founder of NuCara.

The new ownership will provide a smooth transition for employees and clients. Terry Flatt, Executive Vice President, who has been with the company for 31 years, will stay on as a stockholder and will assume the position of CEO of Hammer. “We are excited about the future and I’m confident with the merger of our two operations our clients and referral sources will not only continue to receive the exceptional service they have come to expect, but we will be in a position to offer expanded services in many of our markets.”  As part of this ongoing commitment, Hammer Medical Supply will maintain their nine central Iowa locations under the Hammer name.

“The home medical business fits perfectly in the NuCara model. Our purpose as a company is to help keep people healthy and in their homes as long as possible.  Partnering with Hammer Medical Supply and their dedicated staff helps us do that more effectively,” says Brian Wegmann, CEO and shareholder of NuCara.

With the addition of the Hammer Medical Supply locations, NuCara now owns and operates over 30 pharmacies and medical equipment & supply locations in five states. For the communities NuCara serves, NuCara provides pharmacy services, medical equipment, respiratory services, custom prescription compounding, home infusion services, after breast surgery products, home modification services and much more, all for the benefit of their patients to enable them to stay independent and in their home.