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.

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©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.

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National Immunization Month

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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: http://www.cdc.gov/vaccines/schedules/

CDC Vaccine Website: http://www.cdc.gov/vaccines/parents/index.html

National Immunization Awareness Month Page: http://www.cdc.gov/vaccines/events/niam.html

 

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.

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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.

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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 http://www.nucara.com.

Understanding Depression

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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.

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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.

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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!

https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml

 

Hammer Medical Supply Looks to the Future with NuCara

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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.

Smoking Cessation Journey

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By: Alyssa Vosecky, PHC, PharmD Candidate Class of 2017, The University of Iowa College of Pharmacy

Previously in January, we provided an article about how to start your journey towards smoking cessation and why it is important for your health to give up smoking. Perhaps you’ve thought about quitting but haven’t made the move. Perhaps you have taken a step, but weren’t able to follow through to the end. New research shows it can take anywhere between 10-30 attempts to stop smoking without relapse. Do not be discouraged by previous failures. Instead, embrace that you have found a method that didn’t work so you can adjust your next attempt.

There are many different resources available to help in your journey toward quitting. Over the counter products and behind the counter products exist. If one product didn’t work for you there are still options!

Nicotine Replacement Therapy

Nicotine replacement therapy, also known as NRT, is available in many different forms. NRT is designed to help aid in withdrawal symptoms and cravings that many smokers experience. NRT works best when it is used on the first day of quitting to help prevent withdrawal symptoms. There are 5 different products including gum, patches, lozenges, nasal spray, and inhalers. If one product didn’t work well for you, it does not mean the others won’t. It is important to start NRT at the right dose. If you start too low, chances are it won’t work. If you start too high, you may feel sick because more nicotine that you are used to is in your body. Tell your local pharmacist how much you smoke and when you have your first cigarette, and they can guide you to the correct strength of the product. They will also counsel you on how to use the products as they do have special directions. NRT can be expensive and not all insurance companies cover them. Contact Quitline Iowa for assistance with these products. 1-800-QUIT-NOW / smokefree.org

Prescription Medications

Chantix is a prescription medication that blocks the nicotine from reaching the receptors in your brain that stimulate the addiction center. The first week tapers up on the medication and on week 2 the maintenance dose is reached. It is a 12 week course that may be extended to a 24 weeks. This medication requires a prescription and is started 1 week prior to your quit date. This requires planning ahead to acquire a prescription and set a stop date.

Bupropion SR is another prescription option for smoking cessation. This medication also begins with a small taper and is used for 7-12 weeks. The first week of medication should be started prior to the target quit date.

The previous agents help with the nicotine dependence aspect of smoking. Many people find that they still need something to replace the physical cigarette in their hands, or something in their mouth. Suckers are great alternatives as they give you something to hold as well as taste. Other good options include using toothpicks, mints, or bubble gum.

Smoking cessation is a journey. Do not get discouraged by previous attempts that didn’t work. Most people need several attempts before they are able to achieve and maintain a smoke free life. Use previous attempts to help shape your future attempts. It is important to remember that if one product doesn’t work, there are still plenty of options that may.

 

4-1-1 on Diabetes

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By: Alyssa Vosecky, PHC, PharmD Candidate Class of 2017, The University of Iowa College of Pharmacy

Do you or a loved one live with diabetes? Diabetes is a very complicated disease state and it is much more than just checking your blood sugars. Those with diabetes can tell you there is an endless amount of work behind the scenes. Care can seem overwhelming, so let’s look at 3 quick simple things you can do from home to keep your diabetes in check.

  1. Feet

Your feet take you everywhere! It is important to take care of them. Did you know that diabetes can harm your feet? As the sugar in your blood builds up it creates traffic in your blood stream. The sugar has a hard time squeezing through the smaller parts of your blood stream. This can result in damage to the blood stream and nerves leading to sores on and numbness in legs and feet.

What’s the big deal? With feet going numb, you may not feel things like a blister or a sharp object you stepped on. When blisters go unchecked, they can lead to sores that may become infected. A sharp object may also cause a sore or cause further damage to your foot.

What can I do? Check your feet every day.  You can look at the tops of your feet to make sure there are no sores. When it comes to the bottoms of your feet, you can place a hand mirror on the floor and rotate your foot so that you can see all angles. Another helpful trick is to wear white socks. If you were to step on something or have a sore, it is easier to see blood or discharge on the white material.

  1. Blood sugars

You can log your own blood sugars at home. Most meters have the capability to record the time and date of each test. You may also use the old fashion pen and notebook. This data is very useful to not only to the providers, but to you!

What’s the big deal? Your blood sugars act as a tool to show us what your body has been doing to process your sugar. Being high or low can give doctors an idea of who to use your medication. Having the patterns and treads better guide your doctor to know what types of medications will work, how much to give, and what times of days to give the medication.

What can I do? Ask your local pharmacist to assist you in setting up the time and date on your meter. They can also show you how to view the stored data. Check with your doctor and see if they can check the numbers directly from your meter or if they need you to write down the numbers prior to appointments.

  1. Insulin

If you take insulin you know that injections can become routine. Most people find they have a few areas that work great for injecting insulin. While it may be easy to use that same easy to reach spot, it is important to rotate injection sites.

What’s the big deal? Insulin must be injected into our fat tissue for it to be used correctly. When you use one spot repeatedly it can cause scar tissue to build up and make your skin lumpy. Insulin does not like to be around scar tissue and won’t go to work in our bodies the right way. It may even cause the insulin to spray back out after injection so you don’t get your full dose.

What can I do? You can use the “pinch an inch” rule when injecting to help avoid getting the insulin into the muscle tissue. You have a whole belly of injection sites available to use. Make sure to stay at least 1 inch away from your belly button (see diagram below). You may rotate all the way around your belly button as if it were a clock face. You are not limited to the left and right of the belly button.

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