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 http://www.nucara.com.

New Year’s Resolution: Reducing Stress

By: Amy Frew, Drake University, PharmD Candidate 2017


Stress is our body’s natural response to challenging situations, whether it’s running away from a bear, giving a presentation at work, asking someone out on a date, or dealing with the everyday problems in our lives. But a lot of Americans, almost half in fact, report that their daily levels of stress impact their physical and mental health. While there is no quick fix to eliminate all of the stress in our lives, there are ways to manage your stress and minimize its effects.

Identifying Your Stressors

In order to manage your stress, you must first identify what triggers your stress. What stresses you?

  • Financial responsibilities
  • Personal relationships
  • Major life changes
  • Work
  • Family responsibilities
  • Family or personal health concerns

How does high stress affect our bodies?

Stress releases a rush of hormones all throughout your body. Some physical effects of stress include headaches, muscle pain, chest pain, fatigue, upset stomach, and lack of sleep. In the long term, being stressed can increase your risk of diseases like high blood pressure, diabetes, obesity, and even heart attacks and strokes.

These stress hormones also act on our brain and decrease our mental and emotional stamina. Being constantly stressed can cause us to feel anxious, depressed, or angry, which decreases our work performance and may affect our relationships with others. This increased tension in relationships can lead to a vicious cycle of more stress and conflict if we don’t take control of our stress levels.

Healthy Ways to Manage Stress

  • Eat regular, well-balanced meals. Oftentimes, stress causes us to eat too much or skip meals altogether. Designate meal times and make sure to include lean protein, fruits, and vegetables to boost your energy and your spirits!
  • Make time for exercise. Exercise releases endorphins, which cause your brain and your body to feel good. Pick an activity that you enjoy and start light to moderate exercise a couple times a week. Increase your activity level gradually to prevent burnout and injury.
  • Get plenty of sleep. Getting enough rest each night improves your performance and leaves you feeling more energized!
  • Take a break! Step back from the situation for a few minutes to better re-focus your intentions. Take a short walk, close your eyes, take a few slow, deep breaths, or practice yoga or meditation; whatever helps you to regain your calm and improve your mood.
  • Talk to others. Share your feelings and your problems with people you trust, such as a friend, parent, relative, doctor, or religious advisor. If this does not help, you may need to seek further guidance from a psychologist or counselor.
  • Avoid drugs and alcohol. Escaping from your problems in drugs and alcohol may seem easy, but they inevitably leave you feeling worse and creating additional problems and stress.

For more information about managing stress, visit the following websites:

If you or someone you know needs immediate help, please contact one of the following hotlines:

Disaster Distress Helpline 1-800-985-5990
National Suicide Prevention Helpline 1-800-273-TALK
Youth Mental Health Line 1-888-568-1112

The Mayo Clinic. Stress relief basics. http://www.mayoclinic.org/healthy-lifestyle/stress-management/basics/stress-relief/hlv-20049495. Updated April 8, 2014. Accessed January 12, 2017.

Centers for Disease Control and Prevention. Coping with Stress. https://www.cdc.gov/violenceprevention/pub/coping_with_stress_tips.html. Updated October 2, 2015. Accessed January 12, 2017.

Bad Habits Your Heart Hates

by: NuCara Intern, Lindsey GarnerDrake University, PharmD/MBA Candidate 2016


Heart shaped by hands

  1. Smoking

Smoking is a habit for some, but an addiction for others. It is the #1 preventable cause of death and illness in the United States. We know it can cause narrowing of blood vessels leading to your heart, which, coupled with the carbon monoxide in your blood stream, means decreased oxygen flow to your heart. You can end up with chest pain, heart attack, arrhythmias, or death. Aside from the thousands of unhealthy chemicals found in cigarettes, the nicotine in tobacco products causes a rise in blood pressure. See our post here for more information on how to quit.1

2. Putting off going to the doctor

Just because you didn’t have any health problems when you were 25, doesn’t mean you don’t have any now as a 40 year old. Many people don’t realize that over the course of 10-15 years their body has changed to develop high cholesterol, high triglycerides, or high blood pressure. Even though you don’t feel these things, you still need to see a doctor regularly to get them assessed! It’s time to make your yearly physical a priority.

3. Sleeping too much or not enough

Having an irregular sleep pattern is definitely an annoyance for some and inevitable for others (especially those with demanding jobs, kids, or sleep conditions), but not having a steady sleep routine can put undue pressure on your heart. The stress hormone Cortisol is regulated by your sleep schedule. If your sleep schedule is abnormal, your Cortisol level could remain unnecessarily high throughout the day and night.

  1. Drinking too much Alcohol

Drinking excessive alcohol puts additional calories and triglycerides into your body. Extra calories and higher triglycerides (sugary fats in the blood) can lead to obesity, high blood pressure, or diabetes. Binge drinking can cause arrhythmias (heart beats that are out of normal rhythm), which can lead to stroke. What’s considered excessive? For women the American Heart Association recommends no more than one drink per day, and men are allowed to have 2. One drink is one 12 oz. beer, 4 oz. of wine, 1.5 oz. of 80-proof spirits, or 1 oz. of 100-proof spirits.2

5. Ignoring your Belly Fat

Developing a “belly” with age isn’t supposed to be normal! The more fat you store in your midsection, the higher your risk for cardiovascular disease. Ask your doctor to assess your risk based on waist circumference and visceral fat (the fat between your midsection organs). Men who have a waist circumference greater than 40 inches and women with a waist circumference of greater than 35 inches are at higher risk of developing diabetes, hypertension, breast or colorectal cancer, and heart disease.

  1. Ignoring your High Blood Pressure

High blood pressure can be due to stress, eating a poor diet (especially one high in salt), lack of exercise, lack of sleep, excessive weight, drinking too much alcohol, smoking, and advancing age. Any of these sound familiar? Nearly everyone has at least one risk factor for high blood pressure, yet many people don’t remember the last time they got it checked. High blood pressure, while not usually a painful or bothersome diagnosis, can lead to damage in your heart. The longer you let it go unattended, the worse it will get. The good news is that there’s almost always a way to treat it without turning to medication. While medications do an excellent job of improving cardiac outcomes, changing your diet, exercising more, and getting more sleep can all lower your blood pressure.3

  1. Ignoring your Depression or Anxiety

Even though depression, anxiety, and mental health in general is getting much more help and attention than in years past, there are still many people who don’t think they “qualify” for help. Whether it’s due to cultural, familial, or personal ideas, acknowledging depression or anxiety is still stigmatized in some areas. Unfortunately, people with depression frequently have more biomarkers in their system that indicate a higher risk for cardiovascular events and coronary artery disease. While we’re still trying to figure out if depression comes first or follows a coronary event, the fact remains that the two together mean worse outcomes for the patient. That being said, don’t think that you aren’t important enough for treatment. Depression and anxiety can manifest in different ways for different people. Make sure to seek treatment! Your primary care provider or a specialized doctor can both be helpful.

  1. Pretending you don’t have time for exercise

We’re all guilty of this one — whether it’s pretending not to hear your alarm go off in the morning, or insisting that your day was just too long to put in an extra 30 minutes to go work out. As much as we try to convince ourselves that we can’t make time, a 30 minute walk, jog, or run is only 4% of your day! Like it or not, this is the one thing that you absolutely cannot continue to ignore. The more excuses you make, the harder it is to start. So, give yourself a kick start and make it happen!

  1. Acting like your dietary choices “aren’t that bad”

Yes they are, and you know it. If you’re eating more than 50% of foods that come from boxes, cans, or packaged on a shelf, then chances are that you’re eating an unnecessary amount of extra sugar, fat, and salt. The extra sugar can lead to insulin resistance, the extra fat can cause increases in triglycerides, and the salt can cause water retention that leads to high blood pressure. A majority of your food choices should come from complex carbohydrates (fruits, vegetables, legumes, and some whole grains), lean means (including fish), and healthy fats (olive oil, avocados, nuts and seeds). Everything you eat either helps or hurts your body, so consider that next time you stop for some fast food eats. Try keeping a food journal for a week, then tell me if your choices “aren’t that bad.” Bonus points can go to anyone who actually eats the recommended daily value of fiber (25 grams).

  1. Living on caffeine and energy drinks

Energy drinks are packed with caffeine, guarana, and sugar. Drinking even one energy drink can cause a modest spike in blood pressure. Drinking more than one per day is sure to elevate blood pressure, and put you at risk for heart beat irregularities. Drinking more than one per day on a regular basis is going to put your heart in toxic conditions. If you have a familial history of heart disease or arrhythmias, you’re at an even higher risk. Feeling any of the following after drinking one energy drink is a reason to go see a doctor, immediately: racing heart, skipping or jumping heartbeat, feeling jittery or anxious, or extended dizzy spells.

Current Issues in Health Care: New Practice Model

7990As our healthcare system continues to evolve, pharmacy as it is practiced today is changing, and hopefully for the better. Here is the third of four topics that are in the “hot seat” as we round up the first half of 2014:

New Practice Model


Since 2010, the Iowa Pharmacy Association and its New Practice Model (NPM) Task Force have been developing a practice model to let pharmacists allocate more time for clinical analysis and patient service. The idea is to use technology in place and multiple certified pharmacy technicians to verify prescriptions and free more time up for the pharmacist. Ultimately, the New Practice Model promotes patient safety and desired health outcomes 6.

Current Standing

NuCara and the other participating pharmacies began the statewide pilot project on June 2nd. The technician verification process, otherwise known as the tech-check-tech system, is being closely monitored for errors in real time by pharmacists at these stores. Along with that, IPA is getting biweekly feedback from the stores participating in the pilot. The goal is to expand the model in other community settings by November 2014, and eventually reproduce the model nationwide if it is successful 6.

How are YOU, the patient, affected?

Pharmacists today are equipped with wide-ranging clinical skills. Pending on the success of the pilot, you, as the patient, can expect more time to discuss any health-related concerns with your community pharmacist. Third party pricing decisions have lead some pharmacies to demand their pharmacists to sacrifice time with patients. At NuCara, we want to promote the NPM so pharmacists can apply their knowledge and help their patients! More than just counseling on a new prescription, pharmacists can identify medication interactions, assist in over-the-counter purchases, and directly communicate beneficial medication adjustments to doctors.

Current Issues in Health Care: Ensuring Seniors Access to Local Pharmacies

Couple Enjoying A Game Of GolfAs our healthcare system continues to evolve, pharmacy as it is practiced today is changing, and hopefully for the better. Here is the second of four topics (the first two being current legislation) that are in the “hot seat” as we round up the first half of 2014:

H.R. – 4577: Ensuring Seniors Access to Local Pharmacies


Similar to HR 4190, this legislation would amend the Social Security Act. It also focuses on the same Medicare beneficiary groups as follows: Medically Under-served Areas, Medically Under-served Populations, and Health Professional Shortage Areas. However, the bill is written to affect Part D of Medicare, or the part that is most often used in the pharmacy. Under the law, insurance plans would be required to offer preferred network benefits to pharmacies in the previously defined regions.

Current Standing

Although only introduced in last month, this legislation is also picking up steam and already has bipartisan support from 31 congressional representatives 4. Community pharmacies not in a preferred network currently have to either charge patients more for medications and/or net a loss from providing expected, quality care. An article from late 2013 suggested that there are approximately 1,800 pharmacies that are the only provider in their community. Also astounding is the fact that 91% of all community pharmacy owners and operators were non-preferred; on average, these patients then have to travel 20 miles to a pharmacy that can provide savings promised by their insurance plans 5.

How are YOU, the patient, affected?

Similar to H.R. 4190, patients across the country, including all five states where NuCara practices pharmacy, would benefit from increased access to affordable health care. The choice of where to pick up medications or seek health services should be left up to YOU, the patient, not an insurance plan! The restrictions this legislation absorbs directly improve the chances that your local pharmacy and trusted pharmacist will continue to provide exceptional health services and keep their doors open.

Current Issues in Health Care: Change to Benefit Patients and Pharmacists – A Four Part Series

US Constitution And Scales Of JusticeAs our healthcare system continues to evolve, pharmacy as it is practiced today is changing, and hopefully for the better. Here is the first of four topics (the first two being current legislation) that are in the “hot seat” as we round up the first half of 2014:

H.R. – 4190: The Push for Provider Status


This legislation would amend a portion of the Social Security Act to give pharmacists what is known as “Provider Status.” Specifically, this amends Medicare Part B to include pharmacists in the group of professionals that are reimbursed for professional services. The legislation focuses on Medicare beneficiaries in three separate regions as defined by the US Dept. of Health and Human Services’ Health Resources and Service Administration (HRSA): Medically Under-served Areas, Medically Under-served Populations, and Health Professional Shortage Areas 1.

Current Standing

Originally introduced in March of 2014 by a Republican congressman from Kentucky, this legislation now has 56 bipartisan co-sponsors 2. It is gaining support by the day as representatives of congress recognize the benefits this bill would provide. Along with having the most expensive health care system in the world, a recent study also finds that, compared to ten other industrialized and powerful countries, the United States has the worst health outcomes 3.

How are YOU, the patient, affected?

Pharmacists are often considered the most accessible healthcare providers. This legislation manages to further increase that patient access. Additionally, it will assist pharmacists in the provision of high quality and cost-effective services that are within the scope of their education. Both individual households and our government are looking for ways to decrease their healthcare expenditure; this amendment could be a starting point! Check and see at https://beta.congress.gov/bill/113th-congress/house-bill/4190/cosponsors if your district’s congressman is a co-sponsor.

How to Aaah-Choose the Right Allergy Medicine

Little girl blows her noseBy: Rachel Clemens, PharmD Candidate 2014, Drake University

I love the spring. With it comes warmer weather, bright flowers, sunny skies, and fresh grass. However, spring also brings along pollen and ragweed so when spring has sprung, I get allergies. Have you ever gone to the pharmacy to pick out an allergy medicine and had no idea where to start? Or maybe you’ve tried a few things that haven’t worked great for you and you’re looking for another option? Look no further. I’m here to help.

How do I know if it’s allergies or a cold?

Sometimes, it’s hard to tell if you have allergies acting up or if the lingering winter has given you a cold. Here are some of the symptoms that can help you differentiate between the two:

Allergies: watery eyes, itchy nose/ears/throat, sneezing, congestion, red/irritated eyes

Cold: sore throat, congestion, low fever, chills, headache, feeling tired, feeling sore, possible cough

Now that you know that you definitely have allergies, let’s move on to some of the options available to help you feel better fast.

Over-the-counter options

Antihistamines: there are a lot of antihistamines available to try, and some work better than others for some people, meaning that you may have to try a few to find out which one is best for you. These medications are good for helping with symptoms like itching, sneezing, and runny noses. Here’s an idea of what’s out there to get you started:

  • Fexofenadine (Allegra®, Mucinex® Allergy): non-drowsy medication that can be taken once or twice daily, as it is available in 12- or 24-hour formulations. Can also be given in children (but check with a doctor first!)
  • Cetirizine (Zyrtec®): non-drowsy medication taken once daily. Can also be given in children (but check with a doctor first!)
  • Loratadine (Claritin®): non-drowsy medication taken once daily. Can also be given in children (but check with a doctor first!)
  • Diphenhydramine (Benadryl®): good if you have severe itching. Can make you drowsy, which is good if allergies are worse at night but should be avoided during the daytime. Don’t drive while taking it until you know how it affects you.
  • Chlorpheniramine (Aller-Chlor®, Chlorphen®): good for severe allergies. It will dry you up though, so stay hydrated and watch out for side effects like constipation.

Nasal sprays: if your symptoms are mostly centered around your nose (runny nose, congestion, sneezing, itchy nose), then just using a nasal spray can help without the risk of unnecessary side effects.

  • Afrin®: provides 12-hour relief for nasal congestion. Good to try if you have never used a nasal spray before.
  • Nasacort®: provides 24-hour relief of nasal congestion, sneezing, runny/itchy nose.

If you have tried some of these products and they do not seem to work, talk with your doctor about finding a prescription allergy medication that is right for you.

To “D” or not to “D” – when to add in a decongestant

If you have severe congestion, then it might be time to talk with your pharmacist about getting an allergy medication with a decongestant. You’ll know if your congestion is severe because your head feels heavy and full of “gunk”. You may have trouble breathing through your nose if you lay down, and the sinus pressure may be painful. Combination products like Allegra® D, Claritin® D, and Zyrtec® D are available behind the counter and you will need to show an ID to buy them.

**Remember: it’s always a good idea to speak with your doctor or one of our friendly pharmacists before starting a new medication regimen, even if it’s available over the counter! Everyone is different and they can help ensure you get the best product for you.**