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.

New Year’s Resolution: Reducing Stress

By: Amy Frew, Drake University, PharmD Candidate 2017

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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

 

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  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

Summary

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

Summary

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.