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

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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

Self-Treatment:

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.*

 

 

 

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.

basicsofbrainchemistry

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.

happyserotonin

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

hammervan

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

cigarette2
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

diabetes3.jpg

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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ESC Drug Drop Off Event A Success

takeawayNV
Eastern Story County residents turned out Saturday, April 29th to help make the ESC Drug Drop Off a success.  Made possible through a partnership between NuCara Pharmacy, Nevada Police Department, YSS of Eastern Story County Board, and the Story County Prevention Policy Board, this event brings awareness to our communities about the issue of medication misuse and abuse.  During the two hour long event, 128.5 pounds of unused and unwanted medications were turned in to be safely destroyed.

With the rise of opioid use in the U.S. more and more people are becoming aware of the concerns related to misuse and abuse of prescription medications.  Misuse or abuse of medications is classified by the National Institute of Drug Abuse (NIDA) as using prescription medications in a way other than prescribed by your doctor, using someone else’s prescription medications, or using the prescription medication to seek a high or euphoria.  While this issue is a concern for all, youth and older adults are all at greater risk for prescription misuse use and abuse.

NIDA states, after alcohol, tobacco and marijuana, prescription medications are the most commonly used drugs among youth.  While males are more likely to misuse medications than women, the number of adolescent females reported to misuse medications exceeds that of adolescent males.  These females are also more likely to meet criteria for substance use disorder for prescription medications.

Older adults are at greater risk for misuse of medications for a number of reasons.  According to NIDA, older adults are more likely to experience multiple chronic health conditions.  Meaning they are more likely to be prescribed more medications.  Many older adults take at least one prescription medication daily and at about 50% take five or more daily.  Also, as we age our bodies metabolize medications differently.

This misuse, intentional or not, can have serious medical consequences.  Ridding our homes of unused and outdated medications is one step we can all take to help prevent misuse and abuse of medications.  You can turn in your unused and outdated medications to an officer at the City of Nevada Police Station.  NuCara Pharmacies are also able to take back medications through their TakeAway program.  For questions about this program please contact your local pharmacist.  The City of Ames Police Department also has a permanent drug drop box located inside the police station entrance.  For other recommendations about how to safely dispose of your expired and unused medications visit the DEA website at http://www.justice.gov/dea/index.shtml.

Additional Information re: DEA Take Back Initiative – www.DEA.gov