Medication Adherence – Why does it matter to me?


By Emily Henningsen, PharmD Candidate, Class of 2018, University of Iowa College of Pharmacy

Medication adherence is defined by the American Pharmacist Association as the extent to which a patient’s behavior (i.e. taking medications at the correct time, dosage and frequency) corresponds with agreed-upon recommendations from a healthcare provider. Studies have shown that up to 50% of patients do not take their chronic medications as prescribed. Nonadherence costs healthcare systems anywhere from $100 to 289 billion annually in extra doctors visits, hospitalizations, and emergency room visits.

People may not take their medications for a variety of reasons:

  • Forgetfulness.
  • Multiple medications with different regimens.
  • Unwanted side effects.
  • Feeling that medication isn’t working or not knowing why the medication is important.
  • Barriers exist like transportation, income or knowledge about disease state.

We are all human, and forgetting to take your medication is okay if it happens every once in a while. It can be hard to take medications when you aren’t feeling any effect from them or you are taking multiple medications at multiple times throughout the day. For example, blood pressure medications may not make you feel any different. If your blood pressure is not under control, however, it can lead to heart disease or stroke later on in life, which will lead to the need for more medications in the future.

Your physician has your best interest in mind and prescribes medications individualized to you and your current medical conditions and needs. If you ever have any questions regarding your medication regimen or the reasons you are on various medications, have a conversation with your doctor. Pharmacists are an excellent resource to utilize when it comes to medications as well. They can offer you with advice on what to do if you forget to take a dose of your medication or the possible side effects of medications if you are experiencing any. Pharmacists also have access to information about the cost of medications and may be able to recommend a cheaper alternative that they can suggest to your doctor that will work just as well as the medicine you are currently taking if cost is an issue.

Here are some helpful reminders that can help you remember to take your medications!

  • Take medications at the same time every day.
  • Take medications with a daily routine like after brushing your teeth or while getting ready for bed.
  • Keep pill bottles in spots you will remember to take them – for medications taken in the after brushing your teeth, leave them by your toothbrush holder or on your nightstand next to your alarm.
  • Use a pill box to organize multiple medications or medications that are taken at different times every day.
  • Keep a medicine calendar with your pill bottles and note each time you take a dose.
  • Talk to your pharmacist about what to do in the event of a missed dose.
  • When traveling, be sure to bring enough medication to cover the entire duration plus a few extra days in case travel plans get delayed.
  • Try a mobile app like Mango Health, iPatientCare, or Dosecast where you can enter your medications and schedule and get notifications sent to your phone when it is time to take them.
  • Talk to your pharmacist about enrolling in a program through the pharmacy that offers automatic refills or medication packaging so you don’t run out of medication.

NuCara Pharmacy Is Now Dispensing Opioid Antidote


NuCara Pharmacy is now dispensing opioid antidote, naloxone, without a prescription in its Iowa and North Dakota pharmacy locations. This service is available at full-service pharmacies only and is not currently available at telepharmacy locations.

According to CDC, “Drug overdose deaths in the United States have more than doubled since 1999. From 1999 to 2014, more than 165,000 people have died in the U.S. from overdoses related to prescription opioids.”

A new law allows trained Iowa and North Dakota pharmacists to dispense naloxone to an individual at risk of an opioid-related overdose, or a person who may be in a situation to help an individual at risk of an opioid-related overdose. This law is intended to offer expanded access to a safe and effective opioid reversal medication in hope to help save lives through drug overdose prevention and education.

What is naloxone?

Naloxone hydrochloride, also called naloxone, is an opioid antidote used for reversing opioid-related overdose in the incident of consumption of one or more opioid drugs causing a drug overdose event.

The pharmacist determines the appropriate naloxone product to be dispensed. Naloxone products include:

  • Intranasal naloxone with atomizer
  • Intranasal naloxone spray
  • Intramuscular auto-injector naloxone

Who can eligible to obtain naloxone?

  • An individual at risk of an opioid-related overdose
  • A family member, friend or any person in situation to help an individual at risk of an opioid-related overdose
  • A first responder employed by a service program, law enforcement agency or fire department
  • If eligible recipient is a minor, a parent or guardian should provide consent.

Signs and symptoms of an individual experiencing opioid-related overdose:

  • A history of current use of narcotics or opioid or fentanyl patches on the skin or needle in the body
  • Unresponsive or unconscious individuals
  • Individuals who are not breathing or have slow/shallow respirations
  • Individuals who have snoring or gurgling sounds
  • Blue lips and/or nail beds
  • Pinpoint pupil
  • Clammy skin

Note that individuals in cardiac arrest share many of the same symptoms as those experiencing opioid-related overdose. Individuals who have no pulse, are in cardiac arrest and require CPR.

If you or another individual experience an opioid-related overdose, call 911 or seek emergency medical attention immediately.

How to Seek Help for Addiction to Prescription Drugs

Information and referrals for prescription drugs and other substance abuse services:

Drug Rehab Services allows you to locate help from drug and alcohol centers in the United States. Their helpline provides free and confidential information and referrals for alcohol and other drug abuse problems and related concerns.

24/7 service: 1-800-304-2219

Other ways for confidential treatment:

  • Talk to your doctor.
  • Talk to your health insurance company.
  • Many employers offer employee assistance programs that help support and direct individuals experiencing problems with substance abuse towards the right path.


What should I do if I get the flu?


By: Pamela Wiltfang, PharmD, MPH, BA, CHES

It’s that time of year where Influenza is going around. Fortunately, there are steps you can take to make your experience with the flu a little more bearable, and to prevent it spreading to other friends or loved ones.

Influenza is a viral infection, and cannot be treated by antibiotics. Oftentimes your body just needs time to fight off the virus, and most people who get the flu will have mild illness and will not need medical attention. In more severe cases a doctor may prescribe you antiviral medication, such as Tamiflu. These can work to make the illness milder, and decrease the amount of time that you are sick. Antivirals work best if they are started within 2 days of when you start to show symptoms of the flu, but can still be helpful if started later. If you are prescribed antivirals, follow your doctor’s direction for taking the drug.

The use of over the counter acetaminophen or NSAIDs such as ibuprofen can help relieve some flu symptoms such as sore throat, headache, muscle ache, and fever. Decongestants such as pseudoephedrine can help relieve congestion symptoms, but shouldn’t be used if you have a history of high blood pressure or other heart problems. Antihistamines such as chlorpheniramine or diphenhydramine (Benadryl) can provide relief for a runny nose, but should be used with caution in people older than 65 due to side effects such as drowsiness, confusion, and dizziness. Always use the recommended dosage of over the counter medications, and check with your pharmacist if you have any questions or concerns.

In order to prevent the spread of the flu to your loved ones, make sure to take steps to prevent their exposure to the virus.

–  Limit contact to others as much as possible to avoid infecting them.

–   Cover your mouth and nose when you cough or sneeze either with a tissue or the corner of your elbow.

–   Wash your hands frequently with soap and water, or use an alcohol based hand sanitizer.

–  Disinfect all surfaces and objects that you have come into contact with that might be contaminated with the flu.

–  Stay home until at least 24 hours after your fever is gone except to get medical care or for other necessities.

–  In addition to the steps listed above, always remember to get your yearly flu shot to decrease the chances of being infected with the influenza virus.

If you have any other questions always feel free to ask your local NuCara Pharmacist.

Cold and Cough Over the Counter RELIEF


By: Carley Castelein, PharmD Candidate 2018,Drake University

Walking the aisles near the pharmacy can be a daunting when you are sick and seeking something to make you feel better. There are so many products and each presents its own claim to fame. Here is a short breakdown of a few common active ingredients to look for when you are trying to treat a certain symptom:

  • Sinus and nasal congestion: Pseudoephedrine (commonly known as Sudafed) can be purchased at most pharmacies. It should not be used if you have high blood pressure.
  • Running noses: Antihistamines such as Allegra (fexofenadine), Claritin (loratadine), and Zyrtec (cetirizine) can be used to dry up nasal passageways.
  • Persistent cough: Dextromethorphan, commonly written as DM on products packaging labels can help decrease your coughing frequency and can cause some drowsiness. If you have a dry cough it would be appropriate to use this but if your cough is productive (a lot of mucus) you do not want to suppress it and keep that mucus inside of you! If you have asthma or COPD it is not recommended that you use products with this ingredient.
  • Tight chest caused by mucus: Mucinex (guaifenesin) loosens and thins your mucus secretions making your cough more productive to release the mucus from your body.
  • Nasal irritation: Menthol, found in Vicks, will create an anesthetic (insensitivity to pain) for your nose.

As for zinc, it can block the adhesion of the virus to the nasal tissue and potentially slow the replication process but it must be taken within 24hours of onset and at least every 2 hours while awake. However, it can also irritate your stomach. Vitamin C supplementation for prevention and treatment is very controversial, it may not prevent the cold but it could reduce the duration.

Many of these products come in combination and my advice is to stick to what your symptoms are—if you don’t need it, don’t buy it! Non-pharmacologic treatments are always the safest treatment: stay hydrated, use throat lozenges, and utilize a cool mist vaporizer at night.

Have a Cold? Consider This…

Little girl blows her nose

By: Carley Castelein, PharmD Candidate 2018, Drake University

Cold season is upon us so it is important to know when you should go to the doctor.

It is easy to know when you aren’t feeling well from a cold: your throat is sore, your nose is stuffed up or running like crazy, and then a cough appears by day four or five. However, did you know the average cough lasts about 17 days and that if your cold lasts less than 10 days, there is about a 2% chance it is caused by bacteria?

Many people seek a doctor within a week of getting sick, hoping for some antibiotics to relieve their suffering and return to normal. However, prescribing antibiotics for a viral infection is causing larger problems. Not only are the side effects, such as diarrhea and yeast infections, of some antibiotics bothersome, they are also making antibiotics less powerful against certain bacteria.

Each year about 2 million people become sick because of bacteria that are resistant to antibiotics, and at least 23,000 people die as a result of these infections. It is important to think about your symptoms and take care of your body when you aren’t feeling well to protect yourself and loved ones, so consider plenty of fluids, rest, and some symptomatic relief to see if you can avoid a trip to the doctor and unnecessary antibiotics.

For more information visit the Centers for Disease Control and Prevention’s Get Smart campaign at


Ebell MH, Lundgren J, Youngpairoj S. How long does a cough last? Comparing patients’ expectations with data from a systematic review of the literature. Ann Fam Med. 2013;11(1):5-13.


Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1-S39.



Sleep Habits for Your New Year


By: Carley Castelein, PharmD Candidate 2018, Drake University

It’s the beginning of the new year and everyone is making resolutions to uphold through out the year but perhaps there is something holding you back from meeting these goals. It may in fact be your sleep habits. Did you know that 25% of US adults report insufficient sleep or rest at least 15 out of every 30 days? The National Heart, Lung, and Blood Institute says that adults should be getting 7-8 hours of sleep a day. View recommendations for other age groups here:

Sleep is crucial for your body to restore itself and can have an affect on a number of endocrine, metabolic, immune system and memory functions. These functions will have a larger implication on your healthy eating goals, exercising ability, motivation and so forth! Utilize these tips for healthier sleep habits and maintain good sleep hygiene throughout the year.

  • Avoid stimulants such as caffeine and nicotine close to bedtime.
  • Exercise to promote quality sleep, as little as 10 minutes can help!
  • Avoid large meals within 1-2 hours of bedtime
  • Try to expose yourself to natural light throughout the day
  • Go to bed at the same time each night and rise at the same time each morning
  • Avoid bright screens within 1 hour of bedtime
  • If you can’t fall asleep, get up and do something then return to bed when you feel tired

Prioritizing your sleep and making a commitment to good sleep hygiene may be what is in between you and achieving some of your goals in 2017. To read more about the effects of poor sleep visit the Centers for Disease Control and Prevention at

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. Updated April 8, 2014. Accessed January 12, 2017.

Centers for Disease Control and Prevention. Coping with Stress. Updated October 2, 2015. Accessed January 12, 2017.