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.

What is Telepharmacy?

Defined simply, telepharmacy is the provision of pharmacy services at a distance. While used in countless ways across various pharmacy practice settings, the most relevant example to NuCara is telepharmacy in a community pharmacy practice.

As a leader in rural health care, telepharmacy is a natural fit to NuCara. We currently own and operate three telepharmacy sites and are providing the verification and counseling services for an additional four sites in Illinois. A telepharmacy operates just like a traditional community pharmacy, however the pharmacist verifies the prescriptions and counsels the patient through the use of technology. Patients will receive the same level of service at a NuCara telepharmacy as they do at any other NuCara Pharmacy.


Zearing, home to NuCara’s first pilot telepharmacy location in Iowa.

NuCara first entered the world of telepharmacy in 2013 with the opening of the second telepharmacy pilot in the state of Iowa in Zearing. Since then, we have welcomed Enderlin, North Dakota, to the NuCara family as well as a second Iowa pilot site in State Center.

With the recent legislation signed by Iowa Governor Branstad, we expect more telepharmacy services to be in our future. We have gathered excellent patient safety and have been working to provide additional pharmacist-provided clinical services such as immunizations and MTM into our telepharmacy sites.

Additionally, we are very excited about the “hybrid” telepharmacy model, which we define as having a pharmacist on site at least one day each week. This allows the efficiency of a telepharmacy, while providing regular access to an on-site pharmacist. NuCara has also used the same technology to provide quick and easy assess to other specialists, like respiratory therapists, to our patients in rural areas. As technology evolves, NuCara continues to be a pioneer in how to best serve our patients through innovation.

NuCara in Pleasant Hill Adds New Natural Product Line

By: Julia Johnson, MHA, CPhT

Your NuCara Pharmacy in Pleasant Hill has a special integrative approach to healthcare and carries several natural products designed to help each person reach their maximum health potential. The pharmacy’s newest addition of natural products is the renowned Young Living brand of essential oils. The popularity of essential oils is rapidly growing due to their ability to act as natural medicine without any side effects. The medicinal benefits derive from the oils’ antioxidant, antimicrobial, and anti-inflammatory properties.

Essential oils (EOs) are concentrated liquids containing volatile aroma compounds from plants and have been used medicinally for thousands of years. Although EOs have declined in evidence-based medicine, they are reemerging as the popularity of aromatherapy and natural medicine increases. Aromatherapy is a form of alternative medicine intended to support overall health and wellbeing through the aroma of EOs. Aromatherapy goes beyond appealing smells by offering some of the following health benefits:
• Relaxation and stress relief
• Mood enhancement
• Relief of minor discomforts
• Boosting the immune and respiratory systems

In addition to their aromatic uses, essential oils can be used topically and in some cases internally. Not all EOs can be ingested, so it is important to read their labels carefully.
Listed below are a few common essential oils and some of their uses:
• Lavender: Known for its calming properties, wound healing, insect bites and reduces inflammation.
• Peppermint: Provides natural boost of energy, improves mental alertness, relieves/reduces migraines, alleviates symptoms of congestion and aids in digestion.
• Lemon: Has antiviral properties, great for cleaning, uplifting, and detoxing.
• Frankincense: Strengthens immune system and soothes inflamed skin conditions.

The Young Living essential oils are 100% pure, therapeutic-grade oils. Young Living is confident with their purity and authenticity claims due to their patented Seed to Seal process. This five-step process applies the most rigorous quality controls possible to ensure consumers are receiving essential oils the way nature intended.

Overall, essential oils can be a great natural, complementary health treatment in a variety of situations. However, due to a lack of scientific evidence, EOs should not replace traditional medical treatments recommended by your doctor. It is suggested to do research and talk with qualified individuals before using EOs.

For more information and ideas on how to use essential oils, visit Young Living’s official blog: https://www.youngliving.com/blog/
1. http://seedtoseal.com/en/seedtoseal
2. https://www.youngliving.com/en_US/discover/guide/about

NuCara Pilots New Pharmacy Practice Model

Pamela Wong, our Director of Clinical Services, leads an innovative New Pharmacy Practice Model pilot project with four of NuCara’s pharmacy locations: Lenox (Alicia Lynn), Story City (Betty Grinde), Traer (Phyllis McKee), and Washington (Samantha Peterson).
Under the guidance of the New Pharmacy Practice Model Task Force and coordination with the Iowa Board of Pharmacy, a pilot and research demonstration project was designed to ensure safe and effective medication dispensing through a pharmacy technician verification process (i.e., Tech-Check-Tech) in controlled situations in community practice as a means to provide pharmacists the time and resources for clinical pharmacy services. Tech-Check-Tech programs have been effectively implemented across hospitals in Iowa and across the country, but not within a community pharmacy setting. Given the importance of medication therapy to manage chronic conditions, community pharmacists are well-positioned to deliver services, such as medication therapy management (MTM), while addressing medication non-adherence and other medication-related issues.
This is a model of pharmacy practice that enhances patient safety and improves patient health outcomes.  It is important for this new practice model be recognized by patients, other healthcare providers, and payers of healthcare as a valuable service model; reproducible; professionally rewarding; and financially sustainable. All participating pharmacies plan to utilize the full breadth of patient care service offerings including:  medication therapy management (MTM), immunizations, medication synchronization, disease state management, collaborative practice agreements, and care coordination services with local health-systems.
For the full article, click this link: http://www.ihconline.org/aspx/general/page.aspx?pid=81

Young Receives Award at the Iowa Pharmacy Association’s Annual Meeting

IMG_4073The Iowa Pharmacy Association (IPA) is pleased to announce the 2014 award recipient of Pharmacy Technician of the Year Award goes to Alissa Young, CPhT, of Ames. The award was presented at the Association’s 2014 Annual Meeting Banquet on June 14 in Altoona.

Alissa Young was born and raised in Spencer, IA. Growing up on a farm, she developed a love of all animals at a young age. She moved to Ames in 2005 to attend Iowa State University and graduated in 2010 with a Bachelor’s Degree in Animal Ecology. In October of 2012, Alissa was hired as a pharmacy technician at NuCara pharmacy in Nevada. She became PTCB-certified the following summer. In March of 2013, she made a career move to Zearing to work at the newly-opened NuCara telepharmacy. Alissa enjoys the rewards and challenges of working with innovative telepharmacy technology and helping the people of Zearing in the process. Alissa and her husband Greg, a Civil Engineer, live in Ames with their two Basset hounds, Brutus and Rocky.

The Pharmacy Technician of the Year Award is an award designed to recognize a pharmacy technician in Iowa who has demonstrated outstanding involvement in the Iowa Pharmacy Association and enthusiasm for the profession of pharmacy in Iowa.

Alissa’s nominator said, “Alissa has a great work ethic and exemplifies the potential brilliant career that one can have as a pharmacy technician and we are grateful to have her on our team.”


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.**

You or a loved one suffering from Sleep Apnea?

Come to a NuCara Sleep Clinic and meet our respiratory experts! We can provide answers to questions about Sleep Apnea as well as other respiratory illnesses.

Receive free machine cleanings, a free filter, machine and mask checks, supply checks, and look at our new machines!

Below is a list of clinic dates, times, and locations:

Visit these NuCara locations:
Ackley • Friday, May 25th • 3 – 5 p.m.
Conrad • Thurs., May 24th • noon – 5:30 p.m.
Nevada • Weds., May 23rd • all day
Ottumwa • Weds., May 16th • all day
Story City • Monday, May 21st • 2 – 6 p.m.
Traer • Tues., May 22nd • 11:30 a.m. – 3 p.m.
Washington • Tues., May 22nd • 3 – 5:30 p.m.


Vinton • US BANK  • 414 A Ave.
Friday, May 25th • 10 a.m. – 3 p.m.

Questions? Call Kisha at 641.684.5453.