Posted by Parisa Karimi, PharmD Candidate 2015
Myasthenia Gravis is a very rare autoimmune disease. The prevalence of this disease affects 14-20 per 100,000 in our population. I decided to conduct a presentation at Western University of Health Science about this disease to spread awareness on the topic. This disease personally affects me because my father was diagnosed with it in 2011. I asked him if he would be so kind to be apart of my presentation and he agreed. I believe his presence is what made the presentation special and unique. The audience seemed intrigued by his experience. The first half of the presentation, I educated the audience about the disease, epidemiology, its mechanism, triggers, and treatment. The second half of the presentation was an interview style presentation. My father spoke about his experience living with this disease and how it has affected his life. I concluded the presentation showing a video of a young 23-year-old female who was diagnosed at the age of 17 and was presenting with symptoms. I figured since my father was not currently presenting with symptoms, this would be a great way to show the audience what he actually goes through when he does suffer from symptoms of Myasthenia gravis. I have attached my presentation to this blog and hope to spread more awareness on Myasthenia Gravis.
Posted by Parisa Karimi, PharmD Candidate 2015
FDA on August 1, 2014 approved empagliflozin (Jardiance) to improve glycemic control in
adults with type 2 diabetes.
It is indicated as an adjunct to diet and exercise to improve glycemic control in
adults with type 2 diabetes mellitus.
MECHANISM OF ACTION: It is a sodium glucose co-transporter-2 (SGLT2) inhibitor. Empagliflozin works by blocking the reabsorption of glucose in the kidney, increasing glucose excretion and lowering blood glucose levels in adults with type 2 diabetes who have elevated blood glucose levels.
DOSAGE AND ADMINISTRATION: The recommended dose of empagliflozin is 10 mg once daily in the morning, taken with or without food. In patients tolerating empagliflozin, the dose may be increased to 25mg
Patients with Renal Impairment: Assessment of renal function is recommended prior to initiation of empagliflozin and periodically thereafter. It should not be initiated in patients with an eGFR less than 45 mL/min/1.73 m2
No dose adjustment is needed in patients with an eGFR greater than or equal to 45 mL/min/1.73 m2. It should be discontinued if eGFR is persistently less than 45 mL/min/1.73m2
CONTRAINDICATIONS : History of serious hypersensitivity reaction to empagliflozin.
Severe renal impairment, end-stage renal disease, or
ADVERSE REACTIONS : The package insert lists following important adverse reactions
Posted by : Rahul Patel, PharmD. Candidate 2015.
One of the most common reasons a patient will come in to the pharmacy is because of pain management. Therefore, it is important for the pharmacist to know the benefits of each individual drug within its class in order to give the appropriate recommendation. Acetaminophen is effective and generally better tolerated than ibuprofen, naproxen sodium and other nonsteroidal anti-inflammatory (NSAIDs). However, over usage of acetaminophen is associated with liver toxicity. Ibuprofen is a member of the NSAID class which can cause gastrointestinal ulcers, asthma symptoms and heartburn. In addition, Ibuprofen has the risk of Reyes syndrome in people under the age of 18. Acetaminophen has rare minimal side effects compared to NSAIDs. NSAIDs have an anti-inflammatory effect at higher doses for which acetaminophen lacks. Naproxen Sodium will provide a longer analgesic effect than Ibuprofen and can be dosed twice a day instead of four times a day. Therefore, the naproxen sodium is preferred for pain management if acetaminophen fails or if an anti-inflammatory effect is needed. In addition, Naproxen sodium has shown to be safer compared to Ibuprofen for patients that have cardiovascular disease.
For Information on acetaminophen, ibuprofen, and naproxen sodium please refer to the links below:
4) Aleve (naproxen sodium), Naprosyn (naproxen), & Anaprox (naproxen sodium) briefing document for US Food and Drug Administration Advisory Committee Meeting. Bayer Healthcare LLC, Consumer Care Division, Hoffmann-La Roche Inc. January 10, 2014.http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/ Drugs/ArthritisAdvisoryCommittee/UCM383181.pdf
Posted by Parisa Karimi, PharmD2015
According to consumerreports.org, in 2012 US consumers spent $ 753 million on glucosamine supplements. Glucosamine is used by people to either prevent joint degeneration, to help with joint pain or to have disease modifying effect on osteoarthritis. Considering the degenerative disease affecting more than 27 million Americans, this is a huge market.
What is Glucosamine ?
Glucosamine is an amino sugar and a prominent precursor in the biochemical
synthesis of glycosylated proteins and lipids. Glucosamine is part of the
structure of the polysaccharides chitosan and chitin, which compose the
exoskeletons of crustaceans and other arthropods, as well as the cell walls of
fungi and many higher organisms.
Current Evidence on Glucosamine
Two Systematic Reviews comparing glucosamine with placebo for OA
found mixed results regarding the efficacy of glucosamine for pain
relief and physical function. The 2005 systematic review comparing glucosamine with placebo showed that "glucosamine was superior to placebo in the treatment of pain and functional impairment resulting from symptomatic OA". To read more about this article [click here]. The systematic review published in 2010 showed that "compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space" [Click Here] to read more about this article.
Regarding disease modification, a systematic review found no statistically
significant differences in minimum JSN (joint space narrowing) between glucosamine and placebo at 1-year follow-up, though a moderate effect was detected at 3 years. To read more on this systematic review [click here].
With regards to safety, studies did not find any significant difference in adverse events between the glucosamine and the placebo group. So, we can say that glucosamine is a safe supplement, so far.
Current recommendations from the Osteoarthritis Research Society International, is that for symptomatic relief, its benefit is "Uncertain" and its "Not appropriate" for use of disease modifying.
Posted By: Rahul Patel, PharmD. candidate 2015
As a pharmacy Intern working in a retail pharmacy, I have noticed many patients coming to pick up their antibiotics also inquire about probiotics. Human beings contain normal flora, which prevent pathogens from colonizing and causing disease. Normal flora is considered “friendly bacteria” and when patients are taking antibiotics to destroy the bad bacteria unfortunately, sometimes the good bacteria is destroyed with it. Probiotics are organisms such as bacteria or yeast that are believed to improve health. When the balance of friendly bacteria in the intestines is disturbed some digestive disorders can occur. This usually occurs after an infection or after taking antibiotics. Information is still needed in regards to the safety of probiotic use especially for young children, elderly people, and those who have comprised immune systems. In 2011, according to experts at Yale University, probiotics are most effective for: treating childhood diarrhea, ulcerative colitis, necrotizing enterocolitis, and preventing antibiotic-associated diarrhea and infectious diarrhea.
When it comes to choosing a probiotic, studies haven’t concluded differences between the different types of brands. However, foods such as yogurt have shown to be effective for replacing normal flora. In addition, yogurt has other nutritional benefits that other probiotics do not have. Therefore, when considering cost, effectiveness, and health benefits, yogurt would be the best recommendation. Yogurt has active organisms in it that contribute to its probiotic effect. The nutritional content can also help prevent osteoporosis because of its calcium content.
For more information regarding probiotics please refer to the links below:
Posted by Parisa Karimi, PharmD 2015
When a patient is experiencing intermittent heartburn (GERD), the first thing we think of as a pharmacological agent is antacids. Tums, also known as calcium carbonate, has been a mainstay for treatment for many years. Its effectiveness, safety, and relatively low cost should not be underestimated. According to some studies, however, there are calcium receptors in the stomach that, when activated, increase gastric acid secretion. Therefore, by taking calcium-containing antacids, we are putting ourselves at risk for acid rebound. I would recommend products containing both magnesium and aluminum antacids which are not known to cause acid rebound. In addition, to being very effective acid neutralizers, the two together are designed to offset each other's adverse effects: diarrhea (magnesium) and aluminum (constipation).
By: Peyman Mahdavian, PharmD candidate 2015
Over the last decade there has been a considerable rise in the use of herbal supplements by consumers. With all the side effects of “Western Medicine” that are brought to the attention of patients, it is natural that patients move towards the use of “natural” herbal supplements. But, as we are well aware by now that the supplement industry is not as tightly regulated by the FDA as the prescription drugs, its important and a personal responsibility for patients or any consumer to know these products’ effects as well as side effects. One should ask the question, “Are herbal supplements really benign?” Since these products are not highly regulated by FDA there can be inconsistencies in its active ingredient and also might contain different levels of heavy metals which can lead to heavy metal toxicity. A 2004 study published in JAMA that tested 70 herbal medicine products (HMPs) that are sold in USA found that 20 percent of the products has either lead, mercury and /or arsenic and if taken as recommended by the manufacturers then it could result in intake of heavy metal toxicity. To read more about this study [click here]. To read more about heavy metal toxicity [click here].
As health care professionals, we should also consider one another aspect and that is drug interaction with these herbal supplements. Some common drug herb interactions are ginseng with warfarin, ginseng with phenelzine, St. John's wort with paroxetine and digoxin. To read more drug herb interaction click here.
Some herbs have been associated with toxicities, for example, Kava-kava, chaparral and comfrey have been reported to cause liver damage.
To read more about some herbal products and its adverse effects click here.
Rahul Patel, PharmD Candidate 2015
Nowadays, the grocery stores are inundated with gluten-free foods. Many people select gluten-free products compared to the whole grain products thinking that it is a healthier choice. Gluten is a protein in wheat, barley, rye and triticale (a rye/wheat hybrid) that is hard for some people to digest.
Some people think that gluten free diet is good for people who are gluten sensitive. A study published in 2013, Gastroenterology journal found that gluten sensitivity may not exist at all. [Click here] to read more about the study. Therefore, only people with the very rare condition of celiac disease should avoid gluten containing foods. Gluten free food, however, can be good and healthier news for people having celiac disease.
First, here are some facts about Celiac Disease.
According to a 2012 study the prevalence of celiac disease in USA is 0.71 percent, which may be much lower than it is estimated by the so-called "health food" companies. To read more about that study [click here].
Understanding Celiac Disease: Celiac disease, also known as gluten intolerance, is an autoimmune disorder. Upon ingestion of gluten, a person’s immune system responds by attacking the lining of the small intestine and destroying villi. Villi are tiny fingerlike protrusions lining in the small intestine, which allows nutrients from food to be absorbed through the walls of the intestine and into the bloodstream. A person becomes malnourished without healthy villi because their body cannot absorb any nutrients no matter how much food they eat.
Symptoms: The symptoms of celiac disease vary from person to person.
Infants and Young Children:
Diagnosis: Early diagnosis is very critical in order to prevent complications later in life. The diagnosis of celiac disease is a 2-step process:
First: Blood Sample: a blood sample is tested for high levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA).
Second: Intestinal Biopsy:
If blood tests and symptoms suggest celiac disease then a biopsy of the small intestine is performed to check for damage to the villi.
A confirmed diagnosis is made when the blood test and the biopsy results are positive.
Following a strict gluten-free diet is the only treatment for celiac disease. This means a person will have to give up some of their favorite foods for the rest of their lives if they want to stay healthy. Complete avoidance of gluten can be very difficult to achieve since it is found in hundreds of food items and many everyday products, but with strict discipline it can be possible for them to maintain a gluten-free diet. A gluten-free diet is a must for them because even a tiny amount of gluten can damage the villi of the small intestine which can interfere with the absorption of nutrients from food.
For more information about celiac disease please refer to the following links:
So, what about people who do not have celiac disease? If one doesn't have celiac disease, there is no need to choose gluten free food. While gluten itself doesn't have any special nutritional value there are many vitamins and minerals in whole food. A gluten free diet makes it very hard to get in the recommended daily amounts of vitamins, minerals. There are many health benefits of whole grain products. To read more about whole grain foods [click here].
Posted By: Rahul Patel, PharmD candidate 2015.
One of the major epidemics that has been haunting our country for decades is the rapid increase in deaths related to opioid overdose. Many patients become tolerant to this class of medication, thus require higher dosage to achieve the same therapeutic effect. There are two primary types of addiction. One type, which is the true definition of addiction, is to have drug-seeking behavior in the absence of pain. The other type of addiction is called pseudo-addiction. Pseudo-addiction is when a person has drug-seeking behavior due to inadequate pain control from their medication.
According to the Institute of Medicine, as of 2012, over 100 million people suffer from chronic pain in the US. Many of these patients require opioid therapy to help treat their pain. In turn, addiction is a high plausibility in many of the patients that continue to take the medication after their pain has been resolved. The Center for Disease Control (CDC) reported that from 1999 to 2006 the deaths related to opioid overdoses increased by 18%. This is a devastating and threatening statistic considering that there are not any other treatment options that have proven to be superior to opioids for pain management. However, from the years 2007 to 2011 the total deaths related to opioid overdose only increased by 3%. The CDC believes that the reduction in rate of deaths could be related to two things. As of 2006, the FDA called for a more limited use of the opioid medication methadone. Methadone is a medication that is commonly used for patients that are trying to wean off of heroin addiction. In addition, the CDC believes that the reduction in the rate of deaths is linked to the recent legalization of marijuana in some states. Overall, states that have legalized marijuana have seen a reduction in opioid related deaths by 25%. Regardless of what the link to the reduction may be, this is a major step toward the right direction to control the epidemic. In addition, the DEA just announced that as of October 06, 2014, opioid medication that contain hydrocodone combinations will now be considered schedule II medications. This means that patients will only receive prescriptions for thirty-day supply and would require a new prescription in order to receive more therapy for their pain management. This new regulation is part of the effort to help curb addiction and further control the usage of opioid therapy.
Recently, researchers studied the risk of stroke and all-cause mortality in women ages 50-79 and its link to a potassium rich diet. The patients were followed for eleven years and the findings of the study proved to be very intriguing. The results concluded that the group that ate the most potassium was 12% less likely to suffer from any type of stroke. In addition, they were also 16% less likely to suffer from an ischemic stroke, which is the most common type of stroke that occurs when an artery to the brain is blocked. It is important to note that the link between increased potassium intake and reduced risk in mortality was stronger in patients that did not suffer from hypertension. Among the women who did not have high blood pressure, those who ate the most potassium had a 27% lowered risk of stroke and 21% lowered risk of all-cause mortality. This finding suggests that there is greater benefit of increasing potassium intake in the population that does not have high blood pressure. It is very important to note that potassium helps to lower blood pressure and helps to offset the blood pressure increasing effect of sodium. The US Dept. of Agriculture recommends an intake of 4700mg of potassium per day. However, very few people take this recommendation seriously enough to follow it. Some foods that can be eaten to help increase potassium intake naturally includes: bananas, white beans, sweet potatoes, tomatoes, dairy foods, and meat. It is important to note that for some people, particularly elderly with kidney disease, it can be dangerous to intake too much potassium. Therefore, it is important to consult with your physician or pharmacist before increasing potassium in your diet.
By: Peyman Mahdavian, PharmD Candidate 2015