Millbrook Pharmacy Health Tips
Here you will find health tips on a variety of topics. If you are looking for information that you can't find here please don't hesitate to email your suggestion/question to david@millbrookpharmacy.com.
VITAMIN D TO PREVENT FALLS
Vitamin D improves muscle strength among the elderly and helps prevent falls and fractures. The daily dose must be 800 i.u. per day or more (any less won’t do). Some prescribers are giving 50,000 i.u. once a month for convenience.
Measures to reduce falls:
- Watch out for drugs that cause drowsiness, dizziness, impaired balance
- Exercise to strengthen muscles and balance
- Remove tripping hazards at home
- Correct vision with glasses or surgery
DIAPHORESIS
Excessive sweating may be caused by something as tame as exercise and spicy food but at other times, it may be a sign of emergency medical condition that requires treatment.
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Diabetes |
Insulin & other anti-diabetic drugs may cause hypoglycemia which leads to diaphoresis |
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Stimulants |
Caffeine, Cocaine, amphetamine |
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Central acting drugs |
Alcohol, morphine, anti-psychotics |
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Withdrawal from drugs |
Alcohol, narcotic pain killers |
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Serotonin syndrome |
Excessive use of Prozac-like drugs |
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Heart attack |
Rapid firing of sympathetic system |
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Infections |
Accompanied by fever and chills, especially in malaria & TB |
PSYCHOSIS
A person suffering from psychosis becomes detached from reality. His thinking is disorganized, his behavior is bizarre. He is unable to carry out his daily living activities, nor is he able to interact socially. There may be hallucination and delusional thoughts.
Substances that contribute to psychosis:
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OTC |
Prescription |
Illicit |
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Antihistamines |
Antidepressants |
Amphetamine |
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Dextromethorphan |
Antiepileptics |
Cocaine |
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Phenylpropanolamine |
Benzodiazepines |
LSD |
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Levo-dopa |
Marijuana |
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Methylphenidate |
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DRUGS IN VIRAL RHINITIS (COMMON COLD)
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Drug |
Comment |
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Decongestant (e.g. pseudoephedrine) |
Relieve nasal congestion and improve air flow Single dose gives relief for 3 to 10 hours Safe to use for 3 days |
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1st generation antihistamines (e.g. Benadryl) |
May reduce nasal secretion but does not improve recovery time |
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2nd generation antihistamines (e.g. Claritin) |
Non-sedating but no anticholinergic activity and no evidence to support their use alone in controlling rhinorrhea |
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Antihistamine-Decongestant combo |
Have been shown to improve short-term nasal symptoms |
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Vitamin C |
Daily intake of 1 g is associated with a reduction in duration & severity of symptoms |
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Zinc lozenges |
Improved benefit (reduced symptoms & duration of the cold) when started with the onset of symptoms |
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Echinacea purpurea |
Probably effective in the prevention and treatment of common cold in adults May reduce the severity of symptoms among children if given early |
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North American ginseng |
Given daily starting in November for 4 months significantly reduces number, severity and duration of colds |
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Acetaminophen or ibuprofen |
May be helpful for fever or headache in pre-school children |
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Saline drop |
Aids in cleaning the nose in infants |
WHICH BLOOD PRESSURE PILL IS SAFE DURING PREGNANCY
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Acceptable choices |
Comment |
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Labetalol |
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Extended-release nifedipine (e.g. Adalat-XL) |
It isn't associated with
significant adverse outcomes in newborns and infants. |
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Methyldopa |
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PNEUMONIA TREATMENT OPTIONS
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Class |
Drug |
Adverse |
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Aminoglycoside |
Gentamicin, tobramycin |
Nephrotoxicity, ototoxicity |
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Cephalosporin (1st generation) |
Cefazolin |
Anaphylaxis, rash, kidney & liver toxicity |
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Cephalosporin (2nd generation) |
Cefaclor, cefprozil, cefuroxime |
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Cephalosporin (3rd generation) |
Cefotaxime, ceftazidime, ceftriaxone |
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Cephalosporin (4th generation) |
Cefepime |
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Fluoroquinolone |
Ciprofloxacin, levofloxacin, moxifloxacin |
GI upset, photosensitivity, cartilage damage, headache, dizziness |
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Glycopeptides |
Vancomycin |
Nephrotoxicity, ototoxicity, intense flushing (red man syndrome) |
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Ketolide |
Telithromycin |
Nausea/vomiting, hepatotoxicity |
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Lincosamide |
Clindamycin |
Diarrhea, n & v, abdo pain |
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Macrolide |
Azithromycin, clarithromycin, erythromycin |
GI upset, jaundice |
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Nitroimidazole |
Metronidazole |
GI upset, taste alteration, dizziness |
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Oxazolidinone |
Linezolid |
GI upset, bone marrow suppr |
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Pencillin |
Pen-V, Pen-G, amoxicillin, ampicillin, cloxacillin |
Allergy, GI upset, nephrotoxicity |
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Rifamycin |
Rifampin |
Rash, liver toxicity, thrombocytopenia, body fluid discoloration (contact lens stain) |
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Sulfonamide |
Co-trimoxazole |
GI upset, rash |
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Tetracycline |
Doxycycline |
GI upset, photosensitivity |
TOXIC EPIDERMAL NECROLYSIS (TEN)
It is a drug reaction whereby the skin is peeling off from all over the body. Epidermal cells keratinocytes which hold the skin to the body are dying out (necrosis), hence the peeling off.
Some consider TEN to be a more severe form of Stevens-Johnson Syndrome.
There is an initial week of fever before red rash and skin peeling.
Most affected are the epithelia covering the mouth, eyes, and vagina where there are blisters, crusts, and ulceration.
Treatment is to remove the offending drug, place patient in burn unit or intensive care, and intravenous immunoglobulin.
HYPOGLYCEMIA & ADRENERGIC COUNTER REGULATION
Hypoglycemia may come about for various reasons, e.g. malnutrition, exercise, excessive dosage of antidiabetic drugs. The manifestations of hypoglycemia include: excessive hunger, chilliness, trembling, dizziness, speech disorders, sensory and/or visual disturbances, shallow respiration or bradycardia. In more severe cases, the clinical symptoms of a stroke or coma appear.
Our body responds to hypoglycemia by initiating adrenergic counter-regulation which brings about a new set of symptoms: sweating, damp skin, anxiety, tachycardia, hypertension, palpitations, angina pectoris and cardiac arrhythmias.
However, under the influence of sympatholytic drugs such as beta-blockers, clonidine, the signs of adrenergic counter-regulation to hypoglycemia may be reduced or absent.
IMMUNE GLOBULIN: HEART ATTACK & STROKE
The use of immune globulin in Canada is on the rise:
- Replacement therapy for primary or secondary immunodeficiency syndromes
- Idiopathic thrombocytopenic purpura
- (off label)Passive immunizing agent or immunomodulating agent
Immune globulin increases serum viscosity which may be the causative factor for stroke, heart attack, thrombosis, and pulmonary embolism. Risk factors include dehydration (e.g. exercise and use of diuretics), age, atherosclerosis.
MEDICATION INDUCED HEADACHE
This phenomenon occurs in people who use painkillers for migraine or tension headaches. When these painkillers are used at higher than recommended dosage for too long, your body becomes used to the medication. “Rebound” or “withdrawal” headache occurs when you don’t take another pill. You will experience this headache almost every day, all day, even when you wake up in the morning. You feel this steady pain all over your head.
Common medicines that cause medication headache:
- Codeine
- NSAID’s
- Acetaminophen
- Triptans
- Ergotamine
Treatment is to stop, completely, all painkillers. Be aware when you stop the painkillers, the headaches will get worse for a while. You may also feel sick, anxious and sleep badly. However, medication headache should go away in a week, although in some cases it takes weeks or months.
Sometimes, your doctor may prescribe an alternate painkiller to ease off your drug-free period, e.g. a course of NSAID or low dose amitriptyline.
To prevent medication headache:
- Do not use headache pills for 2 or more consecutive days
- Do not use headache pills for more than 15 days in a month
- Avoid codeinated products because they are more likely to cause medication headache
NEEDLE INJURY HEPATITIS B CONCERN
Sharps injuries or blood/mucous membrane exposure poses a risk of transmitting bloodborne pathogens such as hepatitis and HIV.
The exposure site should be washed immediately with soap and water, and mucous membranes should be flushed with water.
The risk of developing hepatitis from a percutaneous exposure can be as high as 1 in 3.
Vaccine responders do not require treatment.
Nonresponders with only 1 vaccination series should get one dose of hepatitis B immune globulin (HBIG) and re-vaccination.
Nonresponders who have had 2 vaccination series should get 2 does of HBIG given 1 month apart.
For unvaccinated workers, the vaccine series should be inititated. HBIG is also indicated if the source is hepatitis B positive.
NEEDLE INJURY AT WORK & HIV CONCERN
Sharps injuries or blood/mucous membrane exposure poses a risk of transmitting bloodborne pathogens such as hepatitis and HIV.
The exposure site should be washed immediately with soap and water, and mucous membranes should be flushed with water.
The average risk for HIV transmission after a percutaneous exposure to HIV-infected blood is 1 in 300. After a mucous membrane exposure, risk is 1 in 1000.
Start antiretroviral PEP (postexposure prophylaxis) as soon as possible (e.g. within hours) after exposure and continue for 4 weeks unless source is found HIV-negative.
Two-drug therapy is used if the HIV status of the source is unknown (e.g. needle from a sharps container). Examples include zidovudine/lamivudine (Combivir) and tenofovir/emtricitabine (Truvada).
Additional drugs (e.g. lopinavir/ritonavir – Kaletra) may be necessary if the exposure is severe (e.g. deep puncture) or the source has symptomatic HIV infection.
MISSED PILLS
It is not easy to be perfect taking pills. We are bound to miss a pill here and there because
our life is never simple. In a 2002 Canadian Contraceptive Study, 6 out of
10 women had missed at least 1 pill during the previous 6 months. And 1 out of
10 missed 6 pills or more. Forgetting a pill in the 2nd or 3rd
week of the 21-day cycle is not likely to increase the risk of ovulation. But
if pills are missed at the beginning or the end of the 21 day cycles, there is
much higher risk of ovulation.
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Week 1 |
Week 2 |
Week 3 |
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Missed 1 pill |
Take it as soon as remembered (may mean taking 2 pills in 1 day) |
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Missed 2 or more pills in a “continuous” regimen |
· Take 2 pills as soon as possible and continue rest of package as usual. · Use a back up method of contraception for 7 days after missed pill. · Use emergency contraception after unprotected intercourse. |
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Missed 2 or more pills in a “cyclic” regimen |
As above |
Discard the remainder of the pack and start a new pack on the day when remembered. Menstruation may not occur in that month. Use a back up method of contraception for 7 days after missed pills. Use emergency contraception after unprotected intercourse
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COLD OR FLU
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Symptom |
Cold |
Flu |
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Fever |
No |
Yes |
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Headache |
No |
Yes |
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Aches & pain |
No |
Yes |
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Weak/tired |
No |
Yes |
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Runny, stuffy nose |
Yes |
No |
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Sneeze |
Yes |
No |
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Sore throat |
Yes |
No |
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Complication |
Bronchitis, pneumonia |
Kidney, heart failure |
GOUT DIET
Basically, you try to avoid food that are high in protein and purine which, when metabolized, becomes uric acid - the culprit in gout.
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Reducing |
Increasing |
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Beef, pork, lamb |
Physical exercises |
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Gravy (meat based) |
Control body weight |
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Seafood (anchovies, cod, haddock, herring, sardine, mussels, scallops) |
Fresh vegetables (except those mentioned in left column) |
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Mushrooms, legume foods like peas, beans and lentil, and vegetables such as cauliflower, spinach and asparagus. |
Fresh fruits (e.g. wild cherry, black cherry) |
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Potato and corn (not more than twice/week) |
Water |
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Alcoholic beverages, especially beer. |
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CHLAMYDIA & GONORRHEA TREATMENT
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Chlamydia |
Gonorrhea |
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Causative organism |
C. trachomatis |
N. gonorrhoeae |
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Incubation |
More than a week |
Less than a week |
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Onset |
Gradual |
Sudden |
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Dysuria |
Mild |
Severe |
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Discharge |
Little Mucoid |
Plentiful Purulent |
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Treatment |
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Single dose of either
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PROPHYLAXIS FOR DENTAL PROCEDURES
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First choice |
Amoxicillin 2g |
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If allergic to ampicillin (amoxicillin) |
Cephalexin 2g Or below |
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If allergic to pencillins |
Clindamycin 600mg or Clarithromcin 500mg or Azithromycin 500mg |
The single dose is taken 30 to 60 minutes before procedure (or up to 2 hours after procedure).
HEART FAILURE SYMPTOMS
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Common symptoms |
Atypical symptoms |
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Dyspnea, orthopnea, exercise intolerance, fatigue, fluid retention, weight gain, nocturia, cough |
Cognitive impairment, delirium, anorexia, nausea, abdominal discomfort, oliguria, cyanosis |
Heart Failure Classes
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Class I |
No symptoms |
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Class II |
Symptoms with regular daily activities |
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Class III |
Symptoms with less than regular activities |
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Class IV |
Symptoms even at rest |
HEART FAILURE TREATMENT
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ACE inhibitor |
Beta blocker |
ARB |
Spironolactone |
Cardiovascular risk factors |
Lifestyle |
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HF symptoms + LVEF<40% |
Yes |
Yes |
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Hypertension, hyperlipidemia, diabetes to be aggressively managed |
Salt restriction, exercise |
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If ACEI not tolerated |
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Yes |
Yes |
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Yes |
Yes |
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If beta blocker not tolerated |
Yes |
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Yes |
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Yes |
Yes |
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If still HF symptoms |
Yes |
Yes |
Yes |
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Yes |
Yes |
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Severe HF + LVEF<30% |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
QUADRUPLE THERAPY FOR H.PYLORI ULCER
The American College of Gastroenterology recommends either triple or quadruple therapy as first-line for treating ulcers caused by H. pylori.
Quadruple therapy is a good first choice for patients who have recently used a macrolide or are allergic to penicillin. The course should last 10 to 14 days.
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Losec 20mg BID |
Nexium 20mg BID (or 40mg OD) |
Pantaloc 40mg BID |
Pariet 20mg BID |
Prevacid 30mg BID |
Tetracycline 500mg QID |
Metronidazole 250mg QID or 500mg TID |
Bismuth compound BSS 525mg QID |
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Yes |
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Yes |
Yes |
Yes |
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Yes |
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Yes |
Yes |
Yes |
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Yes |
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Yes |
Yes |
Yes |
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Yes |
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Yes |
Yes |
Yes |
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