Friday, May 28, 2010
Plavix Genetics - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
PLAVIX GENETICS
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
On the Origin of Species was published over 150 years ago by Charles Darwin. It laid out his theory of evolution.
Darwin actually published many papers, and books over his career. He was a barnacle expert and spent a lot of time breeding plants. In his green house he determined that you got better, stronger plants if you cross-fertilized them than if you self-fertilized them. Remember, Darwin had no idea what DNA or genes were or that you could pass your genes on to your off-spring. But when he saw that during breeding it is better to cross breed than to put close relatives together, this made him worried about his own children. You see, Darwin married his first cousin, Emma Wedgwood. A recent study of Darwin’s family tree showed a higher than expected inbreeding coefficient. That means his offspring were more likely than average to have two identical copies of a gene. All genes come in pairs. Most “bad” genes are what we call recessive. That means if you have one copy of the bad gene and one good gene, the good gene will win out and you will not develop the bad trait. However, if you have two identical genes, and they are both for a bad trait, you will get that bad trait. If you marry your first cousin, your children are more likely to have two identical bad genes than the general population. So your children are more likely than average to have genetic diseases.
Speaking of genetics, they are becoming more and more important in the pharmacy. We have always known that not all people react the same way to a medication. Certain medications work well for some people and not for others. Now we think some of this difference could be from genetics. Let’s look at two blood thinners, warfarin and clopidogrel.
Warfarin is a very common blood thinner. It thins the blood by effecting how Vitamin K is used in the body. Vitamin K is involved in the clotting cascade which is a complex series of chemical steps that lead to blood clots. Two enzymes that effect how warfarin works are the one that breaks down warfarin in the liver and other that helps the body form Vitamin K. There are different genetic variations of these enzymes in different people. So, one 5 mg tablet of warfarin may thin the blood a lot in one person and not very much in another depending on the genetic variations of these enzymes.
There was a study was to see if genetic testing could help doctors to better choose doses of warfarin for their patients. They did genetic testing of 868 patients on warfarin and compared them to 2688 controls on warfarin without genetic testing. The result was that the people with the genetic testing had less side effects than the non tested patients. So we should do the warfarin genetic tests on everyone, right? Well, not yet. The problem is that the genetic testing is very expensive. And, there are those that argue that the people in the genetic testing arm of the study were just followed more closely than the control group and that is why they did better. So at the moment doing the standard INR test is still the most cost effective way to adjust someone’s warfarin dose. Down the road, will we be doing genetic tests? Maybe.
Clopidogrel or plavix is a different blood thinner. Clopidogrel is a pro-drug. It must be broken down by an enzyme to be activated. Last November clopidogrel was in the news because the FDA in the US said the stomach medication omeprazole slowed down this activating enzyme and that might make clopidogrel a less effective blood thinner. Now, the FDA is requiring a warning on clopidogrel about the different genetic variations of the activating enzyme. About 3% of us are poor clopidogrel metabolizers, which means that if you give us clopidogrel our genetic variation of the enzyme won’t activate it very well and our blood won’t be thinned as much. There is a genetic test to see if you are a poor metabolizer of clopidogrel, but again it is expensive and not very common in Canada. And the studies haven’t been done to see if the results of the genetic tests would help patients or not. So this is another example of a genetic test that might be helpful down the road , but not today.
So whether you are the great great great grandchild of the father of evolutionary biology or you are on a blood thinner, genetics may play a pivotal role in your health
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
On the Origin of Species was published over 150 years ago by Charles Darwin. It laid out his theory of evolution.
Darwin actually published many papers, and books over his career. He was a barnacle expert and spent a lot of time breeding plants. In his green house he determined that you got better, stronger plants if you cross-fertilized them than if you self-fertilized them. Remember, Darwin had no idea what DNA or genes were or that you could pass your genes on to your off-spring. But when he saw that during breeding it is better to cross breed than to put close relatives together, this made him worried about his own children. You see, Darwin married his first cousin, Emma Wedgwood. A recent study of Darwin’s family tree showed a higher than expected inbreeding coefficient. That means his offspring were more likely than average to have two identical copies of a gene. All genes come in pairs. Most “bad” genes are what we call recessive. That means if you have one copy of the bad gene and one good gene, the good gene will win out and you will not develop the bad trait. However, if you have two identical genes, and they are both for a bad trait, you will get that bad trait. If you marry your first cousin, your children are more likely to have two identical bad genes than the general population. So your children are more likely than average to have genetic diseases.
Speaking of genetics, they are becoming more and more important in the pharmacy. We have always known that not all people react the same way to a medication. Certain medications work well for some people and not for others. Now we think some of this difference could be from genetics. Let’s look at two blood thinners, warfarin and clopidogrel.
Warfarin is a very common blood thinner. It thins the blood by effecting how Vitamin K is used in the body. Vitamin K is involved in the clotting cascade which is a complex series of chemical steps that lead to blood clots. Two enzymes that effect how warfarin works are the one that breaks down warfarin in the liver and other that helps the body form Vitamin K. There are different genetic variations of these enzymes in different people. So, one 5 mg tablet of warfarin may thin the blood a lot in one person and not very much in another depending on the genetic variations of these enzymes.
There was a study was to see if genetic testing could help doctors to better choose doses of warfarin for their patients. They did genetic testing of 868 patients on warfarin and compared them to 2688 controls on warfarin without genetic testing. The result was that the people with the genetic testing had less side effects than the non tested patients. So we should do the warfarin genetic tests on everyone, right? Well, not yet. The problem is that the genetic testing is very expensive. And, there are those that argue that the people in the genetic testing arm of the study were just followed more closely than the control group and that is why they did better. So at the moment doing the standard INR test is still the most cost effective way to adjust someone’s warfarin dose. Down the road, will we be doing genetic tests? Maybe.
Clopidogrel or plavix is a different blood thinner. Clopidogrel is a pro-drug. It must be broken down by an enzyme to be activated. Last November clopidogrel was in the news because the FDA in the US said the stomach medication omeprazole slowed down this activating enzyme and that might make clopidogrel a less effective blood thinner. Now, the FDA is requiring a warning on clopidogrel about the different genetic variations of the activating enzyme. About 3% of us are poor clopidogrel metabolizers, which means that if you give us clopidogrel our genetic variation of the enzyme won’t activate it very well and our blood won’t be thinned as much. There is a genetic test to see if you are a poor metabolizer of clopidogrel, but again it is expensive and not very common in Canada. And the studies haven’t been done to see if the results of the genetic tests would help patients or not. So this is another example of a genetic test that might be helpful down the road , but not today.
So whether you are the great great great grandchild of the father of evolutionary biology or you are on a blood thinner, genetics may play a pivotal role in your health
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, May 14, 2010
Diabetic Feet - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
DIABETIC FEET
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
“So is there any such thing as a diabetic shoe?” My parents are snowbirds. Every winter they go down to Texas. They got back recently, and we were catching up on the phone. While down south my dad was out walking, and saw an ad for diabetic shoes in a pharmacy window. It sounded like a scam to him, but I told him foot care was actually very important for diabetics.
I often talk about the big 4 problems in diabetes. The big 4 are: heart attack and stroke, blindness, kidney disease and amputation. I call these the big 4 because diabetics sometimes ask, “Why do I have to test my blood sugar, take my medications, watch my diet and exercise. I feel fine.” The answer is although a diabetic may feel okay, if they keep their blood sugar down and look after themselves, hopefully they can avoid these big 4 problems.
Diabetes is considered the leading, non-traumatic cause of amputation. The part of the body most likely to be amputated in diabetics are the feet. Unfortunately, over the years in the pharmacy I have seen many diabetics that I've known get their feet amputated. Some people with an extra dose of misfortune had more and more of their foot and leg amputated in several consectutive operations. So, not to scare you, but foot care in diabetics is deadly serious.
Why are diabetics so prone to foot problems? Well diabetes works against the feet in a couple of ways. Over time diabetes can damage nerves. If those are sensory nerves from the feet, a diabetic can't feel things that poke, scrape, or pinch their feet. We call that diabetic neuropathy. This lack of feeling in the feet makes it more likely that a diabetic won’t feel small injuries like blisters or scrapes. So these small injuries can go unnoticed and thus untreated. Which brings us to the second problem working against the diabetic foot. Many diabetics have poor circulation due to the damage diabetes has done to their blood vessels. Less blood to the foot makes it less able to heal after an injury and less able to fight off an infection if one occurs. So diabetics are less likely to notice an injury to their feet and so they are more likely to leave it untreated. That untreated injury is less likely to heal than in a non-diabetic foot and is more likely to get infected. So diabetics are more prone to foot problems.
What can diabetics do to help protect their feet? Start by looking at you feet everyday. Get into the routine of inspecting your feet everyday to make sure there are no cuts, cracks, ingrown toenails or other problems. Get a small mirror to look at the bottom of your feet. When possible, wear white socks. Any blood or other drainage from sores you may not have noticed will show up well on a white sock. Cut your toenails straight across, not too short and file the sharp corners. Do not do home surgery on corns, calluses, slivers or warts. Talk to your doctor about anything you want cut off your foot. The doctor may do it themselves or refer you to a diabetic foot care nurse. And speaking of your doctor, may sure they look at your feet at least once a year. I have even heard it suggested that you take off your shoes and socks on every visit to your doctor to encourage them to look at your diabetic feet as routinely as they would check your blood pressure and sugar.
So what about that diabetic shoe my dad saw advertised in Texas? Do they exist? Rather than just one diabetic shoe, it is more that there are certain characteristics that diabetics should look for in a pair of shoes. Shoes for diabetics should be supportive, and have low heels. Diabetics should not wear pointed toe shoes or shoes like sandals with open toes or heels. Diabetics should never go barefoot. It is recommended they have a pair of shoes to change into for walking around the house. And diabetics should make sure their shoes are fitted properly in a store where the staff are trained to professionally fit their feet.
Canadian Diabetes Association www.diabetes.ca
Canadian Footwear www.canadianfootwear.com
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
“So is there any such thing as a diabetic shoe?” My parents are snowbirds. Every winter they go down to Texas. They got back recently, and we were catching up on the phone. While down south my dad was out walking, and saw an ad for diabetic shoes in a pharmacy window. It sounded like a scam to him, but I told him foot care was actually very important for diabetics.
I often talk about the big 4 problems in diabetes. The big 4 are: heart attack and stroke, blindness, kidney disease and amputation. I call these the big 4 because diabetics sometimes ask, “Why do I have to test my blood sugar, take my medications, watch my diet and exercise. I feel fine.” The answer is although a diabetic may feel okay, if they keep their blood sugar down and look after themselves, hopefully they can avoid these big 4 problems.
Diabetes is considered the leading, non-traumatic cause of amputation. The part of the body most likely to be amputated in diabetics are the feet. Unfortunately, over the years in the pharmacy I have seen many diabetics that I've known get their feet amputated. Some people with an extra dose of misfortune had more and more of their foot and leg amputated in several consectutive operations. So, not to scare you, but foot care in diabetics is deadly serious.
Why are diabetics so prone to foot problems? Well diabetes works against the feet in a couple of ways. Over time diabetes can damage nerves. If those are sensory nerves from the feet, a diabetic can't feel things that poke, scrape, or pinch their feet. We call that diabetic neuropathy. This lack of feeling in the feet makes it more likely that a diabetic won’t feel small injuries like blisters or scrapes. So these small injuries can go unnoticed and thus untreated. Which brings us to the second problem working against the diabetic foot. Many diabetics have poor circulation due to the damage diabetes has done to their blood vessels. Less blood to the foot makes it less able to heal after an injury and less able to fight off an infection if one occurs. So diabetics are less likely to notice an injury to their feet and so they are more likely to leave it untreated. That untreated injury is less likely to heal than in a non-diabetic foot and is more likely to get infected. So diabetics are more prone to foot problems.
What can diabetics do to help protect their feet? Start by looking at you feet everyday. Get into the routine of inspecting your feet everyday to make sure there are no cuts, cracks, ingrown toenails or other problems. Get a small mirror to look at the bottom of your feet. When possible, wear white socks. Any blood or other drainage from sores you may not have noticed will show up well on a white sock. Cut your toenails straight across, not too short and file the sharp corners. Do not do home surgery on corns, calluses, slivers or warts. Talk to your doctor about anything you want cut off your foot. The doctor may do it themselves or refer you to a diabetic foot care nurse. And speaking of your doctor, may sure they look at your feet at least once a year. I have even heard it suggested that you take off your shoes and socks on every visit to your doctor to encourage them to look at your diabetic feet as routinely as they would check your blood pressure and sugar.
So what about that diabetic shoe my dad saw advertised in Texas? Do they exist? Rather than just one diabetic shoe, it is more that there are certain characteristics that diabetics should look for in a pair of shoes. Shoes for diabetics should be supportive, and have low heels. Diabetics should not wear pointed toe shoes or shoes like sandals with open toes or heels. Diabetics should never go barefoot. It is recommended they have a pair of shoes to change into for walking around the house. And diabetics should make sure their shoes are fitted properly in a store where the staff are trained to professionally fit their feet.
Canadian Diabetes Association www.diabetes.ca
Canadian Footwear www.canadianfootwear.com
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, May 07, 2010
Pharmacare 2010 Redux - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
PHARMACARE 2010 Redux
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
I’ve been getting a lot of questions about Pharmacare lately. People seem to be surprised that they need to pay for their medications in April, they don’t understand how Pharmacare works, they don’t know you can get Pharmacare benefits if you are under the age of 65 and some people don’t even seem to know they are entitled to Pharmacare benefits at all.
Manitoba Health defines Pharmacare as “…a drug benefit program for any Manitoban, regardless of age, whose income is seriously affected by high prescription drug costs” So some of the tax money we pay the Manitoba Government goes into a big pool and then if we need a prescription medication and meet certain conditions, Pharmacare will pay for our medications.
So what are those conditions? First, you have to apply for the Pharmacare program. If you don’t apply, no matter what your income is or how expensive your medications are, Pharmacare won’t pay for anything. The good news is the application form is only one page long and you can pick one up at any pharmacy or at the Manitoba Health website. Your pharmacist can help you fill it out.
Once you have applied for Pharmacare benefits, in 4 to 6 weeks, Pharmacare will send you a letter stating your Pharmacare Deductible. Your Deductible is the amount of money you have to spend on eligible prescription medications before Pharmacare starts paying. Your Deductible is based on your income. The higher your income, the more medication you will have to buy for before Pharmacare starts to pay.
The Pharmacare year runs from April 1 to March 31. So every year, everyone has to start paying for their medications again once April fool’s day passes. Then as you pay for your eligible prescriptions, you may eventually spend more than your Deductible. Once you spend more than your Deductible, Pharmacare will start paying for your eligible prescription medications until the next March 31.
What is an eligible prescription medication? Pharmacare has a formulary. A formulary is a list of all the medications that Pharmacare will pay for. Not every medication a doctor can prescribe is on the formulary. Two common questions I get asked are: “My doctor prescribed it. I need it. That means the government pays for it, right?”, and “This new medication is now approved for sale in Canada. If my doctor prescribes it, it will be covered, right?” Unfortunately, the answers to both those questions can be, “No.” Health Canada approves medications for sale, if they determine the medication is safe and effective. Manitoba Health determines which medications it wants to pay for. It puts those medications on the Pharmacare formulary. New medications are usually not covered for a few years after they are released. Manitoba Health only has a limited amount of money with which to pay for prescription medications. So it must make a list of medications it feels it can afford to pay for. Unfortunately, if the medication you need isn’t on the formulary, Pharmacare won’t pay for it.
Actually, the government doesn’t make the formulary as simple as a medication is covered or not. There are actually three different parts of the formulary. Part 1of the formulary are medications that any doctor can prescribe for any condition and Manitoba Health will pay for them. Part 2 (EDS Part 2) are medications that Manitoba Health will not pay for unless the drug is used for a specified condition for a specified time. The doctor is supposed to indicate that the medication meets these criteria by writing “Meets EDS” on the prescription. Part 3 (EDS Part 3) or Exceptional Drug Status is really all other medications that Manitoba Health doesn’t normally pay for. Your doctor can contact Manitoba Health and ask for an exception in your case (exceptional drug status) and hope that Manitoba Health will pay in your exceptional case.
The last question I am often asked is about Pharmacare Pre-Pays. A Pre-Pay is if you want to pay off your whole Deductible at once. Pre-Pays are a Dauphin Clinic Pharmacy program and don’t involve Manitoba Health. Manitoba Health doesn’t want all your Deductible money up front. But, if you go to the Dauphin Clinic Pharmacy, you can pay off your whole Deductible at once. We put your money as a credit on your account. When you fill prescriptions, we charge them against that credit. When the credit runs out, you will be over your Deductible and Pharmacare will start to pay. And the best part about paying your deductible up front is the Dauphin Clinic Pharmacy will give you 10 percent of your deductible back.
I hope that explains some of the common questions about Pharmacare.
Pharmacare application form: www.gov.mb.ca/health/pharmacare/docs/pharmform.pdf
As always if you have any questions or concerns about these products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
I’ve been getting a lot of questions about Pharmacare lately. People seem to be surprised that they need to pay for their medications in April, they don’t understand how Pharmacare works, they don’t know you can get Pharmacare benefits if you are under the age of 65 and some people don’t even seem to know they are entitled to Pharmacare benefits at all.
Manitoba Health defines Pharmacare as “…a drug benefit program for any Manitoban, regardless of age, whose income is seriously affected by high prescription drug costs” So some of the tax money we pay the Manitoba Government goes into a big pool and then if we need a prescription medication and meet certain conditions, Pharmacare will pay for our medications.
So what are those conditions? First, you have to apply for the Pharmacare program. If you don’t apply, no matter what your income is or how expensive your medications are, Pharmacare won’t pay for anything. The good news is the application form is only one page long and you can pick one up at any pharmacy or at the Manitoba Health website. Your pharmacist can help you fill it out.
Once you have applied for Pharmacare benefits, in 4 to 6 weeks, Pharmacare will send you a letter stating your Pharmacare Deductible. Your Deductible is the amount of money you have to spend on eligible prescription medications before Pharmacare starts paying. Your Deductible is based on your income. The higher your income, the more medication you will have to buy for before Pharmacare starts to pay.
The Pharmacare year runs from April 1 to March 31. So every year, everyone has to start paying for their medications again once April fool’s day passes. Then as you pay for your eligible prescriptions, you may eventually spend more than your Deductible. Once you spend more than your Deductible, Pharmacare will start paying for your eligible prescription medications until the next March 31.
What is an eligible prescription medication? Pharmacare has a formulary. A formulary is a list of all the medications that Pharmacare will pay for. Not every medication a doctor can prescribe is on the formulary. Two common questions I get asked are: “My doctor prescribed it. I need it. That means the government pays for it, right?”, and “This new medication is now approved for sale in Canada. If my doctor prescribes it, it will be covered, right?” Unfortunately, the answers to both those questions can be, “No.” Health Canada approves medications for sale, if they determine the medication is safe and effective. Manitoba Health determines which medications it wants to pay for. It puts those medications on the Pharmacare formulary. New medications are usually not covered for a few years after they are released. Manitoba Health only has a limited amount of money with which to pay for prescription medications. So it must make a list of medications it feels it can afford to pay for. Unfortunately, if the medication you need isn’t on the formulary, Pharmacare won’t pay for it.
Actually, the government doesn’t make the formulary as simple as a medication is covered or not. There are actually three different parts of the formulary. Part 1of the formulary are medications that any doctor can prescribe for any condition and Manitoba Health will pay for them. Part 2 (EDS Part 2) are medications that Manitoba Health will not pay for unless the drug is used for a specified condition for a specified time. The doctor is supposed to indicate that the medication meets these criteria by writing “Meets EDS” on the prescription. Part 3 (EDS Part 3) or Exceptional Drug Status is really all other medications that Manitoba Health doesn’t normally pay for. Your doctor can contact Manitoba Health and ask for an exception in your case (exceptional drug status) and hope that Manitoba Health will pay in your exceptional case.
The last question I am often asked is about Pharmacare Pre-Pays. A Pre-Pay is if you want to pay off your whole Deductible at once. Pre-Pays are a Dauphin Clinic Pharmacy program and don’t involve Manitoba Health. Manitoba Health doesn’t want all your Deductible money up front. But, if you go to the Dauphin Clinic Pharmacy, you can pay off your whole Deductible at once. We put your money as a credit on your account. When you fill prescriptions, we charge them against that credit. When the credit runs out, you will be over your Deductible and Pharmacare will start to pay. And the best part about paying your deductible up front is the Dauphin Clinic Pharmacy will give you 10 percent of your deductible back.
I hope that explains some of the common questions about Pharmacare.
Pharmacare application form: www.gov.mb.ca/health/pharmacare/docs/pharmform.pdf
As always if you have any questions or concerns about these products, ask your pharmacist.
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