Friday, June 18, 2010
Drug Allergies - 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
Drug Allergies
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at 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.
The black doctor’s phone rings in the dispensary. The doctor on the other end of the line is frustrated. She wants to prescribe an antibiotic to a patient with a sinus infection. When the doctor asked the patient if she had any allergies, the patient said she couldn’t remember which medication she was allergic to. The patient told the doctor to phone the pharmacy to get a list. When I look at the patient’s profile on the pharmacy computer, I see at least 7 different medications the patient claimed to be allergic to. Now the doctor is even more frustrated. The only medication the doctor thought would work for the patient’s sinus infection was on the allergy list. The doctor has no other medications in her arsenal to help the patient.
We really do have people who come into the pharmacy claiming to be allergic to everything. Now, it isn’t that I’m calling them liars. I am sure they have had a bad reaction to the medications they tell me about. However, part of my job is to try to determine which are true allergies, and which are just intolerances.
So what is the difference between a medication allergy and an intolerance and why should you care? An intolerance is a bad reaction like having an upset stomach, vomiting, diarrhea or headache. Not that these aren’t very unpleasant reactions, but they aren’t true allergies. True allergies are reactions such as a measles-like rash or hives. The most serious type of allergic reaction is called anaphylaxis. Symptoms that could be suggestive of anaphylaxis include facial or throat swelling, light headedness from low blood pressure, asthma or wheezing, and shortness of breath.
When you tell me that you had a bad reaction to a medication, I am listening for words like “my throat closed”, “I had trouble breathing”, or “my face puffed up”. These can mean that you had an anaphylactic reaction, and another dose of that medication could kill you. So I will put a big warning on my computer not to give you that drug or similar drugs in the future. I will caution you to get a Medic Alert bracelet to warn doctors and EMS personnel that you have a life-threatening drug allergy. We may even talk about whether you should get a referral from your family doctor to an allergy specialist. If, instead, you tell me that you had the worst stomach cramps of your life, as unpleasant as they were, stomach cramps are not life threatening. I will put a note on your file and we will tell doctors not to give you that particular medication again, but you didn’t have a drug allergy.
As a patient, you might feel equally bad whether your reaction to a medication was horrible stomach cramps or puffy face and trouble breathing, but to me the difference is very important. If you had stomach cramps on the antibiotic amoxicillin, we will try to not give you amoxicillin again. But, if the doctor determines amoxicillin is the best medication for you, we can still give it to you. We can tell the doctor to give you a lower dose for a longer time, or we can tell you to take it with food or maybe even recommend a stomach medication to take with the antibiotic to make it less likely to bother you. If you tell me that your face got puffy and you had trouble breathing on amoxicillin, things will be different.
We will suspect you had an anaphylactic allergic reaction to amoxicillin. Anaphylactic allergic reactions can be life threatening. If you get amoxicillin again, the second reaction may be worse than the original reaction. So if a doctor prescribes amoxicillin again, I will tell the doctor there is no way you should get the amoxicillin. In fact, I will tell the doctor not to give you penicillin, cloxacillin, ampicillin, or clavulin because they are all very close chemical cousins to amoxicillin and may also cause a life threatening reaction.
If the doctor says, “Okay, what about cephalexin?” things get a little more complicated. Cephalexin is a more distant chemical cousin to amoxicillin. In pharmacy school, I was taught the chance of cross-reactivity between amoxicillin and cephalexin was about 10%. Apparently, now experts are saying it is really more like 1%. So there is very little chance that someone with an amoxicillin allergy will also be allergic to cephalexin. However, if you tell me that your throat closed on amoxicillin, the doctor and I would still be very nervous about giving you cephalexin and would probably avoid it. If you said you had a rash on amoxicillin, and the doctor wanted to give you cephalexin, I would probably say to go ahead. Eventhough a rash is usually a sign of a true allergy, the chance of cross reactivity between amoxicillin and cephalexin is very low and a rash is not life threatening.
So talk to your doctor and pharmacist about your bad reactions to medications. Tell them exactly what kind a reaction you had, how long after the starting the medication it happened and how long ago it happened. If you tell your doctor you are allergic to four or five medications that really just gave you stomach cramps, that may make it very difficult for your doctor to give you medications that might really help you. On the other hand, if you forget to tell your pharmacist that a certain medication made your throat close, we can’t stop you from getting a medication that could threaten your life.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at 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.
The black doctor’s phone rings in the dispensary. The doctor on the other end of the line is frustrated. She wants to prescribe an antibiotic to a patient with a sinus infection. When the doctor asked the patient if she had any allergies, the patient said she couldn’t remember which medication she was allergic to. The patient told the doctor to phone the pharmacy to get a list. When I look at the patient’s profile on the pharmacy computer, I see at least 7 different medications the patient claimed to be allergic to. Now the doctor is even more frustrated. The only medication the doctor thought would work for the patient’s sinus infection was on the allergy list. The doctor has no other medications in her arsenal to help the patient.
We really do have people who come into the pharmacy claiming to be allergic to everything. Now, it isn’t that I’m calling them liars. I am sure they have had a bad reaction to the medications they tell me about. However, part of my job is to try to determine which are true allergies, and which are just intolerances.
So what is the difference between a medication allergy and an intolerance and why should you care? An intolerance is a bad reaction like having an upset stomach, vomiting, diarrhea or headache. Not that these aren’t very unpleasant reactions, but they aren’t true allergies. True allergies are reactions such as a measles-like rash or hives. The most serious type of allergic reaction is called anaphylaxis. Symptoms that could be suggestive of anaphylaxis include facial or throat swelling, light headedness from low blood pressure, asthma or wheezing, and shortness of breath.
When you tell me that you had a bad reaction to a medication, I am listening for words like “my throat closed”, “I had trouble breathing”, or “my face puffed up”. These can mean that you had an anaphylactic reaction, and another dose of that medication could kill you. So I will put a big warning on my computer not to give you that drug or similar drugs in the future. I will caution you to get a Medic Alert bracelet to warn doctors and EMS personnel that you have a life-threatening drug allergy. We may even talk about whether you should get a referral from your family doctor to an allergy specialist. If, instead, you tell me that you had the worst stomach cramps of your life, as unpleasant as they were, stomach cramps are not life threatening. I will put a note on your file and we will tell doctors not to give you that particular medication again, but you didn’t have a drug allergy.
As a patient, you might feel equally bad whether your reaction to a medication was horrible stomach cramps or puffy face and trouble breathing, but to me the difference is very important. If you had stomach cramps on the antibiotic amoxicillin, we will try to not give you amoxicillin again. But, if the doctor determines amoxicillin is the best medication for you, we can still give it to you. We can tell the doctor to give you a lower dose for a longer time, or we can tell you to take it with food or maybe even recommend a stomach medication to take with the antibiotic to make it less likely to bother you. If you tell me that your face got puffy and you had trouble breathing on amoxicillin, things will be different.
We will suspect you had an anaphylactic allergic reaction to amoxicillin. Anaphylactic allergic reactions can be life threatening. If you get amoxicillin again, the second reaction may be worse than the original reaction. So if a doctor prescribes amoxicillin again, I will tell the doctor there is no way you should get the amoxicillin. In fact, I will tell the doctor not to give you penicillin, cloxacillin, ampicillin, or clavulin because they are all very close chemical cousins to amoxicillin and may also cause a life threatening reaction.
If the doctor says, “Okay, what about cephalexin?” things get a little more complicated. Cephalexin is a more distant chemical cousin to amoxicillin. In pharmacy school, I was taught the chance of cross-reactivity between amoxicillin and cephalexin was about 10%. Apparently, now experts are saying it is really more like 1%. So there is very little chance that someone with an amoxicillin allergy will also be allergic to cephalexin. However, if you tell me that your throat closed on amoxicillin, the doctor and I would still be very nervous about giving you cephalexin and would probably avoid it. If you said you had a rash on amoxicillin, and the doctor wanted to give you cephalexin, I would probably say to go ahead. Eventhough a rash is usually a sign of a true allergy, the chance of cross reactivity between amoxicillin and cephalexin is very low and a rash is not life threatening.
So talk to your doctor and pharmacist about your bad reactions to medications. Tell them exactly what kind a reaction you had, how long after the starting the medication it happened and how long ago it happened. If you tell your doctor you are allergic to four or five medications that really just gave you stomach cramps, that may make it very difficult for your doctor to give you medications that might really help you. On the other hand, if you forget to tell your pharmacist that a certain medication made your throat close, we can’t stop you from getting a medication that could threaten your life.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, June 11, 2010
Custom Compounding - 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
Custom Compounding
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at 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.
My mom has a picture of me with my dad, Bob, my grandfather, Stan and my great-grandfather Tom. I was very young in the picture and I don’t remember meeting Tom. But at least I was alive at the same time as him. I don’t know anything about Tom’s dad, my great-great grandfather. Now imagine if my great-great grandfather without writing it down, could somehow give me the knowledge of how to get to a secret cabin in the woods. Remember, were never alive at the same time. Sounds a little like science fiction, doesn’t it? Well that’s exactly what Monarch butterflies do!
Monarch butterfly generation one is born in Mexico flies north to the southern US, mates and dies. Generation two flies from the southern US to the northern US, mates and dies. Generation three flies from the northern US to Canada, mates and dies. Each of these three generations lives only about a month. Now generation four is special. Obviously this is because it is Canadian. Generation four lives for about 9 months. Nine times longer than each of the previous generations. But the really incredible thing is generation four flies all the way back to Mexico. It flies over 3200 km. It seems to know where to go even though it never flew it before. In fact no butterfly has flown the trip in four generations. Just like if my great-great grandfather passed the knowledge of the location of the secret cabin in the woods to me.
Other useful knowledge from the past is custom compounding. Custom compounding is when a pharmacist mixes together a preparation that isn’t commercially available for a patient at the direction of a physician, vet or dentist. In the past, a lot of what pharmacists did was compounding because there weren’t that many commercially available medications around. Now most pharmacies dispense pre-fab pills. However, there are some pharmacies that have retained the knowledge from the past of how to customize a medication for a particular patient.
At the Dauphin Clinic Pharmacy, we have taken the arcane knowledge of compounding and given it a modern twist so we can tailor medications to an individual patient’s needs. For example, we made a topical version of lorazepam for a nursing home patient. Lorazepam can be used to calm someone who is very agitated. But, as you can imagine, trying to give a pill to someone who is very agitated and has dementia can be difficult. Sometimes the nurse even gets bitten. There is an injectable version of lorazepam, but again it is difficult for the nurse and distressing for the patient. But, holding an agitated patient’s hand and rubbing a medication on their wrist is a very natural and calming thing for a nurse to do. So, we made a topical version of lorazepam so the nurse could rub into onto the wrist. It worked well for both nurse and patient.
For animals, under a vet’s direction, we have made a variety of products. We have made everything from injections for cattle to liquid antidotes for dogs who ate rat poison. One interesting thing we compounded was an antibiotic for a cat. We started with a human medication, ground it up an put it into a special fish paste that the cats love. However, we found one cat didn’t like fish, so that cat gets its medication in a chicken paste. When the patient is a cat, it is still important to listen to the patient’s needs.
Any one who has had hemorrhoids will tell you how annoying, painful and itchy they can be. The problem is most suppositories slide right by the hemorrhoid and so they don’t release much of their medication onto the hemorrhoid. At the Dauphin Clinic Pharmacy we have a suppository mold called a Rectal Rocket. It flares at both ends so the suppository stays where it can do the most good. And, of course we can customize which medications we put in the suppository.
So just like the Monarch Butterflies, we have received our compounding knowledge from our pharmacy fore-fathers. Then we put a modern twist on the knowledge of compounding and with it we can help our patients by customizing their medications to their specific needs.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at 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.
My mom has a picture of me with my dad, Bob, my grandfather, Stan and my great-grandfather Tom. I was very young in the picture and I don’t remember meeting Tom. But at least I was alive at the same time as him. I don’t know anything about Tom’s dad, my great-great grandfather. Now imagine if my great-great grandfather without writing it down, could somehow give me the knowledge of how to get to a secret cabin in the woods. Remember, were never alive at the same time. Sounds a little like science fiction, doesn’t it? Well that’s exactly what Monarch butterflies do!
Monarch butterfly generation one is born in Mexico flies north to the southern US, mates and dies. Generation two flies from the southern US to the northern US, mates and dies. Generation three flies from the northern US to Canada, mates and dies. Each of these three generations lives only about a month. Now generation four is special. Obviously this is because it is Canadian. Generation four lives for about 9 months. Nine times longer than each of the previous generations. But the really incredible thing is generation four flies all the way back to Mexico. It flies over 3200 km. It seems to know where to go even though it never flew it before. In fact no butterfly has flown the trip in four generations. Just like if my great-great grandfather passed the knowledge of the location of the secret cabin in the woods to me.
Other useful knowledge from the past is custom compounding. Custom compounding is when a pharmacist mixes together a preparation that isn’t commercially available for a patient at the direction of a physician, vet or dentist. In the past, a lot of what pharmacists did was compounding because there weren’t that many commercially available medications around. Now most pharmacies dispense pre-fab pills. However, there are some pharmacies that have retained the knowledge from the past of how to customize a medication for a particular patient.
At the Dauphin Clinic Pharmacy, we have taken the arcane knowledge of compounding and given it a modern twist so we can tailor medications to an individual patient’s needs. For example, we made a topical version of lorazepam for a nursing home patient. Lorazepam can be used to calm someone who is very agitated. But, as you can imagine, trying to give a pill to someone who is very agitated and has dementia can be difficult. Sometimes the nurse even gets bitten. There is an injectable version of lorazepam, but again it is difficult for the nurse and distressing for the patient. But, holding an agitated patient’s hand and rubbing a medication on their wrist is a very natural and calming thing for a nurse to do. So, we made a topical version of lorazepam so the nurse could rub into onto the wrist. It worked well for both nurse and patient.
For animals, under a vet’s direction, we have made a variety of products. We have made everything from injections for cattle to liquid antidotes for dogs who ate rat poison. One interesting thing we compounded was an antibiotic for a cat. We started with a human medication, ground it up an put it into a special fish paste that the cats love. However, we found one cat didn’t like fish, so that cat gets its medication in a chicken paste. When the patient is a cat, it is still important to listen to the patient’s needs.
Any one who has had hemorrhoids will tell you how annoying, painful and itchy they can be. The problem is most suppositories slide right by the hemorrhoid and so they don’t release much of their medication onto the hemorrhoid. At the Dauphin Clinic Pharmacy we have a suppository mold called a Rectal Rocket. It flares at both ends so the suppository stays where it can do the most good. And, of course we can customize which medications we put in the suppository.
So just like the Monarch Butterflies, we have received our compounding knowledge from our pharmacy fore-fathers. Then we put a modern twist on the knowledge of compounding and with it we can help our patients by customizing their medications to their specific needs.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, June 04, 2010
SUN SCREENS - 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
SUN SCREENS
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at 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.
There has been some good news lately about skin cancer. Dr. Gordon Jung and colleagues at the University of Alberta published a study in the April issue of the British Journal of Dermalology. They looked at Nonmelanoma Skin Cancers in Alberta from 1988 through 2007. In women they found these skin cancers increased until 2000 and then the rates leveled off. They found in men the cancer rates leveled off in 2001 and then actually went down. The researchers are hoping that the decrease is due to people listening to all the public health messages about reducing sun exposure.
Skin cancer is the most commonly occurring cancer in Canada, and the fastest growing cancer in the world. The Canadian Cancer Society estimates that 75,500 people will be diagnosed with non-melanoma skin cancer in 2010. Risk factors for developing non-melanoma skin cancer include: exposure to the sun,
light-coloured skin, eyes and hair, and a previous history of skin cancer.
The Canadian Dermatology Association recommends:
Plan outdoor activities before 11 a.m. and after 4 p.m. The sun's rays are at their strongest between these hours. It's easy to remember - during these hours your shadow is shorter than you are.
GOLFERS: Choose a high SPF product – 30 – 60 – that offers greater protection as you may be out for more than four hours. Use a golf umbrella or golf cart for personal shade. If possible, wait for play in shaded, treed areas.
Cover your arms and legs. Covering your skin will protect it from the sun. Choose clothing that is: loose fitting; tightly woven; and lightweight.
Wear a wide-brimmed hat (3 inches or 7.5 cm). Most skin cancers occur on the face and neck. This area needs extra protection. So a hat with a wide brim that covers your head, face, ears and neck is needed. Hats without a wide brim, like baseball caps, do not give you enough protection.
Use a sunscreen with SPF (Sun Protection Factor) SPF 30 or higher. Look for "broad spectrum" on the label. This means that the sunscreen offers protection against two types of ultraviolet rays, UVA and UVB. Don’t forget to use SPF 30, broad spectrum lip balm as well.
Apply sunscreen generously, 20 minutes before outdoor activities. Reapply often - at least every 2 hours (and after swimming or exercise that makes you perspire). No sunscreen can absorb all of the sun's rays. Use sunscreen along with shade, clothing and hats - not instead of them. Use sunscreen as a backup in your sun protection plan.
We have been hearing these sun protection warnings for years. The good news is that if the Alberta study is right, we are starting to listen. Keep up the good work.
For More Information visit:
The Canadian Cancer Society: www.cancer.ca
The Canadian Dermatology Association www.dermatology.ca
As always if you have any questions or concerns about these or other products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at 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.
There has been some good news lately about skin cancer. Dr. Gordon Jung and colleagues at the University of Alberta published a study in the April issue of the British Journal of Dermalology. They looked at Nonmelanoma Skin Cancers in Alberta from 1988 through 2007. In women they found these skin cancers increased until 2000 and then the rates leveled off. They found in men the cancer rates leveled off in 2001 and then actually went down. The researchers are hoping that the decrease is due to people listening to all the public health messages about reducing sun exposure.
Skin cancer is the most commonly occurring cancer in Canada, and the fastest growing cancer in the world. The Canadian Cancer Society estimates that 75,500 people will be diagnosed with non-melanoma skin cancer in 2010. Risk factors for developing non-melanoma skin cancer include: exposure to the sun,
light-coloured skin, eyes and hair, and a previous history of skin cancer.
The Canadian Dermatology Association recommends:
Plan outdoor activities before 11 a.m. and after 4 p.m. The sun's rays are at their strongest between these hours. It's easy to remember - during these hours your shadow is shorter than you are.
GOLFERS: Choose a high SPF product – 30 – 60 – that offers greater protection as you may be out for more than four hours. Use a golf umbrella or golf cart for personal shade. If possible, wait for play in shaded, treed areas.
Cover your arms and legs. Covering your skin will protect it from the sun. Choose clothing that is: loose fitting; tightly woven; and lightweight.
Wear a wide-brimmed hat (3 inches or 7.5 cm). Most skin cancers occur on the face and neck. This area needs extra protection. So a hat with a wide brim that covers your head, face, ears and neck is needed. Hats without a wide brim, like baseball caps, do not give you enough protection.
Use a sunscreen with SPF (Sun Protection Factor) SPF 30 or higher. Look for "broad spectrum" on the label. This means that the sunscreen offers protection against two types of ultraviolet rays, UVA and UVB. Don’t forget to use SPF 30, broad spectrum lip balm as well.
Apply sunscreen generously, 20 minutes before outdoor activities. Reapply often - at least every 2 hours (and after swimming or exercise that makes you perspire). No sunscreen can absorb all of the sun's rays. Use sunscreen along with shade, clothing and hats - not instead of them. Use sunscreen as a backup in your sun protection plan.
We have been hearing these sun protection warnings for years. The good news is that if the Alberta study is right, we are starting to listen. Keep up the good work.
For More Information visit:
The Canadian Cancer Society: www.cancer.ca
The Canadian Dermatology Association www.dermatology.ca
As always if you have any questions or concerns about these or other products, ask your pharmacist.
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