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Cholesterol: Get the Facts

Our goal is to help our customers become more educated about living a healthy lifestyle so they live longer.  This week we’ll focus on cholesterol. We all hear this word and our immediate thought is that it’s all bad and something to avoid. However, there are two kinds of cholesterol and it’s not all bad for you.

So, what exactly is cholesterol? Cholesterol is a waxy, fat-like substance that’s found in all cells of the body.

We need cholesterol to make hormones, vitamin D, and substances that help you digest food. Your body makes all the cholesterol it needs; however, cholesterol also is found in some of the foods you eat. Cholesterol travels through your bloodstream in small packages called lipoproteins. These packages are made of fat on the inside and proteins on the outside.

Two kinds of lipoproteins carry cholesterol throughout your body: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). Having healthy levels of both types of lipoproteins is important:

LDL cholesterol sometimes is called “bad” cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries, which are blood vessels that carry blood from your heart to your body. The higher the level of LDL cholesterol in your blood, the greater your chance is of getting heart disease.

HDL cholesterol sometimes is called “good” cholesterol. This is because it carries cholesterol from other parts of your body back to your liver. In turn, your liver removes the cholesterol from your body. The higher the level of HDL cholesterol in your blood, the LOWER your chance is of getting heart disease.

By itself, high cholesterol usually has no signs or symptoms, so most people don’t know that their cholesterol levels are too high.

High cholesterol is caused by several factors and there are a few things that you can do to help control your cholesterol levels.

Cholesterol is found in foods that come from animal sources, such as egg yolks, meat, and cheese. Some foods have fats that raise your cholesterol level. For example, saturated fat raises your LDL cholesterol level more than anything else in your diet. Saturated fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.

Trans fatty acids (trans fats) raise your LDL cholesterol and lower your HDL cholesterol which is the exact opposite of what you want. Trans fats are made when hydrogen is added to vegetable oil to harden it.Trans fats are found in some fried and processed foods.

Limiting foods with cholesterol, saturated fat, and trans fats can help you control your cholesterol levels.

There is such a thing as good fat, though. Monounsaturated and polyunsaturated fats that are found in olive, peanut and canola oils can help improve HDL’s anti-inflammatory abilities. Nuts,fish and other foods containing omega-3 fatty acids are other good choices for improving your LDL cholesterol to HDL cholesterol ratio.

Your weight and physical activity can hurt or help your cholesterol levels. The lack of physical activity can lead to weight gain which tends to raise your LDL level, lower your HDL level, and increase your total cholesterol level. With routine physical activity you can lose weight and lower your LDL cholesterol. Being physically active also can help you raise your HDL cholesterol level.

Somethings that you cannot control, like heredity, and your sex and age, play a critical part of your cholesterol level. A condition called familial hypercholesterolemia causes very high LDL. Because this condition begins at birth, it may cause a heart attack at an early age due to plaque build-up in your arteries.

Starting at puberty, men often have lower levels of HDL cholesterol than women. As women and men age, their LDL cholesterol levels often rise. Before age 55, women usually have lower LDL cholesterol levels than men. However, after age 55, women can have higher LDL levels than men. This is one reason why heart disease is the number one killer of women, and because there are usually no symptoms of high cholesterol, it’s important to see your doctor on a regular basis and have your levels checked.

There are several risk factors that affect your LDL cholesterol goal:

  • Cigarette smoking
  • High blood pressure (140/90 mmHg or higher), or you’re on medicine to treat high blood pressure
  • Low high-density lipoprotein (HDL) cholesterol (less than 40 mg/dL)
  • Family history of early heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65)
  • Age (men 45 years or older; women 55 years or older)
If You Have You Are in Category Your LDL Goal Is
Heart disease, diabetes, or a risk score higher than 20% I. High risk* Less than 100 mg/dL
Two or more risk factors and a risk score of 10–20% II. Moderately high risk Less than 130 mg/dL
Two or more risk factors and a risk score lower than 10% III. Moderate risk Less than 130 mg/dL
One or no risk factors IV. Low to moderate risk Less than 160 mg/dL

 

If you are currently taking prescription medications for high cholesterol, be sure to continue taking your medication as directed by your doctor. If you have any questions about the medicines that you are taking, be sure to talk to one or our pharmacists. They will be able to address any concerns you may have.

 

Sources: NIH and WebMD

 

 

 

This week is National Drug & Alcohol Abuse Week (SM)

This week is National Drug & Alcohol Abuse Week (SM). Though, they cover a wide array of topics, we chose to share their information about the dangers of prescription drugs in an effort to help educate parents about prescription drug abuse among teenagers. Hopefully, we can prevent even one death from an overdose with this information.

Prescription drug abuse is when someone takes a medication that was prescribed for someone else or takes their own prescription in a way not intended by a doctor or for a different reason—like to get high.

It has become a big health issue because of the dangers, particularly the danger of abusing prescription pain medications. For teens, it is a growing problem:

  • After marijuana and alcohol, prescription drugs are the most commonly abused substances by Americans age 14 and older.
  • Teens abuse prescription drugs for a number of reasons, such as to get high, to stop pain, or because they think it will help them with school work.
  • Most teens get prescription drugs they abuse from friends and relatives, often times without the person knowing.
  • Boys and girls tend to abuse some types of prescription drugs for different reasons. For example, boys are more likely to abuse prescription stimulants to get high, while girls tend to abuse them to stay alert or to lose weight.

When prescription drugs are taken as directed, they are usually safe. It requires a trained health care provider to determine if the benefits of taking the medication outweigh any risks for side effects. But when abused and taken in different amounts or for different purposes than as prescribed, they affect the brain and body in ways very similar to illicit drugs.

When prescription drugs are abused, they can be addictive and put the person at risk for other harmful health effects, such as overdose (especially when taken along with other drugs or alcohol). And, abusing prescription drugs is illegal—and that includes sharing prescriptions with family members or friends.

There are three kinds of prescription drugs that are commonly abused:

  • Opioids—painkillers like Vicodin, OxyContin, or codeine
  • Depressants—like those used to relieve anxiety or help a person sleep, such as Valium or Xanax
  • Stimulants—like those used for treating attention deficit hyperactivity disorder (ADHD), such as Adderall and Ritalin

Prescription drugs are often strong medications, which is why they require a prescription in the first place. When they are abused, they can be just as dangerous as drugs that are made illegally. Even when they are not abused, every medication has some risk for harmful effects, sometimes serious ones. Doctors consider the potential benefits and risks to each patient before prescribing medications and take into account a lot of different factors, described below. People who abuse drugs might not understand how these factors interact and put them at risk.

Before writing a prescription, doctors take several factors into account:

  • Doctors take into account a person’s weight, how long they’ve been prescribed the medication, and what other medications they are taking. Someone abusing prescription drugs may overload their system or put themselves at risk for dangerous drug interactions that can cause seizures, coma, or even death.
  • Doctors know how long it takes for a pill or capsule to dissolve in the stomach, release drugs to the blood, and reach the brain. When abused, prescription drugs may be taken in larger amounts or in ways that change the way the drug works in the body and brain, putting the person at greater risk for an overdose. For example, when people who abuse OxyContin crush and inhale the pills, a dose that normally works over the course of 12 hours hits the central nervous system all at once. This effect increases the risk for addiction and overdose.
  • Prescription drugs are designed to treat a specific illness or condition, but they often affect the body in other ways, some of which can be dangerous. These are called side effects. For example, OxyContin stops pain, but it also causes constipation and sleepiness. Stimulants, such as Adderall, increase a person’s ability to pay attention, but they also raise blood pressure and heart rate, making the heart work harder. These side effects can be worse when prescription drugs are not taken as prescribed or are abused in combination with other substances—including alcohol, other prescription drugs, and even over-the-counter drugs, such as cold medicines. For instance, some people mix alcohol and depressants, like Valium, both of which can slow breathing. This combination could stop breathing altogether.

How do you know if it’s really abuse?

  • If you take someone else’s prescription medication, even when you take it for its intended purposes (such as to relieve pain, to stay awake, or to fall asleep) it is considered abuse.
  • If you take your own prescription in a way that it is not meant to be taken, it is also abuse. This includes taking more of the medication than prescribed or changing its form—for example, breaking or crushing a pill or capsule and then snorting the powder.
  • If you take a prescription medication to get high, it is also considered prescription drug abuse.

Prescription drugs that effect the brain, including opioid painkillers, stimulants, and depressants, may cause physical dependence that can turn into addiction.

Dependence happens because the brain and body adapt to having drugs in the system for a while. A person may need larger doses of the drug to get the same initial effects. This is known as “tolerance.” When drug use is stopped, withdrawal symptoms can occur. Dependence is not the same as addiction, but it can contribute to a person developing an addiction. It is one of the many reasons why a person should only take (and stop taking) prescription drugs under a doctor’s care.

Carefully following the doctor’s instructions for taking a medication can make it less likely that someone will develop dependence or addiction, because the medication is prescribed in amounts and forms that are considered appropriate for that person. However, dependence and addiction are still potential risks when taking certain types of prescription drugs. These risks should be carefully weighed against the benefits of the medication and patients should communicate any issues or concerns to their doctor as soon as they arise.

Medications that affect the brain can change the way it works—especially when they are taken over an extended period of time or with escalating doses. They can change the reward system, making it harder for a person to feel good without the drug and possibly leading to intense cravings, which make it hard to stop using. This is no different from what can happen when someone takes illicit drugs—addiction is a real possibility. When a person is addicted to a drug, finding and using that drug can begin to feel like the most important thing—more important than family, friends, school, sports, or health.

More than half of the drug overdose deaths in the United States each year are caused by prescription drug abuse. In the last decade, the number of deaths from abuse of prescription drugs has increased dramatically. If you or a friend are in crisis and need to speak with someone now, please call:

  • National Suicide Prevention Lifeline at 1-800-273-TALK (they don’t just talk about suicide—they cover a lot of issues and will help put you in touch with someone close by).

If you need information on treatment and where you can find it, you can call:

 

Source: NIDA for Teens

January is Glaucoma Awareness Month

January is Glaucoma Awareness Month, but just how much do you know about Glaucoma? Most of us have at least heard the word and most of us associate glaucoma with the elderly. But, did you know that you don’t have to be ‘old’ to develop this non-reversible eye disease?

Glaucoma is a condition that is often associated with a buildup of pressure inside the eye. This usually happens when eye fluid doesn’t circulate as it normally should in the front part of the eye. The increased pressure, called intraocular pressure, can damage the optic nerve, which transmits images to the brain. If damage to the optic nerve from high eye pressure continues, glaucoma will cause permanent loss of vision. Without treatment, glaucoma can cause total permanent blindness within a few years.

There are various forms of glaucoma:

Open-angle glaucoma is the most common type of glaucoma. The structures of the eye appear normal, but fluid in the eye does not flow properly through the drain of the eye, called the trabecular meshwork.

Angle-closure glaucoma is also called acute or chronic angle-closure or narrow-angle glaucoma. This type of glaucoma is less common in the United States. Poor drainage is caused because the angle between the iris and the cornea is too narrow and is physically blocked by the iris. the fluid at the front of the eye cannot drain through the angle and leave the eye. Symptoms include severe pain and nausea, as well as redness of the eye and blurred vision. If you have these symptoms, you need to seek treatment immediately. This is a medical emergency. If your doctor is unavailable, go to the nearest hospital or clinic. Without treatment to restore the flow of fluid, the eye can become blind. Usually, prompt laser surgery and medicines can clear the blockage, lower eye pressure, and protect vision.

In low-tension or normal-tension glaucoma, optic nerve damage and narrowed side vision occur in people with normal eye pressure. Lowering eye pressure at least 30 percent through medicines slows the disease in some people. Glaucoma may worsen in others despite low pressures. A comprehensive medical history is important to identify other potential risk factors, such as low blood pressure, that contribute to low-tension glaucoma. If no risk factors are identified, the treatment options for low-tension glaucoma are the same as for open-angle glaucoma.

In congenital glaucoma, children are born with a defect in the angle of the eye that slows the normal drainage of fluid. These children usually have obvious symptoms, such as cloudy eyes, sensitivity to light, and excessive tearing. Conventional surgery typically is the suggested treatment, because medicines are not effective and can cause more serious side effects in infants and be difficult to administer. Surgery is safe and effective. If surgery is done promptly, these children usually have an excellent chance of having good vision.

Secondary glaucomas can develop as complications of other medical conditions. For example, a severe form of glaucoma is called neovascular glaucoma, and can be a result from poorly controlled diabetes or high blood pressure. Other types of glaucoma sometimes occur with cataract, certain eye tumors, or when the eye is inflamed or irritated by a condition called uveitis. Sometimes glaucoma develops after other eye surgeries or serious eye injuries. Steroid drugs used to treat eye inflammations and other diseases can trigger glaucoma in some people. There are two eye conditions known to cause secondary forms of glaucoma.

Pigmentary glaucoma occurs when pigment from the iris sheds off and blocks the meshwork, slowing fluid drainage.

Pseudoexfoliation glaucoma occurs when extra material is produced and shed off internal eye structures and blocks the meshwork, again slowing fluid drainage.

Depending on the cause of these secondary glaucomas, treatment includes medicines, laser surgery, or conventional or other glaucoma surgery.

Glaucoma is usually inherited and may not show up until later in life, but there are cases of infants and children who have glaucoma. In African-Americans, glaucoma occurs more frequently and at an earlier age and with greater loss of vision.

You are at an increased risk of glaucoma if you:

  • Are of African-American, Irish, Russian, Japanese, Hispanic, Inuit, or Scandinavian descent
  • Are over age 40
  • Have a family history of glaucoma
  • Have poor vision
  • Have diabetes
  • Have high blood pressure
  • Take certain steroid medications, such as prednisone
  • Have had trauma to the eye or eyes

For most people, there are usually few or no symptoms of glaucoma. The first sign of glaucoma is often the loss of peripheral or side vision, which can go unnoticed until late in the disease. This is why glaucoma is often called the “sneak thief of vision.”

Detecting glaucoma early is one reason you should have a complete exam with an eye doctor every one to two years so it can be diagnosed and treated before long-term vision loss occurs. Occasionally, intraocular pressure can rise to severe levels. In these cases, sudden eye pain, headache, blurred vision, or the appearance of halos around lights may occur.

If you have any of the following symptoms, seek immediate medical care:

  • Seeing halos around lights
  • Vision loss
  • Redness in the eye
  • Eye that looks hazy (particularly in infants)
  • Nausea or vomiting
  • Pain in the eye
  • Narrowing of vision (tunnel vision)

While glaucoma cannot be prevented, it can be treated. Treatments include:

Eye drops for glaucoma. These either reduce the formation of fluid in the front of the eye or increase its outflow. Side effects of glaucoma drops may include allergy, redness of the eyes, brief stinging, blurred vision, and irritated eyes. Some glaucoma drugs may affect the heart and lungs. Be sure to tell your doctor about any other medications you are currently taking or are allergic to. Because glaucoma often has no symptoms, people may be tempted to stop taking, or may forget to take, their medicine. You need to use the drops as long as they help control your eye pressure as directed by your doctor. Regular use is very important to managing pressures.

Laser surgery for glaucoma. Laser surgery for glaucoma slightly increases the outflow of the fluid from the eye in open-angle glaucoma or eliminates fluid blockage in angle-closure glaucoma. Types of laser surgery for glaucoma include trabeculoplasty, in which a laser is used to pull open the trabecular meshwork drainage area; iridotomy, in which a tiny hole is made in the iris, allowing the fluid to flow more freely; and cyclophotocoagulation, in which a laser beam treats areas of the middle layer of the eye, reducing the production of fluid.

Microsurgery for glaucoma. In an operation called a trabeculectomy, a new channel is created to drain the fluid, thereby reducing intraocular pressure that causes glaucoma. Sometimes this form of glaucoma surgery fails and must be redone. For some patients, a glaucoma implant is the best option. Other complications of microsurgery for glaucoma include some temporary or permanent loss of vision, as well as bleeding or infection.

As part of your healthy new year, make an appointment today to see your eye care professional.

Sources: WebMD and the National Eye Institute

 

DANGER – E-Cigarettes

I was shocked and a bit saddened last week when a customer came into the store with her son who was smoking an e-cigarette. Perhaps they have not been educated about the hidden dangers since these products are not regulated by the FDA. It’s frustrating how these companies can get away with marketing these products as safe, but from what I have read, that is far from the truth. So, allow me to share with you some information that I’ve gathered from the CDC, ALA, National Institute on Drug Abuse, Harvard University and Pharmacy Times.

E-cigarettes are electronic devices that allow users to inhale a vapor containing nicotine or other substances. They are usually battery operated and use a heating element to heat e-liquid from a refillable cartridge, releasing a chemical-filled aerosol.

Because there is no government oversight of these products, nearly 500 brands and 7,700 flavors of e-cigarettes are on the market, all without an FDA evaluation determining what’s in them. So there is no way for anyone—healthcare professionals or consumers—to know what chemicals are contained in e-liquids, or how e-cigarette use might affect health, whether in the short term or in the long run.

Early studies show that e-cigarettes contain nicotine and also may have other harmful chemicals, including carcinogens.  Lab tests conducted in 2009 by the FDA found detectable levels of toxic cancer-causing chemicals—including an ingredient used in antifreeze—in two leading brands of e-cigarettes and 18 various cartridges. A review of studies found that levels of toxins in e-cigarette aerosol varied considerably within and between brands. A 2014 study found that aerosol from e-cigarettes with a higher voltage level contains more formaldehyde, another carcinogen with the potential to cause cancer. According to Consumer Reports, one concern about e-cigs is the fact that larger doses of nicotine can be more harmful, especially to children. The findings are alarming, and the American Lung Association urgently calls for FDA oversight of these products.

Although they do not produce tobacco smoke, e-cigarettes still contain nicotine and other potentially harmful chemicals. Nicotine is a highly addictive drug, and recent research suggests nicotine exposure may also prime the brain to become addicted to other substances.  Also, testing of some e-cigarette products found the vapor to contain known carcinogens and toxic chemicals (such as formaldehyde and acetaldehyde), as well as potentially toxic metal nanoparticles from the vaporizing mechanism. The health consequences of repeated exposure to these chemicals are not yet clear.

Flavors in e-cigarettes also cause concern. Not only are flavors used to target kids, but they may be harmful on their own. E-cigarette and flavor manufacturers and marketers may suggest that the flavor ingredients used in e-cigarettes are safe because they have FEMA GRAS™ status for use in food, but such statements are false and misleading. The reality is that FEMA GRAS™ status does not apply to inhaled substances; it only applies to food, meaning that substances with FEMA GRAS™ status are safe to eat, but perhaps not to inhale. Diacetyl, a flavoring chemical linked to cases of severe respiratory disease, was found in more than 75% of flavored electronic cigarettes and refill liquids tested by researchers at Harvard T.H. Chan School of Public Health.

A survey conducted by the CDC in 2014 found that young adults are trying e-cigarettes more than any other age group. The 18-24 age group had the highest percentage of adults who had ever tried an e-cigarette in their lifetime at 21.6%, according to the CDC study.  The percentage fell more and more for older age groups: 25-44 years (16.6%), 45-64 years (10.2%), and 65 and older (3.7%).

Another worry is the refillable cartridges used by some e-cigarettes. Users may expose themselves to potentially toxic levels of nicotine when refilling them.  In the past year alone, the American Association of Poison Control Centers received more than 2,000 reports of incidents involving children and e-cigs, including many in which children drank the e-cig juice or spilled it on their skin. Cartridges could also be filled with substances other than nicotine, thus possibly serving as a new and potentially dangerous way to deliver other drugs.

In addition to the unknown health effects, early evidence suggests that e-cigarette use may serve as an introductory product for youth who then go on to use other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death. A recent study showed that students who have used e-cigarettes by the time they start 9th grade are more likely than others to start smoking traditional cigarettes and other smokable tobacco products within the next year (Rigotti, 2015).

A Centers for Disease Control and Prevention study found e-cigarettes have become the most-used “tobacco product” among high schoolers, and almost half of all middle and high school students who smoked one type of tobacco product used multiple types. 

So parents, please educate yourselves and learn more about e-cigarettes so you can warn your children about the dangers associated with their use.

Sources: American Lung Association, Pharmacy Times, National Institute on Drug Abuse

 

FDA Approvals for 4th Quarter of 2015

Recently, the following drugs have received approved by the FDA:

Gilead Sciences received approval in November for Genvoya in the treatment of HIV-1 infection.

Those needing management of osteoarthritis pain now have another option in Vivlodex from Iroko Pharmaceuticals.

Aristada from Alkermes received approval for the treatment of schizophrenia.

Those suffering from severe pain may find relief in Belbuca from Endo Pharmaceuticals.
Several new cancer treatments are now available:

Alecensa from Roche has been approved for the treatment of ALK-positive, metastatic non-small cell lung cancer.

Cotellic from Genentech was approved in November for the treatment of BRAF V600E or V600K melanoma.

Janssen Biotech has received approval for Darzalex for the treatment of multiple myeloma.

For the treatment of patients with multiple myeloma who have received prior therapies, Empliciti from Bristol-Myers Squibb has been approved.

Imlygic from Amgen has been approved for the treatment of unresectable recurrent melanoma.

Millennium Pharmaceuticals has been approved for Ninlaro for the treatment of multiple myeloma.

Onivyde from Merrimack has been approved for the treatment of metastatic pancreatic cancer following gemcitabine-based therapy.

A new treatment for metastatic squamous non-small cell lung cancer has been approved: Portrazza from Eli Lilly.

AstraZeneca has been approved for Tagrisso for the treatment of EGFR T790M mutation positive non-small cell lung cancer.

Those suffering from liposarcoma or leiomyosarcoma be find relief in Yondelis by Janssen which as approved in October.
Two new treatments for those with lung disease are now available:

Nucala from GlaxoSmithKline has been approved for the treatment of severe asthma with an eosinophilic phenotype.

For the long-term maintenance treatment of airflow obstruction in patients with COPD, Utibron Neohaler from Novartis has been approved.

 

For more information about these new medications, talk to your doctor for pharmacist to find out more.