April 22, 2013 New Pharmacists Now Able to Effectively Improve Your Health Through Expanded Scope of Practice
As a result of new regulations governing the practice of pharmacy in Ontario, pharmacists are now able to be more deeply involved in your medications and management of your medical conditions. The new regulations came into effect last October allowing pharmacists to make use of their unique knowledge. This is great news for both pharmacists and you, their patients. It will allow pharmacists to be an even more integral part of your medication management and it will provide you with greater convenience as pharmacists are easily accessible in the community.
There are five main areas that these changes will affect:
- Pharmacists can prescribe several effective medications to help you quit smoking. Patients who may wish to try this method of quitting can now be assessed by their pharmacist – who will use their professional judgement to decide if it is right for you. This means that you will not have to wait to see your doctor in order to get on the path to becoming smoke-free and the pharmacist can be involved throughout this sometimes difficult process.
- Pharmacists may be able to renew your prescriptions without you having to see your doctor first. Your condition and your medications must be stable. For example, this may apply to patients who have well-managed chronic conditions like diabetes or high blood pressure. (This new regulation does not apply to narcotics and similar substances and does not eliminate the need to see your doctor for proper followup and monitoring).
- Pharmacists may also make certain changes/ adaptations to your doctor’s prescription if necessary based on professional judgement. For example, they may change the dosage form (tablet/capsule/liquid) or they could alter the dosing regimen and possibly even the dose to suit you better. As always, any changes would be done with your consent and the pharmacist would share them with your doctor.
- Pharmacists can now be of even greater assistance in helping to demonstrate how to use your devices. If you are a patient who uses an inhaler or has self-administered injections, your pharmacist can now use the real device to show you how to use it, rather than using a model one. Pharmacists who are able to administer injections in order to teach you how to use them have completed a training program.
- Specially trained pharmacists can administer the flu vaccine to patients five years and older. This will provide patients with more locations and greater ease of access to the vaccine.
As usual, your pharmacist will make these decisions based on your specific situation, so it is very important to give them as much information about yourself as you can. They need to know about all of the medications you are taking, including anything over-the-counter or any vitamins/minerals that you use. Also it is important to talk to your pharmacist about your lifestyle (eg. the foods you eat and the exercise you do) so they can get the full picture in order to make the best decisions for you
Pharmacists have always been a wonderful source of information and support for patients regarding how to best manage their medicines and their medical conditions. Now that the role of pharmacists has expanded to allow them to have more involvement with their patients, it will be easier than ever for patients to maintain good control of their conditions and medications.
Shingles is caused by the same virus that causes chickenpox (varicella-zoster virus). After the chickenpox blisters heal, the virus remains dormant in nerve cells in your body. It can become reactivated after many years resulting in shingles. It is not known exactly why the virus becomes reactivated, however it is thought that having a weakened immune system along with physical trauma, UV light or stress may play a role. The risk of developing shingles increases with age and people over 50 years old are at the greatest risk. The symptoms include a painful, blistering rash that often breaks out in one part of the body, usually the chest or upper back are involved. Sometimes the pain resulting from shingles can last for weeks, months, or rarely years, after the rash heals. This lasting pain has been described as burning, aching, throbbing or stabbing and can result from something as little as a breeze or the touch of clothing on the skin. Older people are again at greater risk. Shingles may also result in skin infections at the site of the rash or scarring following healing of the rash.
Fortunately, a vaccine is now available to boost your immune system and help to prevent shingles and its complications. It is called Zostavax and is available to adults over 50 years old. The vaccine cannot be used if you are already experiencing symptoms of shingles; it is only used for prevention. The vaccine is given as a single dose by injection just under the skin of the upper arm by a doctor or trained nurse. As all medicines and vaccines can have side effects, some people may experience redness, pain, swelling, or bruising at the site of injection or headache. These are the most common unwanted effects, but they are usually minor. This vaccine was found to reduce the risk of developing shingles by about 50-70% (depending on your age) within the first year after receiving the vaccine.
Zostavax must be stored frozen below -15 degrees Celsius until the day it is to be used. Only a few pharmacies currently have the correct storage facilities for this vaccine to be able to stock it. Zostavax is available from all of the Boggio Family of Pharmacy locations.
Zostavax is safe for most people, however it should not be used by anyone who:
is allergic to zoster vaccine or to any of the ingredients of the medication (including gelatin)
has a weakened immune system (e.g., due to cancer, HIV/AIDS, problems with bone marrow, or other immune system problems)
has active untreated tuberculosis
has had a serious allergic reaction (hives, face swelling, difficulty breathing) to neomycin
takes high doses of steroids (e.g., prednisone, methylprednisolone) by injection or by mouth
Since this is a relatively new vaccine, it is not known if it will provide protection from shingles for longer than 4 years.
Talk to your doctor or pharmacist for more information and advice about shingles and to find out if the Zostavax vaccine is right for you.
Spring is just around the corner. It’s a time of new life – not only for the plants and animals – but for you too! It is the perfect time of year to make a few simple changes to your daily routine in order to get your heart into great shape, so you’ll have a spring in your step for many years to come!
Our heart is like the engine of our body. Without fuel, it will not work; without maintenance and regular use, it will not function properly; and if you look after it, it will last for many years without the need for repair.
The fuel for our heart is the food we consume. Healthier food choices will result in a healthier, stronger heart.
Here are five easy ways to improve your diet:
Cook with less fat – Steam, bake, broil, or grill meat, poultry or fish instead of frying.
Eat more vegetables and fruit – Add them wherever you can: soups, sauces, stews. Fresh, frozen or canned are all healthy choices.
Use less salt – Try to avoid adding salt when cooking and always taste your food before shaking the salt over it. Try flavouring your food with herbs, spices, garlic, or lemon juice instead.
Cook with more whole grains – Use brown rice, whole wheat flour, and whole wheat pasta in recipes where you would normally use the white version. Also, instead of quick oats, use whole rolled oats as they are the healthier option.
Don’t miss out on fibre – Eat the peel with the apple or the skin of a baked potato for extra fibre as long as they are washed. You could also add rinsed, canned beans to recipes for a fibre boost!
Daily physical activity is the regular use that your heart needs to continue functioning properly. According to Canada’s Physical Activity Guidelines, adults 18-64 should be doing a total of at least 150 minutes of aerobic activity each week. Aim for about 30 minutes of exercise on most days of the week. Activities may include brisk walking, bike riding, dancing, or jogging. The best way to get started is to incorporate physical activity into your daily routine. Take the dog for a brisk walk around the block, spend a day at the park with the family on the weekend, do some gardening, or maybe join a dance class and make some new friends too!
Along with a well-balanced diet and daily physical activity, your heart needs a check-up every once in a while. Your doctor can check your weight, blood pressure, cholesterol levels and blood sugar during an appointment to see that your heart is in good working order and may make recommendations to you based on the results.
Drinking too much alcohol, smoking and high levels of stress can also have negative effects on the heart. If you drink alcohol, limit yourself to no more than two drinks a day for women or three drinks a day for men. If you are a smoker, the sooner you become smoke-free, the sooner your body will recover. Talk to your pharmacist about ways to kick the habit. Everyone experiences the feeling of being stressed at some point or another, but the key is how you handle it. It may be as simple as taking a few deep breaths for some people, while others may do daily meditation or practice yoga to remain stress-free. Taking time for yourself each day to do something you enjoy is another way of keeping your stress level to a minimum. Find a new hobby, activity or project that you might enjoy doing either on your own or with friends.
Many people will already be doing one or more of these things to look after their hearts, and that is great, but if this all seems a bit daunting, don’t worry because of course, you do not have to make all of these changes at once! Decide to make one change this month and maybe add another next month. Before long, you’ll be right on track to keeping your mind, body and heart happy and healthy.
Very few products available in your local pharmacy can claim as many uses as Omega-3 fatty acids. Omega-3s are a type of unsaturated fat that are found in high quantities in certain fish (such as salmon, herring, sardines) as well as plant sources (such as flax).
The two most common Omega-3s found in supplements are EPA and DHA. Some supplements will have their Omega-3s derived from fish oils while others will be derived from plant sources. Be sure to choose a product that lists the amount of EPA or DHA per capsule.
There has been some concern by patients over the levels of heavy metals (such as mercury) in Omega-3 fish oils. However, heavy metals tend to accumulate in the protein of the fish rather than the fats. In addition, Health Canada tests all Omega-3 products for their heavy metal content before being made available to the public.
Here are 5 common medical conditions that Omega-3s can help treat:
1. Arthritis – Omega-3s have been shown to help decrease inflammation in the body, therefore they may help relieve some of the pain associated with both osteoarthritis and rheumatoid arthritis. Between 3 – 5 grams of EPA and DHA for 12 weeks are needed for the anti-inflammatory effects.
2. Hyperlipidemia – Omega 3-s can help lower triglyceride (fat) levels circulating in the body. High triglyceride levels contribute to the formation of fat deposits in blood vessels. This can lead to hardening of the arteries, which allows for the formation of dangerous clots which can cause a heart attack or stroke. Studies have shown that 2 – 4 grams of fish oils can lower triglycerides by 20-50%.
3. Hypertension – Omega-3s have a modest effect on reducing blood pressure and may be a viable option for patients with mild hypertension who do not wish to start a prescription medication at this time. Omega-3s reduce the production of agents that constrict blood vessels and increases production of agents that open blood vessels. For cardiac health, 1 gram of EPA plus DHA daily is recommended.
4. Depression – Studies have shown that 1 gram of EPA twice daily may yield anti-depressant and/or mood stabilizing effects. Omega-3s may be suited for the treatment of specific populations, such as pregnant or lactating women where conventional antidepressants must be used with caution.
5. Loss of Vision – Recent studies have shown the beneficial effects of omega-3s on vision, specifically decreasing risk of age related macular degeneration. Further investigations are needed to confirm the results of these studies, however many ophthalmologists are now recommending that their patients take Omega-3 supplements.
If supplements are not for you, try to replace the meat in two of your meals per week with fish. Certain populations (such as Mediterranean and Inuit) that eat high amounts of fish and little amounts of red meats have much lower rates of cardiovascular disease compared to the North American populations.
Omega-3s are not for everyone. For patients on blood thinners such as Coumadin (warfarin) or Aspirin (ASA), be sure to check with your physician or pharmacist before starting on Omega-3s as they may increase the risk of bleeding.
Many patients come into the pharmacy and have questions about cholesterol and what they can do to decrease it. Whether they found out they have elevated cholesterol through routine blood work or have a family history of high cholesterol, patients are curious about natural ways of lowering their cholesterol.
There are two types of cholesterol: a “good” cholesterol (HDL) and “bad” cholesterol (LDL). For patients with high cholesterol, the goal of therapy is to increase the amount of HDL and decrease the amount of LDL. Approximately 80% of cholesterol is made by the body and only 20% comes from the food you eat.
Many commercials for food products such as cereals and margarines are advertising that they can help lower cholesterol. The goal of this article is to examine the evidence of the effectiveness of various natural health and food products on the market that claim to lower cholesterol.
Products that contain soluble fibres such as psyllium (ie. Metamucil) or oat bran are known as bile acid binders. These products increase the excretion of cholesterol from the body as well as increase the breakdown of cholesterol in the body to less harmful products. Between 10 and 30 grams of psyllium fibre daily mixed with others foods has been shown to have a significant cholesterol lowering effect.
Between 1.5 and 3 grams per day of Niacin (Vitamin B3) has been shown to lower bad cholesterol while increasing good cholesterol. In some patients, Niacin can cause skin flushing (redness of the skin) as well as itching. There are “flush-free” or “no flush” Niacin products available; however, their effectiveness has not been established.
Plant sterols and stanols often found in margarines labeled heart healthy (such as Becel Pro-activ) have been shown to prevent some of the absorption of cholesterol from the diet and can be included as part of a healthy diet high in fruits and vegetables to lower cholesterol.
Finally, some studies have shown that between 600 and 1200mg of garlic in three divided doses can lower the levels of cholesterol and triglycerides (fat) in the body. Unfortunately, some patients report bad breath as well as nausea and flatulence when taking this amount of garlic.
Patients who have been prescribed a cholesterol lowering medication called a “statin” such as Crestor (rosuvastatin) or Lipitor (atorvastatin) can consider taking Coenzyme Q10. Statins inhibit the synthesis of Coenzyme Q10, which may lead to muscle weakness and impaired energy metabolism.
If you have any questions about natural health products available to help lower your cholesterol, be sure to ask your physician or community pharmacist to see if those products are right for you.
It is time to start thinking about getting the Flu vaccine. There will be flu shot clinics offered in the local area in the upcoming weeks that anyone can go to. Often these clinics are underutilized. There is still a great deal of misunderstanding about the flu vaccine and who should be immunized.
Each year an average of 20,000 people are hospitalized, and between 2,000 and 8,000 Canadians can die of influenza and its complications. Those most likely to suffer complications of the flu are the most vulnerable; children under two and adults over 65. The seasonal influenza vaccine is safe and effective and can benefit people of all ages. The flu shot only provides protection up to 12 months; immunization is required each year. This year’s flu shot protects against the H1N1 flu virus as well as two other strains of flu. October to mid-November is the best time for immunization, but the vaccine may still be given in winter months.
Who should get immunized? The following is a list from the recommended guidelines.
People at high risk of influenza-related complications, including:
- Adults and children with chronic conditions such as:
- Cardiac or lung disorders such as asthma
- - Diabetes mellitus and other metabolic diseases
- - Cancer, immunodeficiency, immunosuppression
- -Renal disease
- Children and adolescents with conditions treated for long periods with aspirin
- All residents of nursing homes or other chronic care facilities
- Seniors aged 65 years or older
- Pregnant women
- Children aged 6 months to 23 months of age
- Persons who are morbidly obese
- Aborigional peoples
People capable of transmitting influenza to those at high risk of complications, including:
- Health care and other care providers
- Household contacts of those at high risk and to infants less than six months
- Members of a household expecting a newborn during flu season
- Women at all stages of pregnancy or breastfeeding mothers
- Those providing regular child care to children 0-23 months
- Those who provide services within closed settings to persons at high risk
- People who provide essential community services
- People in direct contact with avian influenza infected poultry
- Healthy people aged 5-64 years should consider getting the vaccine even if they are not in one of the above groups
The list of those who should receive the vaccine is extensive. If you have had an anaphylactic reaction to the vaccine or one of its components you should not get the vaccine. Or, if you have an allergy to eggs you should discuss getting the vaccine with your health care practitioner. However, it has been shown that egg-allergic individuals may be vaccinated using the TIV vaccine.
Children 6 months to less than 9 years who have never received the seasonal flu vaccine require two doses, with a minimum of four weeks between doses.
Please remember that the flu shot cannot cause the flu. If you have become sick after getting the shot in the past it was a coincidental infection of some other kind. The main side effect is pain and redness at the site of injection for a day or two afterward.
The flu shot is effective. Scientific studies show the effectiveness of the flu shot to range from 70% to 90%.
Adults over 65 should also look in to getting the pneumococcal vaccine. Pneumococcal disease, a common complication of influenza, is a bacterial disease that can cause meningitis, bacteremia (a bloodstream infection) and pneumonia. You can get this vaccine at the same time as the flu shot through your doctor.
To date you must get your flu shot through your doctor or the flu shot clinics in the area. At some point in the near future this vaccine may become available to be given by your pharmacist who will be trained to give injections.
If you have any questions about any of the above information please call or visit your local pharmacy.
Ringworm is a common name for fungal skin infections. These types of infections are also referred to as tinea. They affect approximately 10% to 20% of the population. Ringworm appears as rings or round red patches with clear centers and red, scaly borders. Tinea can affect the scalp, nails, or skin.
Management for superficial fungal infections involves some simple non-drug methods, and over-the-counter remedies in the form of sprays lotions and creams. Affected individuals should try to reduce moisture in the affected area. Loose-fitted clothing made of cotton or material that absorbs moisture should be worn. The skin should be dried completely before covering with clothing. If the infection involves the feet, flip flops should be worn with bare feet to prevent spread to others and reinfection.
There are also many topical antifungal agents available. Examples include Canesten cream (clotrimazole), Nizoral shampoo (ketoconazole), and Monistat-Derm (miconazole), to name a few. Creams and solutions are useful because they can be rubbed into the area. Solutions work in hairy areas because they are easier to apply. Powders can serve as useful additions to creams and solutions. They are helpful when the infection is wet or oozing, or where a drying agent is needed. When applying the antifungal product it should be applied to the lesion as well as one to two inches around the lesion. The antifungal should also be used for one to two weeks after lesions clear to reduce the rate of recurrence.
Patients who have diabetes, or those who are immunosuppressed may need prescription oral therapy. It is best for your doctor to assess theses fungal infections. Fungal infections of the nail are also resistant to over-the-counter treatment.
There are some home remedies for treating nail fungus. Patients have tried applying Vics VapoRub and tea tree oil. There is not a lot of evidence to suggest the efficacy of these products for this condition, however some people may wish to try them before resorting to an oral medication.
If you think you may be affected by a fungal infection there are a number of treatment options available. Most issues can be resolved with some persistence and the proper product. Please speak to your pharmacist about what option is best for you.