There are five main areas that these changes will affect:

1. 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.

2. 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).
   
3. 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.

4. 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.

5. 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. 

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)

• is pregnant

• 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.

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:

1. Cook with less fat – Steam, bake, broil, or grill meat, poultry or fish instead of frying.

2. Eat more vegetables and fruit – Add them wherever you can: soups, sauces, stews. Fresh, frozen or canned are all healthy choices.

3. 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.

4. 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.

5. 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.

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.

            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.

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

-Anemia

 
• 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

Others

• 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.

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.

Infection with HPV occurs with skin-to-skin contact.  Warts are caused by viruses and are passed from person to person.  A common way of contracting the virus is by walking barefoot in public pools, showers etc.

About 30% of warts clear spontaneously in six months and 65% to 78% clear in two years without any treatment.  However, most people would like to resolve warts more quickly than this.  Salicylic acid is a first line OTC option.  This medicine slowly destroys virus-infected skin and may stimulate the immune response of the person infected through mild irritation, which in turn helps clear the infection.  There are a number of salicylic products available.  They range in concentration from 17% to 40%.  A 40% product should be used for plantar warts.  The use of salicylic acid on facial warts is not recommended because of a potential risk of hypo- and hyperpigmentation (skin discolouration).

There is a bit of a regimen to follow with salicylic acid products.  Before treatment the warts should be soaked in warm water for five minutes.  Then, an emery board or pumice stone should be used to remove dead tissue.  The salicylic acid treatment should then be applied.  Treatment may need to be continued for up to 12 weeks. If the wart causes pain, patients can take acetaminophen or ibuprofen for the discomfort. Examples of OTC salicylic acid wart removal products include Compound W, Dr. Scholl’s Clear away Plantar, and Duofilm Wart Remover.

Cryotherapy (freezing) is another common wart removal treatment. This causes irritation and tissue destruction so that the individual mounts an immune response against the virus.  Doctors typically use liquid nitrogen which freezes tissues to -196ºC.  There are also home cryotherapy systems available.  These contain dimethyl ether and propane (DMEP).  Examples include Dr. Scholl’s Freeze away wart Remover, Or, Compound W Freeze off.  Evidence shows DMEP and liquid nitrogen are fairly similar in efficacy.  After application of cryotherapy a blister is formed under the wart.  The frozen skin and wart falls off after about ten days and reveals newly formed skin underneath.   It is recommended that OTC cryotherapy only be repeated three times usually in ten day intervals.

The use of duct tape as a wart treatment has gained popularity.  By putting duct tape over the wart they think the virus is deprived of oxygen which causes irritation and stimulates the immune response to the virus.  Typical administration involves applying silver duct tape over the wart and removing a week later.  Scrubbing the area with an emery board and leaving it open over night.  Then reapplying duct tape.  Silver duct tape has been shown to be more effective than clear duct tape, possibly because of the adhesive.

There are also a number of prescription products that can be used for warts if OTC treatments are ineffective.  Patients with diabetes should consult their physicians before beginning treatment for their warts.  Also, genital warts must be treated by physicians and are not suitable for treatment with OTC methods.

In general OTC wart treatments are effective, however, it may take several weeks for the wart to be removed.  For proper selection of a treatment method come in and speak to your pharmacist.

Constipation is a symptom that occurs when waste moves too slowly through the body, resulting in stool that is dry and hard. This often makes it difficult and painful to pass.

Some medications such as antidepressants, water pills, and certain pain killers (such as Oxycontin and Codeine) may cause constipation.

The frequency of bowel movements varies from person to person, from as little as twice a week to a couple of times a day, and is affected by diet, medications, and exercise.

If you are having trouble going to the washroom, the first thing a pharmacist will usually recommend is increasing the amount of fibre in the diet by eating whole grains, fruits and vegetables. In addition, drinking at least 8 glasses of water will minimize constipation.

If these suggestions do not work, there are several options available to you.

For  short-term treatment of constipation, ( if you haven’t been to the washroom in several days), a saline laxative such as Milk of Magnesia can be tried.  Alternatively glycerin suppositories work quite well.  If symptoms still do not resolve you could consider an enema with the advice of your physician.

Stimulant laxatives such as Dulcolax and Senokot can also be used to maintain regularity.  If you are on long term narcotic therapy you may need to take these types of medications as long as you are taking the narcotics.

For long-term treatment of constipation, bulk-forming agents such as Metamucil or Prodiem Plain can be used. These bulk-forming agents increase the stool weight, allowing the stool to pass through the body faster and cause more frequent bowel movements. These agents typically take about 12-72 hours to take effect and are usually safe to use for long periods of time. When taking bulk-forming agents, it is recommended to drink lots of fluid.

For young children there are a few options.  For immediate relief a pediatric glycerin suppository can be tried.  For chronic long term management PEG 3350 is often prescribed, or is available over-the-counter as LAX-A-Day.  You should consult your family doctor however if you want to try an oral medication for a child suffering from chronic constipation.

If you are not having trouble going to the washroom, but you find the stool to be too hard and painful to pass, the pharmacist may recommend a stool softener such as Colace (docusate sodium) that will soften the stool for increased comfort.

Before deciding on a therapy, talk to a pharmacist and they can help you decide on a treatment that is right for you.

However, there are compounds in grapefruit called furanocoumarins that can interfere with the way your body metabolizes certain medications. This can lead to dangerously high levels of medication in the body and may increase the risk of rare but serious or life-threatening side effects such as slowed heart rate and muscle deterioration. For a few medications, it can lead to decreased effectiveness because these medications need to be metabolized in order to become active. Don’t take these interactions lightly, as some can cause potentially dangerous health problems.

Both grapefruit juice (either fresh or frozen) and the fruit itself can affect certain medications and the effects have been seen with as little as one 8-ounce (250 mL) glass of grapefruit juice. The effects of grapefruit juice on medications can last up to 3 days, so taking them at different times of day will not help. Naturally sweet orange juice has not been shown to affect medications the way grapefruit juice does, but tangelos (which are related to grapefruit), lime juice, andSeville(sour) oranges may affect medications.

Many medications may be affected by grapefruit juice, including medications for:

This is not a complete list; grapefruit juice may affect medications for conditions other than those listed here. Also, if you are taking any natural health products, check the labels to see if they contain grapefruit, tangelo, Seville orange, or lime juice. Avoid these fruits and juices until your doctor or pharmacist has told you it’s safe to have them.