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Boggio Family of Pharmacies

Boggios: A healthy choice for your whole life

Monthly Archives: April 2011

There has been a new drug approved to prevent blood clots in people with atrial fibrillation.  Atrial fibrillation is a condition where the heart beats too quickly.  Sometimes this can result in pooling of blood in one of the chambers of the heart which can lead to a blood clot.  This clot can travel to the brain or the lungs and cause a stroke or other serious medical problems.  Traditionally people have taken warfarin to prevent these clots, another drug Pradax is now available.

There are some distinct benefits of Pradax over warfarin and it may be worthwhile to discuss these with your physician.

Warfarin requires frequent monitoring in the form of a blood test called INR testing.  This is not needed with Pradax.  This makes Pradax a great deal more convenient for patients who have difficulty getting to the lab, and for those patients whose INR is hard to control.  This also cuts down on the frequent change of dosing some patients experience with warfarin.

Pradax may also be better at preventing strokes than warfarin.  It is less likely than warfarin to cause bleeding in the brain, (a rare but serious downside of anticoagulants), and it is less likely to interact with medicines and food.

There are however some drawbacks to consider.  Pradax is more expensive than warfarin.  It costs about $120.00 a month.  Warfarin is much less and is covered by the senior’s drug plan.  As of yet Pradax is not covered by the Ontario Drug Benefit Program, but it may be covered by some private insurers.  It may be worth a call to your insurance company to see if it is covered under your plan.

Pradax is taken twice daily as opposed to once daily for warfarin.  It is more important to not miss a dose as this can increase your risk for stroke.

Pradax is also more likely than warfarin to cause heartburn or a stomachache.  Pradax may also cause bleeding in the stomach more often than warfarin.

Pradax capsules need to be kept in their moisture resistant packaging.  Once they are open the tablets are only good for 30 days.  There are no such storage requirements for warfarin.

Pradax may be a good drug for some people.  If you are having trouble keeping your INR at the right therapeutic range and you need frequent dose changes of your medication, you should talk to your doctor or pharmacist about this medication.

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Symptoms of menopause can be very uncomfortable.  The three most common complaints are hot flashes, insomnia, and vaginal dryness.  After the Women’s Health Initiative trial many patients discontinued their hormone therapy due to concerns about cardiovascular problems and breast cancer with Premarin and Premplus.  Unfortunately this left many women struggling with their symptoms.

Mort recent guidelines have emphasized that short-term use of hormone therapy during early menopause may not be that risky.  The risk of heart disease is small if hormones are taken within the first 10 years of menopause.  Also, evidence indicates that the risk of breast cancer probably doesn’t increase when combination hormone therapy is used for only 2 to 3 years.  (Of course you should consult your doctor for their opinion on this information).

There are other options if patients do not want to go the traditional route of hormone replacement.  The best way to deal with symptoms is to treat them individually.

For patients with hot flashes try non drug options first.  Patients should exercise, manage their weight, stop smoking and avoid hot drinks, caffeine and alcohol.  There are some herbal products on the market that can be tried, but in general do not have much evidence for effectiveness.  Black cohosh is being used by many women but it does not seem any better than placebo for hot flashes.  In addition there have been some reports of liver toxicity with its use.  Soy may provide a small benefit.  A common dose is 60 grams /day of soy protein from food, or up to 120 mg/day of soy isoflavones from supplements.  Evening primrose, dong quai, wild yam, and red clover, chasteberry and ginseng have not been shown to work for hot flashes.   There are some prescription drugs that can be tried as well.  These include venlafaxine, gabapentin, and clonidine.  You can ask your doctor if one of these agents are right for you.

Vaginal dryness can be treated by an over the counter product called Replens.  If this proves ineffective a local estrogen therapy such as Vagifem can be tried.

Insomnia can be treated with a low dose non addictive prescription medication such as Zopiclone. An over the counter medication like Gravol or Benadryl can also be used on an occasional basis.

Osteoporosis is a real concern for menopausal women not on hormone therapy.  Women of this age should make sure they are getting 1500 mg of calcium and 1000 IU of vitamin D daily.

Bio-identical Hormone Replacement is another option for symptom treatment.  Hormones used in this treatment are identical to those in the human body.  Bio-identical Hormone therapy is very individualized treatment.  Patients have their hormones analyzed through a saliva test and then their prescriptions are tailor made to meet their needs.  Doses and hormones used are compounded in the pharmacy for each individual depending on their deficiencies and physician’s prescription.  For further information on this type of treatment please visit our website www.boggios.com.

Menopause can be an extremely difficult time for many women.  Luckily there are some good treatment options for the most bothersome symptoms.  The best approach to dealing with them is to consult your doctor and pharmacist about the safest most effective treatment for you.

Right now one million Canadians have Type 2 diabetes and do not know it.  That statement is from the Canadian Diabetes Association Website (www.diabetes.ca).  Diabetes is a growing epidemic and health concern.  There are new treatments and resources available to help manage diabetes.

Bayer and Roche have new meters recently available.  Bayer has a meter called the Didget.  This meter is aimed at kids and rewards them for good monitoring habits.  It comes with games and connects to the Nintendo DS or Ds Lite System.  Patients can get this through their local diabetes education centre or specialist.  Another new meter is called the A1C Now Selfcheck.  This meter captures the three month average of a patient’s glycosylated hemoglobin.  This is close to lab results that your doctor sees and gives patients a very good idea how well controlled their diabetes is.  This test can now be performed at certain pharmacies that have this meter.

Roche’s new meter is called the Accu-Chek Mobile.  This meter uses strip-free testing.  Instead of inserting individual test strips for each blood test a cartridge is inserted which is good for 50 separate tests.  The benefit of this machine is the elimination of strip handling which can be difficult for people with arthritis, Parkinson’s or other dexterity issues.  This machine is free for Humalog or Novorapid insulin users since they must test their blood sugar more often.

There is new medication available as well. Victoza is a relatively new product on the market.  This medication is for patients with type 2 diabetes.  This is a non-insulin, once-daily, injectable  medication, that can help improve blood sugar and has been shown to be able to provide the additional benefit of weight loss.  This medication may used alone or with other medications such as Metformin.  Other similar medications to this will be on the market shortly.  You can call your insurance company to see if this medication would be covered for you.

Besides additional products on the market there are also additional services available for diabetics.  Pharmacists can provide a diabetes medication consult, free to the patient, paid for by the Ministry of Health, and an unlimited number of diabetes follow-ups.  These consults can involve the pharmacist explaining medications, insulin use, and glucometers.  The pharmacist can also use the A1CNow meter and check your average three month blood sugar.  Pharmacists can also provide referrals to diabetic community services and web resources that are available to patients.

If you have diabetes, or are concerned that you may be at risk please call the pharmacy and book an appointment today.

Head lice is a very common problem that can affect anyone.  Head lice are tiny insects that are the size of a sesame seed.  They live on the scalp of humans where they feed on blood and lay their eggs (nits). Young lice are transparent but as they feed on blood they become reddish brown or black in colour.  Nits are whitish-grey tan, or yellow ovals about the size of a grain of sand.

To check for head lice look at the back of the head at the base of the skull.  Diagnosis of a lice infestation requires detection of a living louse.  The presence of nits alone is a sign of a past infestation and may not indicate an active infestation.    You may not be able to see the actual lice but you can probably spot the nits which will be attached to the shaft of the hair, usually in a tear drop shape.  The farther the nits are away from the scalp indicates the longer the individual has been infected.

Head lice can not fly or jump from one person to another.  They can move quickly and transmission occurs through close contact with an infected individual.  Sharing hats brushes, combs, or pillows, can spread head lice.  Also, when children are playing together and they have close head to head contact they can transmit head lice.  To help avoid them advise your child not to try on dress-up clothes at school, and to tuck their hat and mittens in their coat when they are not wearing them.

There are a couple of treatment options available over the counter in Canada.  These include Nix, Kwellada-P, R&C, and Resultz.  Nix, Kwellada-P, and R&C contain insecticides.  Resultz contains ingredients that are not classified as traditional insecticides that work by dissolving the wax that covers the exoskeleton of head lice causing subsequent dehydration and death.  All of the products are considered safe if they are used as directed.

Do not rinse the products while your child is in the bath to avoid over exposure to the active ingredients. Read the instructions on the packaging carefully. Some products must be applied to dry hair and others to wet hair.  All close contacts to the infected individual should be treated regardless if lice can be detected on them or not.  Also, the  affected individual should be retreated within in 7 to 10 days of the first infestation.  In addition to using an OTC product, manual removal of lice and nits is necessary.  The hair should be inspected in one inch segments. A fine-toothed come can be used to comb out remaining live lice and nits.  This may need to be repeated several times throughout the week.  Not doing proper manual removal can cause failure of treatment.

Wash all bedding, stuffed animals and soft toys in the washer, and dry in a hot dryer.  Vacuum areas that can not be washed.  Do not use mayonnaise, petroleum jelly, olive oil, margarine, or other natural products.  There is little evidence to prove efficacy and/or safety.

If all of the steps are followed and the lice persist, they may be resistant to traditional treatment.  In some cases the individual can be prescribed an antibiotic (trimethoprim/sulfamethoxazole) which will kill the lice when they take blood from the host.  Another option is to try permethrin 5% cream left on the head overnight.  If you run into treatment resistant lice you will need to contact your physician before these methods are attempted.

Although lice can be troublesome and time consuming to treat, most problems can be solved by following the directions of the products and being persistant in making sure the problem is eradicated.

For further information on lice treatment please come and speak to your pharmacist.

One of the greatest breakthroughs in medicine was the discovery of antibiotics.  Antibiotics have saved more lives than any treatment or other type of medication to date.  When used properly antibiotics can heal individuals, who previous to their discovery, would never have recovered.  However, often antibiotics are used inappropriately and indiscriminately.  This leads to a number of problems.

The first of these is antibiotic resistance.  The bacteria we are trying to eliminate get “smart”. A mutation occurs in the bacteria and they “develop” defenses against the antibiotics.  Picture it like a battle front in your body.  You get infected with a bacteria and then you send an “army” of antibiotics against the bacteria.  If used properly you eliminate all of the bacteria.  However, sometimes not all of the bacteria are eliminated and now that they have been exposed to that type of antibiotic they develop a defense mechanism against it.  This “smart” bacteria can be passed on to another individual or remain in your system.  The bacteria can grow and next time you try to treat the bacteria the antibiotic is no longer effective.   This leaves doctors with fewer antibiotics to treat the same infection.  Eventually “Super Bugs” are created which can’t be treated with the usual antibiotics and the individual can develop an untreatable infection that may be life threatening.

The second problem with overuse of antibiotics are adverse drug reactions.  One in five emergency room visits for adverse drug events are due to antibiotics.  Antibiotics can also cause side effects such as diarrhea and rash.   As well, patients can sometimes develop C. Difficile diarrhea.  This is an extremely perfuse diarrhea which can result in hospitalization.  Some antibiotics can interfere with patient’s medication like warfarin and cause the patient’s INR to fluctuate.  They can affect patient’s blood sugar if they have diabetes, and can cause problems for elderly patients if they aren’t dosed properly for ageing kidneys.

Sometimes it’s difficult to know when an antibiotic should be used, however, statistics show they are not needed for most upper respiratory infections.  The common cold and influenza do not respond to antibiotics.  Less than 10% of acute bronchitis cases are caused by bacteria.  Most middle ear infections also resolve without antibiotics.  Sore throats are usually caused by a virus.  Only 15% to 30% of sore throats in children are cause by bacteria and only 10% of cases are strep throat in adults.  Also, almost all cases of acute bacterial sinusitis resolve without antibiotics.

If your family or emergency physician are reluctant to prescribe an antibiotic it is because they suspect a viral infection that is usually self limiting.  Also it is best not to save antibiotics from dental visits or previous infections.  Firstly, they expire and become less effective over time.  Secondly, what is good for one type of infection is not necessarily what is needed for a different type of infection.  Different bacteria are susceptible to different types of antibiotics.  A chest infection requires a different agent from a urinary tract infection.  If you are using the wrong type of antibiotic you are delaying appropriate treatment and putting yourself at risk for resistance and side effects.  Sometimes it is best for the physician to order blood work or urine cultures to determine the type of antibiotic needed.  This allows them to choose the agent that will best treat your infection.

All this being said there are definite times when antibiotics are needed and patients shouldn’t hesitate to be seen by a physician.  Often we see patients with skin infections caused by bug bites where they have delayed being treated because they didn’t realize they needed an antibiotic.

If you are unsure whether an antibiotic is necessary contact a physician, or your pharmacist.  Follow the directions on your medication and finish all of it as directed.    There is definitely a need for antibiotics but overuse is going to lead to fewer and fewer treatment options.  This will be less of a problem if patients and health care practitioners work together to make good decisions about their medication.

The birth control pill is one of the most commonly used medications.  However, there still remain some misconceptions about the pill.

There are a number of different types of pills.  They all contain the same type of estrogen.  Newer pills have less estrogen than older pills.  Newer pills are effective in preventing pregnancy and they demonstrate reduced symptoms of bloating and breast tenderness.  The lower dose pills may be less effective if one pill is missed.  If an individual goes for longer than seven days in a pill free interval that is when they are at most risk of pregnancy.  This means it is very important to take the last pill and the first pill of a cycle.  There are some recommendations that a pill with a higher dose of estrogen should be used in women weighing over 154 pounds for increased effectiveness.

Pills differ in the type of progesterone they contain.  Some pills are particularly effective for improving acne.  Diane 35 is used to treat moderate to severe acne.  Yaz is used for mild to moderate acne.  There may be a very small increased risk of forming a clot on these pills, and so pills such as Alesse and Marvelon can be tried first.

Some pills are monophasic, meaning they have constant levels of estrogen and progesterone.  Others have changing levels of progesterone.  Both types of pills are effective, the only difficulty with a triphasic pill is that it is not ideal to be taken without a pill free interval.  If an individual wants to take their pills back to back to avoid a period, they may still get a period with the triphasic pill.

Sometimes women develop migraines on the pill because of a drop in estrogen during the week off the pill, or they want to avoid having a period.  In this case it may be worth taking Seasonale.  This is a pill you take for three months in a row without a break.  This is safe to do and may help with the above mentioned issues.

Patients should be aware that some medications can decrease the effectiveness of the pill.  Rifampin, barbiturates, phenytoin and carbamazepine can all decrease effectiveness.  Experts say that antibiotics are unlikely to reduce efficacy of the pill.

The pill is a good tool for treating a myriad of issues.  It can prevent pregnancy, clear acne, regulate and lighten cycles.  There a number of options when it comes to the type of pill you take to address each of these concerns.  Talk to your doctor or pharmacist to determine the right one for you.

In the last few months we have seen a number of people for treatment of Pinworms.  This type of infection is fairly common most often found in children five to ten years of age because of poor hand washing and close contact in school.  The treatment is simple but some steps need to be followed to help prevent reinfection and spread of this problem.

The most common symptom of this problem is an itchy rectal area.  This is caused by tiny eggs deposited around the anus by a female worm.  When someone with pinworms scratches their perianal area, eggs may lodge under their fingernails and spread to anything he or she touches.  Infested dust, clothing, bedding, or toys can also spread eggs.  When someone accidentally ingests these eggs they become infected.  Adult females live for approximately three months in a human host.  At night they migrate from the rectum to the anus and deposit their eggs.  In moist, humid conditions eggs can survive for up to two weeks.

Pinworms do not cause abdominal pain, bloody stools, fevers, or poor appetite.  If you have these symptoms you should go to the hospital.

If you suspect your child has pinworms the best way to detect them is the “Scotch tape test”.  This is best done at night after a few hours of sleep.  Wrap a piece of cellophane tape around a tongue depressor sticky side out and press it to the skin around the anus to collect any eggs.  Take the tape to the doctor who can look under a microscope to look for pinworm eggs.  If you can collect several samples of tape, 90% of cases will be detected.

If one person in the household is diagnosed with pinworms all of the members of the family should be treated for the condition.  There are two main types of treatment.   The first is Combantrin (taken as a single dose as a liquid or tablet) which is purchased without a prescription.  It is dosed based on weight and should not be given to pregnant women or children under one year of age.  The second is Vermox.  This is a prescription medication also not recommended for pregnant woman, or children under two years of age.  Both types of treatment may need to be repeated because eggs can survive for a few weeks.

Other steps to take include careful hand washing (including scrubbing under fingernails), especially after using the toilet and before eating.  All bedding, clothing and toys need to washed.   Clean underwear and pajamas need to be worn every night.  Bathrooms should also be cleaned particularly well to remove eggs.

It is common to become reinfected with pinworms several months after treatment.  If this happens the doctor should be contacted and everyone should be retreated.

Pinworms are an annoying, but usually, unserious infection.  With proper treatment and care it can be cured.  Talk to your doctor or pharmacist if you suspect you or a family member is infected.