Health Topics

Every day, patients stop at the pharmacy and ask for acetaminophen containing codeine. The general belief is that it can’t be harmful if they don’t need a prescription to get it, and the codeine must make it a better pain killer.

Codeine is an opiate used for treating mild to moderate pain, and an antitussive (cough suppressant) used for coughs that don’t respond to non-opiate medications. The “High Test” acetaminophen contains 8 mg of codeine in addition to 300 mg of the acetaminophen found in regular tablets.

Although most textbooks list the addictive potential of codeine as low, because it provides little euphoria compared to more potent opioids like heroin, codeine preparations can result in both physical and psychological dependence.

Physical dependence with low doses of codeine (defined as less than 200 mg per day, or 25 acetaminophen with codeine tablets) over the short term is uncommon. However, regular and frequent use of codeine over extended periods can lead to tolerance of its pain relief and cough suppression. Signs of physical dependence may be seen as soon as eight hours after the last dose. The symptoms will usually peak within two days and disappear within a week. Symptoms may include anxiety, sweating, yawning, runny nose, watery eyes, abdominal discomfort and “gooseflesh”, as well as a return of the pain that the codeine was originally intended to relieve. Sometimes this pain can return at an even higher intensity than was first experienced, which often leads the patient back to the codeine to escape the pain. Psychological dependence is common in low dose daily users.

For cough suppression, a minimum of 15 mg of codeine is required, or two acetaminophen with codeine tablets. Before trying this medication option, you should speak to a pharmacist or to your doctor, because it is generally not a good idea to suppress a cough. Coughs are designed to help rid the lungs and throat of foreign matter, and suppressing them may prolong an illness or aggravate an infection. However, sometimes it’s necessary to suppress an annoying cough temporarily, in order to get a good night’s sleep. The non-prescription codeine preparations can help in this case.

Codeine and acetaminophen attack pain via different routes, so when acetaminophen alone doesn’t work, it’s thought that adding codeine may take the edge off that pesky pain. Research has shown that you may see some benefit from a dose of 60 mg of codeine in combination with high doses (more than 600 mg) of acetaminophen, but there is no literature to support the effectiveness of the low dose (8 mg) non- prescription codeine preparations. In order to get a 60 mg dose of codeine, it is necessary to take 7.5 acetaminophen with codeine tablets.

This would result in a dose of 2250 mg of acetaminophen. It is recommended for adults to take a maximum of only 1000 mg of acetaminophen every 4 to 6 hrs, or about three 325 mg tablets. (The maximum daily dose of acetaminophen is 4000 mg or 12 tablets). At higher doses, you run the risk of having serious liver problems while your body tries to metabolize the acetaminophen.

So, the “High Test” acetaminophen is not always the best choice to relieve your pain. Talk to a pharmacist about the other non-prescription products available. We can help you identify the type of pain you arc experiencing, and we will suggest appropriate types of pain relief medication, or other courses of action, to help put you at ease.

A recent Gallup Survey found that 83% of Canadians lack knowledge about antibiotics. There are serious misconceptions about antibiotic use; it’s my job to combat those misconceptions. So read on. ..maybe you’re in the majority and I can help you too!

Antibiotics are used to kill or harm specific bacteria. The first antibiotics discovered in the 1930’s; today there are drugs that save lives by curing diseases like pneumonia, tuberculosis and meningitis; antibiotics also clear up many other infections, making life more enjoyable for all of us.

Because bacteria are living organisms, they are always changing in an effort to resist the drugs that we use to kill them. Incorrect use of antibiotics allows bacteria to adapt to the drugs and become resistant, meaning that the antibiotics are no longer useful. The way things are going now, in the near future there may not be any antibiotics left to combat some strains of bacteria.

So, you ask, how am I supposed to use these powerful bug killers? Here’s a list of important DOs and DON’Ts for taking antibiotics:

1. DO discuss the prescription with your pharmacist. It’s important to know exactly how to take the medicine so it can work most effectively for you.
2. DO take the antibiotic at the same time each day. You’ll probably be prescribed more than one dose per day; it’s important to continue taking the medication at regular intervals through the day because it stays in your system a certain amount of time. If you let the level decrease too much, the medication can no longer fight as effectively against the bacteria.
3. DO take all of the medication, even if you begin to feel better. By stopping before the end of the prescription, you may not kill all the bacteria. They can become resistant, making your infection even worse and much harder to treat.
4. DON’T insist that the doctor prescribe antibiotics. Antibiotics can only cure bacterial infections. They are USELESS against a cold, the flu or other viral infections.
5. DON’T share other people’s antibiotics or use old prescriptions. Individual antibiotics are effective against specific bacteria; never assume that the leftover ones in your medicine cabinet (that shouldn’t be left over anyway, because you’re supposed to finish all of them!) do the trick for you this time. If you take a look in your cabinet tonight and find some leftovers, bring them to the pharmacy for disposal.
6. DON’T ignore unexpected side effects. Give the pharmacist a call if you experience anything “unusual” while taking your medication.

If we all remember to follow these simple guidelines, not only ~ we be feeling better faster when we get sick, but we’ll be ensuring that the medications available ~ continue to be useful in the years to come. That’s a bit of insurance for our kids -fewer “superbugs” to contend with as they get older.

The trees and flowers are in full bloom for another year…as any allergy sufferer will tell you. Spring and summer (and even fall) bring a steady stream of patients to the pharmacy, each hoping desperately for relief from the itchy, watery eyes and stuffy nose that seem to be the penalty for living in this area. There is little comfort in the knowledge that you are not suffering alone, but even that small comfort is better than none.

There are many antihistamines available without a prescription. They are all effective, as long as they are used properly. To use them properly, it’s important to know what they do.

Histamine is a substance released in the body when a person is exposed to an allergen. It causes the familiar redness, itching, irritation and swelling that are common in ‘allergic reactions’. Antihistamines are used to block the histamine receptors in the body, so histamine cannot cause such reactions. In order to be effective, the block has to come before the histamine release, so optimum benefit is obtained by using the antihistamine on a regular basis BEFORE experiencing the usual allergy symptoms. Once the allergic response has begun, an antihistamine can be used to prevent further release of histamine if exposure to the allergen is continued, but the symptoms already present will not be relieved and must be tolerated until they run their course. There are products available that will give temporary relief, but they should not be used regularly.

While antihistamines are effective in minimizing symptoms in most patients, They are sometimes less effective in patients who experience chronic symptoms. Always keep in mind that no antihistamine can be expected to relieve 100% of symptoms all the time, so even if you use them properly, you will probably notice some of the normal symptoms of your allergies from day to day. This does not mean that the medication is not working for you anymore, unless the symptoms worsen despite faithful proper use of the medication. If that’s the case, your pharmacist may be able to recommend an alternative antihistamine. Sometimes one product will work better for you than another, or will give you fewer unwanted side effects (like drowsiness). So be sure to return to the pharmacy if your symptoms get worse, or if you have any questions about the medications you are taking.

1. From the table below, select the calcium-rich foods you ate yesterday.
2. Record the number of servings of each food.
3. Total the number of servings.
4. Multiply this total by the number of mg of calcium per serving (indicated).
5. Add the results in each group to calculate your typical daily calcium intake.

Before taking any over-the-counter cold remedies, talk to your pharmacist or doctor if:

• you are not sure it’s a cold.
• you are pregnant or breast-feeding.
• you have any other health problems (eg. high blood pressure, diabetes, thyroid disease).
• you are taking any other drugs, either from your doctor or something you can buy off the shelf.
• you are treating a child under two years of age.
• you want to give an antihistamine to a child under six years of age.

Did You Know…

1. Going out with wet hair won’t make you catch a cold. Nor will wet feet, wet clothing or drafts. Emotional stress, however, may make you more susceptible to colds.
2. Colds are caused by viruses. When a cold virus finds a home in your nose, your body starts to fight back. That’s what causes cold symptoms.
3. Colds are caused by a different kind of virus than ones that cause the “flu”. Getting a flu shot will not protect you from the common cold.
4. Antibiotics do not work for the common cold. When a doctor prescribes an antibiotic, it is usually to treat or prevent a bacteria-causing infection, such as middle ear infection or strep throat.
5. Taking leftover antibiotics can be dangerous. Some out-dated products can do damage to your body. Taking an antibiotic for only a few days can make bacteria resistant to its effect, so it is important to take the full prescription when given an antibiotic.
6. There’s evidence that chicken soup IS good for colds. Like any warm or spicy fluid, chicken soup helps the air passages get rid of irritating mucus.
7. The drying effect of some antihistamines can help a runny nose, but all antihistamines do not have this effect. Your pharmacist can help you find one that will help this cold symptom. Antihistamines should not be used for a stuffy or congested nose. Their drying effect may make a plugged nose worse.
8. There is no truth to the saying “feed a cold, starve a fever”. A light, nutritious diet, and lots of fluids, is best for both of these conditions.
9. Cold remedies come with one or more “active ingredients”. Look for a product that has only the ingredients you need for your cold symptoms. Your pharmacist can help you choose the best product.
10. Some cough and cold remedies contain alcohol or sugar (also called sucrose, dextrose, glucose). If you want sugar or alcohol free medicine for yourself or your child, look on the side of the box; these ingredients will be listed under “non-active ingredients”, “non-medicinal ingredients”, or “also contains”. If in doubt, ask your pharmacist.

Although there are many health and medication related topics to discuss, there are a few topics that seem to lend themselves to reprinting. How to take care of yourself and/or your family when facing a cold is one such topic.There are three different conditions that have similar symptoms, to some extent, and are often mistaken for each other: colds, influenza (flu) and allergic rhinitis. Colds are generally characterized by nasal congestion with thick discharge, a sore or scratchy throat, a cough (productive or dry) and a tightness in the chest. The flu usually involves an overall malaise (“feeling bad”) with associated fever, chills, body aches and pains, and a sore throat. People with allergic rhinitis commonly exhibit symptoms such as sneezing, watery eyes and nasal congestion with. clear, more watery discharge. The onset is often predictable and there is rarely a fever associated with this condition.

There are four basic classes of agents available in Canada to give relief of cold symptoms.

1. Nasal Decongestants. There are oral andtopical decongestants available.

Oral decongestants (e.g. pseudoephedrine – Sudafed®, Drixoral®) are fairly common and can relieve congestion within 15-30 minutes. The duration of action is generally 4-6 hours, with some long-acting brands lasting up to 12 hours. They should not be used for more than 3-5 days at a time, and may cause some difficulty sleeping if taken within 4 hrs or so before bedtime. They will increase nasal discharge as congestion is relieved. These items should not be used by people with severe or unstable high blood pressure. Topical decongestants (e.g. xylometazoline Otrivin® – oxymetazoline – Drisfan®)have a faster onset of action, usually being effective within 5-10 min of use, and generally last up to 12 hours. Again, these agents should not be used for more than 2-3 days consecutively, as there is a good chance of developing rebound congestion that leaves the patient caught in a vicious cycle of compounding the congestion while trying to treat it

2. Antitussives. These items are used to control non-productive coughs,because they suppress the cough reflex in the couch centre of the brain. Common products contain dextromethorphan (any produce with “DM” in its name) or codeine. The usual doses of dextromethorphan (used 3-4 times daily as required) are: adults 15-30 mg; children 6-12 yrs 6.75 mg; and infants >1 yr old 3.75 mg. Products containing dextromethorphan should not be used by people taking certain antidepressants, so it is wise to speak to a pharmacist or your doctor if you are taking other medications.
3. Expectorants. These products decrease the viscosity of secretions from the lungs and respiratory system, helping to lubricate irritated areas and promoting removal of mucus. The only expectorant approved by the Expert Advisory Committee is guaifenesin, so any cough syrup chosen as an expectorant should have this as the main ingredient. The recommended dose is 200 mg four times daily, taken with plenty of water.

Using the strictest definitions, an herb is a plant with a soft stem that dies down to the ground after flowering. However, the term “herb” is usually applied much more liberally to mean any plant of which part or all has been used to flavour food, supplement nutrition or treat medical illnesses. In 1985, the World Health Organization estimated that 80% of the world’s population relies primarily on herbs for it’s healthcare needs.

The first written record of herbs dates back more than 5,000 years to the Sumerians who described medicinal uses of such plants as laurel, caraway and thyme. The earliest book on herbal remedies is a Chinese listing of 365 medicinal plants and their applications, and dates back to 2700 BC. In 1000 BC, the Egyptians used garlic, opium, castor oil, mint and other herbs as medicine. The Romans and Greeks also valued plants for their medicinal benefits and records of their medical practices provided inspiration for later Western medical learning.

During the Middle Ages, herbs continued to be important in medicine, and they reached new heights in the 15th, 16th, and 17th centuries when several books on herbs, commonly called herbals, were published. For the first time some were written in English and in languages other than Latin or Greek. Since then, however, the use of herbs as therapeutic products has slowly diminished.

The introduction in the 17th century of active chemical drugs and the rapid development of sciences such as chemistry in the 18th and 19th centuries led to the dominance of chemical therapy in the 20th century. Synthetic chemicals seemed to be the way of the future.

Healthcare providers and consumers still interested in herbal medicine rapidly became disillusioned with herbal products because they could not rely on the products to be effective on an ongoing basis. It became obvious that there was little or no consistency in manufacturing or quality control testing, and products did not necessarily contain appropriate amounts of the therapeutic ingredients. By the 1960’s, consumers were again beginning to consider herbal medicines and naturopathy and homeopathy to complement traditional chemical therapy. The belief that botanical remedies were “naturally” superior to man-made drugs helped to promote their use in the general public. However, quality control was still a problem, and there was no guarantee that the herb named on the bottle was the same as the herb contained within.

In recent years, manufacturers and suppliers have made great advances in laboratory and manufacturing technology; manufacturers are now able to determine necessary levels of active ingredients in herbal products and to manufacture products consistently with these levels. In addition, ongoing quality control testing of raw materials and finished products ensures that the appropriate levels are met. Products manufactured in this scientific manner are considered “standardized” and can be relied upon for safety and effectiveness. If in doubt, look on the label for the word “standardized” or ask a pharmacist.

If you, or someone you know, has recently been diagnosed with diabetes…you are not alone. In fact, 1.5 million Canadians has diabetes, and this figure is estimated to double by the end of 2010. The good news is that there is much interest in finding ways to better control this disease; through medication management, nutrition guidance and encouragement of an active lifestyle. This is best achieved through your partnerships with a variety of health care professionals, who can help you with your specific health care needs.

Our pharmacists are here to help you…

Controlling you blood sugars: Why is control important? How do you know when your blood sugar is controlled? What affects good control? What do you do if your blood sugars are not well controlled? These are questions that we can help answer.

Blood sugar monitors and strips: In the last decade, blood glucose self monitoring devices have become easier and faster to use. By monitoring your blood sugar, you can see how food, medication, alcohol, exercise, illness and stress can affect your control. If you need a blood glucose monitor or would like to change your monitor…call for an appointment and we will book a session to meet with you and discuss:

• proper instructions and care
• when and how to record your results
• services available to you, such as lancet disposal and control check on your meter

Foot Care: Good foot care starts with good advice. Staff at our home health store can provide instruction that will help keep your feet healthy. Call for an appointment with a foot care nurse who can provide foot care essentials at a reasonable price.

By strict definition, an herb is a plant whose stem is soft and dies down to the ground after flowering. However, the term “herb” is often applied to any plant, part or all or which has been used to flavor food, supplement nutrition or treat medical illnesses. Herbs and herbal medicine have played, and will continue to play, an important role in the healthcare practices.

Lice infestations are a year-round problem, however the autumn return to the classroom tends to result in a peak of reported cases. Tens of millions of cases of head lice are reported each year in North America. Lice are not something to be ashamed of. They are not known to transmit disease, nor do they indicate poor hygiene or uncleanliness. Anyone can get head lice, regardless of sex, race, age, hair length, or socio-economic status. Lice are very contagious and can easily take epidemic proportions. Head lice feed on the blood of their host, much like mosquitoes. They need a warm 30 degree C environment. That’s why they live on the head, the warmest part of the body. Adult lice can only survive away from the body for about 48 hours at room temperature

What Are Head Lice?

• Head lice are tiny gray insects (parasites) that live exclusively on the human scalp. You won’t find them on cats or dogs or any other household pet. Head lice are grayish-white in colour and about 2-3mm in size (the size of a pinhead), and multiply very quickly.

How Lice Spreads

• Heat produced by the body is required for head lice to survive and their eggs (called nits) to hatch. Typically, lice cannot survive away from the body for more than 48 hours. Because lice cannot jump or fly, they are usually transmitted during direct personal contact where the lice can move quickly from one head to another. Head lice may also be picked up when sharing combs, brushes, hats, scarves, pillows, towels, stuffed toys, or just about any article that has come in contact with an infested person.

What To Look For

• In most cases, the first sign of an infestation is constant itching of the scalp, particularly around the ears and the back of the head. Rash-like red marks resulting from scratching may also be visible. If an infestation has been reported in your child’s group, look for lice even if there is no obvious itch; some children don’t experience any itching. Head lice are difficult to see because they are very small and because they avoid light.
  Their nits, which are small, almost white and oval in shape, may be easier to spot. They can be found attached to individual hairs very close to the scalp. Nits may look like scalp flakes or shampoo residue, but they are firmly fastened to hair shafts and difficult to remove by hand. Inspect several hairs in different areas along the hairline and around the ears.

Check Family Members

• If your child has head lice, inspect the hair of family members too. Those who are infested must be treated. You should also inform the parents of your child’s friends and appropriate authorities such as teachers, the school nurse or day-care administrator.

Wash Clothes and Clean House

• To reduce the risk of spreading lice to others, machine-wash all exposed clothing, including head-gear, coats, scarves, as well as bed linens and towels in hot water, then dry them for at least 20 minutes on the hot cycle. Items that are not machine-washable, such as stuffed toys or pillows, should be dry-cleaned or stored in tightly sealed bags for 2 weeks. Soak combs and brushes in hot water for 5 to 10 minutes. It is also recommended that the home environment be kept clean. Thoroughly vaccuum carpets, upholstered furniture, pillows and mattresses.

Treatment of Head Lice

• Medication designed to treat head lice is available from the pharmacy without a prescription. Before using any medication, consult with your doctor, pharmacist or school nurse. It is important that two treatments be applied, one week apart. When using a Head Lice Product: Timing is important – if the product is rinsed off too soon, the lice and nits may not be killed. If it is left on too long, you’re causing unneeded exposure to the lice killing chemicals. These products should not be used near the eyes, nose or mouth. A towel held tightly over the eyes protects them during treatment. Apply a second treatment in one week to kill any newly-hatched lice before they are mature enough to lay new eggs. (Repeat the treatment once only).

TO REMOVE NITS:

Removing the nits after treatment makes it easier to see any new infestations. Bright, natural light helps you to see the nits better.
Comb the hair to remove snarls, then take hold of a lock of hair. Use your thumbnail against your first finger to strip the nits from the hair starting from the roots right down to the tips. Pin back that lock of hair and continue until nits are removed. Try to remove the very tiny eggs laid right next to the scalp.

You can also comb-out the nits holding a fine-tooth comb (nit comb) on a downward angle. The hair should be kept wet during the combing operation and it is important that the comb be wiped clean frequently and freed from clogging.

Products Available For Treatment of Head Lice

	Pyrethrins (e.g. R&C Shampoo) This product should not be used for anyone with a known allergy to ragweed or chrysanthemums. It is important to apply this shampoo to dry hair and leave on the area for 10 minutes. Then add a little water and work the shampoo in the hair and skin. Rinse thoroughly. Remove the dead lice and eggs as instructed in the package instructions.
	Permethrin (e.g. Nix) This product should not be used for persons with a known allergy to chrysanthemums, synthetic pyrethroids, or pyrethrins. Do not use on children under age 2 unless directed by a physician. The hair should be washed with a conditioner-free shampoo, and a conditioner should not be used after washing. Itching my increase for a while after treatment, but this is not a concern.
	SH-206 Shampoo This product is safe and has a low incidence of skin irritation. The shampoo is applied to wet hair, lathered and scrubbed vigorously for 10 minutes and then rinsed. A second application should be done in 48 hours.

Insect repellents protect the skin against insect bites for several hours after topical application. The most effective topical insect repellent is N,N-diethyl-m-toluamide, commonly known as DEET, which is effective in repelling a variety of mosquitoes, ticks, fleas, and flies (biting insects), but is ineffective against wasps or bees (stinging insects). Insect repellents may also contain other chemicals which are not as effective as DEET against mosquitoes and ticks. Once applied, insect repellents surround the application site with a vapour which deters insects. Wind, rain, time and perspiration are able to reduce the size of this vapour barriere and reapplication in necessary.

To avoid insects and insect bites, individuals should avoid brightly coloured clothing, strong and flowery perfume, overripe fruit and clover fields. Covering up with clothing and tucking pant legs into socks and using mosquito netting (for example, draped over a baby carriage, stroller or playpen).

Topical application of DEET can cause skin reactions such as redness, irritation, burning and dermatitis. DEET is absorbed through the skin and may cause systemic toxicity. Reports of serious toxicity in children have generally been associated with excessive or prolonged use of DEET. Consequently, insect repellents should be used cautiously to prevent side effects in children.

Citronella based repellents provide short term protection from mosquitoes, but are not effective against other insects. Other purported repellents include Avon’s Skin-So-Soft and Thiamine (vitamin B1) but data is lacking as to their effectiveness.

GUIDE TO SAFE USE OF INSECT REPELLENTS

• Do not use insect repellents on children less than 6 months old. In older infants and children, products containing greater than 50% DEET are not recommended.
• Sprays should be avoided when possible as they are difficult to apply uniformly and are easily inhaled. Lotions, liquids and sticks are preferred.
• Avoid applying to the hands of children who tend to put fingers in their mouth
• Avoid contact with eyes and mucous membranes
• Avoid long term use or frequent applications
• Store all repellents out of reach of children
• If spraying repellents onto clothing, use a test area first to evaluate possible damage to fabric.

HEALTH ORGANIZATIONS

Asthma
Allergy Asthma Information Association
1-800-611-7011
Asthma Society of Canada
1-800-787-3880
www.asthma.ca

Cholesterol
The Heart and Stroke Foundation of Canada
1-800-360-1557
http://www.heartandstroke.ca/

Diabetes
The Canadian Diabetes Association
1-800-BANTING
www.diabetes.ca

Respiratory
The Lung Association
1-800-668-7682
www.on.lung.ca

Arthritis
The Arthritis Society
1-800-321-1422
www.arthritis.ca

Epilepsy
Epilepsy Canada
1-800-860-5499
www.epilepsy.ca/

PROFESSIONAL ORGANIZATIONS

Ontario College of Pharmacists Ontario Pharmacists Association
Canadian Pharmaceutical Association
Canadian Home Care Association
Site of Virtual Hospital
Ontario Medical Association

Have you been thinking about quitting smoking?

With restaurants and bars in the Quinte area becoming smoke-free, now is an excellent time to follow through with your plan to quit smoking. Smoking is becoming more and more socially unacceptable, especially with recent evidence that second hand smoke can lead to health problems in children and adults who are in contact with exhaled smoke.

How can your Kelly’s pharmacist help?

Our pharmacists can assist you in your plan to quit smoking. We provide:

1. Information booklets that can help you better prepare to quit.

These will guide you through the essential stages of quitting, including: motivational ideas to get you thinking about quitting, planning ideas to get you prepared to quit and advice on staying smoke free.

2. Advice on ‘Quit Smoking’ products

We can help you decide which product will be of most benefit to you in helping quit smoking. We can advise you on how to use the product correctly so that you get the most benefit and we will be there to answer any questions you might have. Some third party drug plans cover products specifically for aiding in quitting smoking. Call your medical plan company to see which products they cover. You can then arrange an appointment with your physician and request a prescription as needed.

3. Clinic session

We can arrange a private session with our pharmacist to discuss a personalized plan of action. Your health status, smoking history and previous attempts at quitting can be addressed.

Please call our pharmacy at (613) 962-5388 or visit us at 411 Bridge St. E., (Bridge St. E. and Herchimer Ave.), Belleville, Ontario for further information about appointment times and any applicable fees.

What is Photosensitivity?

Photosensitivity is an abnormal or exaggerated response by the skin to sunlight or artificial light. It can include reactions such as mild reddening of the skin, second-degree burns, blistering and fever. Photosensitizing Agents Many medications are implicated in causing photosensitivity reactions. This is because sunlight and a variety of medications do not mix. The following are some examples of common drugs that can be photosensitive: in other words the medication causes your skin to be increasingly reactive to sunlight or artificial light.

Antihistamines astemizole (Hismanal)
– diphenhydramine (Benadryl)
– terfenadine (Seldane)
– tripelennamine (Pyribenzamine)

Certain antibiotics
– tetracycline
– sulfa drugs (eg. Bactrim)
– quinolone derivatives (eg. Noroxin, Cipro)

Certain psychiatric drugs
– chlordiazepoxide (Librium)
– loxapine (Loxapac)
– paroxetine (Paxil)
– phenothiazines (Chlorpromazine, thioridazine, perphenazine, methotrimeprazine (Nozinan)
– sertraline (Zoloft)
– trazadone (Desyrel)
– tricyclic derivatives (eg. amitriptyline, nortriptyline)

Anti-diabetic drugs
– chlorpropamide
– glyburidegliclazide (Diamicron)
– tolbutamide
– acetohexamide (Dimelor)

Cardiovascular drugs
– thyazide diuretics (furosemide, hydrochlorothiazide)
– amiodarone (Cordarone)
– ACE inhibitors (enalapril (Vasotec), captopril (Capoten), lisinopril (Prinivil, Zestril), quinapril (Accupril)
– diltiazem (Cardizem)
– felodipine (Plendil, Renedil)
– flecainide (Tambocor)
– hydralazine (Apresoline)
– methyldopa (Aldomet)
– quinidine
– sotalol (Sotacor)

Oral contraceptives

Non-steroidal anti-inflammatory drugs
– diclofenac (Voltaren, Arthrotec)
– diflunisal (Dolobid)
– etodolac (Ultradol)
– ibuprofen (Advil, Motrin)
– ketoprofen (Orudis)
– naproxen (Naprosyn)
– phenylbutazonepiroxicam (Feldene)
– sulindac (Clinoril)
– tenoxicam (Mobiflex)
– tiaprofenic acid (Surgam)

Other medications
– 5-ASA (Asacol, Pentasa)
– carbamazepine (Tegretol)
– cholestyramine (Questran)
– coal tar derivativesdantrolene (Dantrium)
– flutamie (Euflex)
– fluvastatin (Lescol)
– interferon (Intron)
– omeprazole (Losec)
– pravastatin (Pravachol)
– quinine
– selegilene (Eldepryl)
– simvastatin (Zocor)

Prevention of Photosensitivity Reactions

If you are taking medications that are photosensitive, tighten up on the rules that you should already be following:Avoid the sun between the hours of 10 a.m. and 3 p.m.Apply a sunscreen (after sweating, swimming and 30 minutes before going outdoors).Avoid sunscreens that are scented or sunscreens containing PABAMake a habit to ask your pharmacist if the medication you are taking reacts adversely in the sun. If it does, cover up or avoid the sun altogether. Finally, do not confuse photosensitivity with a faster way to tan.

Summer will soon be upon us, and with it comes the chance for many of us to take a trip. When preparing for your road trip vacation, be sure to pack a First Aid Kit, complete with the following all-purpose products to help ease many of the discomforts you are likely to encounter.

• CALIMINE LOTION – good for relieving the itch of the dreaded poison ivy. Poison ivy is a ‘contact allergen’ that causes an allergic reaction following contact between your skin and the plant, or even between your skin and a pet that has brushed by the plant.
• PAIN RELIEVER – no long road trip should begin without a bottle of acetaminophen or ibuprofen. While vacations are supposed to be fun and relaxing, we all know that after two or 3 renditions of ’99 Bottles of Beer on the Wall’, a headache is almost guaranteed. Pain relievers can also provide relief from sunburn and minor injury.
• SUNSCREEN – make sure that the sunscreen you take along has an SPF (sun protection factor) of at least 15; SPF 30 would be even better. Apply the sunscreen liberally at least a half hour before heading into the sun; reapply after swimming or perspiring. The least irritating lotions, for sensitive skin, are unscented and PABA free products.
• PEPTO BISMOLâ – diets often change drastically while you are on vacation. Days filled with hamburgers, fries and soda. With chips and ice cream as snacks, could mean an upset stomach or two in the evening.
• GRAVOLâ – for any kind of motion sickness, be it driving, flying or boating, a motion sickness tablet before the trip can make a world of difference.
• POLYSPORINâ – an antibacterial first aid ointment helps to prevent infection in minor cuts and abrasions. It doesn’t take up as much room as the hydrogen peroxide bottle and it’s much less likely to spill.
• MEDICATIONS – the effectiveness of some drugs can be diminished by extremes of heat or humidity, so make sure that all medications are stored under proper conditions. Check at the pharmacy before your trip if you are taking medications on a regular basis, because many medications can cause increased sun sensitivity. Most important of all – have a great trip!

A lot of people look at the pill bottle handed to them at the pharmacy and gasp in shock as they see the monstrous “horse pill” they’ve just received. “How do you expect me to swallow THAT?!” they ask incredulously.

It’s easy to tell that the thought going through a person’s mind at that time is “Do I really feel bad enough to warrant the struggle it’s going to take to swallow this thing?” Of course, your pharmacist can’t answer that question for you (or for anyone else) but chances are pretty good that if the doctor prescribed the horse pill, then you need to take it.

Keep in mind that most of us regularly swallow chunks of food that are larger than most tablets or capsules that are prescribed. Here are a few suggestions that may help the medicine go down a bit more smoothly:

1. Chew up a small piece of bread or other soft food, so there is something in your mouth to swallow with the medication. This may help it slip down virtually unnoticed.
2. Since tablets and capsules slide down easier if coated with saliva or water, try taking a drink of water before you take the pill, so your throat is already moistened. Then take the medication with a glass of water as usual.
3. It may be easier to swallow the medication if the mouthful of water that you use to wash it down comes from a bottle rather than from a cup or the fountain. Sometimes the burst of liquid that comes with gulping the water out of a bottle (like chugging a pop from a can) will wash the medication down in a “jet stream”.
4. Taste is also a big problem with some medication. Since the taste buds on the tongue are concentrated in different areas, if you put the tablet or capsule on the tip of your tongue, you11 avoid most of the “bitter” taste buds.
5. Another idea is to chew up a few ice chips before swallowing the medication, to numb the taste buds first.
6. Sometimes it’s possible to crush the tablet or open the capsule and sprinkle the crystals into some sugar, jam, honey, applesauce, etc, to disguise the taste.

However, before doing any of these, be sure to ask a pharmacist if the action will decrease or destroy the effectiveness of the medication. Some medications must remain in their original form to be beneficial.

No matter what medication you’re taking, from a one-time pain reliever for a minor headache to daily medication for a long term condition, it is essential for you to know about it.

Knowing about your medication means more than just recognizing the name and remembering the directions for taking it. You should understand how the medication works, what side effects you may experience and what to do if they occur.

The best person to discuss your medication with is your pharmacist. That’s what we’re here for! Don’t be afraid or embarrassed about asking questions, even if the pharmacy looks busy. If a pharmacist can’t take enough time right then to answer all your questions completely, we’ll set up a convenient time to get together and discuss all your concerns. No question is ever too trivial to ask; no answer is so complex that it can’t be understood. If you are confused by something you are told, ask to have it explained again. We can also provide some written information, if you prefer, so you can take it home and read it later. You can still come back and ask questions afterwards.

To help you get started, here are a few of the questions you should have answered before you leave the pharmacy with a new prescription:

1. Why am I taking this medication (what will it do for me?)
2. What side effects should I watch for, and what can I do about them?
3. Will this medication interact with any other medications that I’m taking? (Be sure to tell the pharmacist about non-prescription items that you’ve bought on your own)
4. Are there any foods or beverages that I should avoid while taking this medication?
5. What should I do if I miss a dose?
6. How long should I continue to take it? For example, until the bottle is empty, or until the condition disappears?
7. Is there anything else I should know before I take this? Remember, the pharmacist is there to make sure you benefit from your medication. You have the right to be involved in your medical care and the best way to be involved is to ask questions.

Remember, the pharmacist is there to make sure you benefit from your medication. You have the right to be involved in your medical care and the best way to be involved is to ask questions.

These days, many of us wonder if we’re eating properly; some of us know we aren’t. A question that gets asked regularly at the pharmacy is, “What kind of vitamins should I be taking?”

That’s a hard question to answer, because many factors must be considered before deciding to take vitamin supplements at all. An appraisal of an individual’s overall state of health is important in determining which vitamin supplements, if any, are required in the diet.

In Canada, over-nutrition is more common than malnutrition. There are some situations in which vitamin supplementation is a good idea, such as during pregnancy and lactation, in managing blood coagulation disorders, or in chronic kidney failure, but the need for vitamin supplementation in the general public is relatively low.

Many people assume that there are so many vitamin products on the market, it must be important to take them regularly. There are definite signs and symptoms of vitamin deficiencies; these symptoms are rare in our society.

Remember that your doctor is the best person to determine whether or not you actually have a deficiency, because many symptoms can indicate problems other than a vitamin deficiency.

Prior to taking vitamin supplements, other medications that you may be taking should be considered, because there are a number of drugs that interact with vitamins. For example, antacids containing aluminum hydroxide (like Mylanta®, Diovol®, Maalox®) can decrease the amount of vitamin A that gets absorbed, if taken together; cholestyramine (Questran®) can cause a decrease in the absorption of all fat-soluble vitamins (vitamins A, D, E and K); and vitamin C can cause an increase in the amount of iron that gets absorbed. Ask a pharmacist about possible interactions with your medications before deciding on a vitamin supplement.

Of course, the best way to ensure that you get the proper amount of each vitamin is to eat a well-balanced diet. Your pharmacist can suggest foods to help increase your vitamin intake, before resorting to supplements. If you already eat a wide variety of foods on a regular basis, you probably do not need to take vitamin supplements.

Remember, if you have concerns about your vitamin intake, talk to your pharmacist or to your doctor, before buying a vitamin supplement.

KELLY’S VITAMIN GUIDE

Vitamins are organic substances which are essential to the normal functioning of the body and with only a few exceptions, cannot be manufactured by our bodies. They are necessary for our growth, vitality and well-being and we must obtain them from organic foods or dietary supplements.

KELLY’S MINERAL GUIDE

As important as vitamins are, they can do nothing for you without minerals, and though the body can synthesize some vitamins, it cannot manufacture a single mineral.