Ask The Pharmacist

Sunday, June 30, 2013

What to do About Nighttime Leg Cramps

Muscle cramps are caused by a strong, sudden tightening of body muscles, most commonly being the leg calf muscles. Certain conditions such as peripheral arterial disease, kidney disease, thyroid disease, pregnancy, and multiple sclerosis have been linked to leg cramps that occur during sleep. Leg cramps may occur more often in people who do not have enough water, calcium, potassium, and magnesium in their body. Certain blood pressure-lowering (Coreg, Cozaar, Zestril), cholesterol-lowering (Lipitor), and mood-stabilizing (Abilify) medications may also cause nighttime leg cramps.

There are daily activities that can help ease the pain of leg cramps. Regular stretching before bedtime and un-tucking of the bedroom sheets may be helpful. When a leg cramp does occur, a quick muscle massage, flexing of the foot, a brisk walk, a cold pack, a heating pad, or a warm bath may help reduce the intensity of the pain. Staying hydrated with water and sports drinks can provide the nutrients your body needs to help prevent the cramping sensation. Over-the-counter pain medications such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve) can help relieve leg pain. A physician should be consulted if leg cramps are severe and occur frequently.

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Sunday, June 23, 2013

What is Done to Help Manage Angina

When a substance called plaque builds up in the main arteries of the heart, it reduces the amount of oxygen and nutrients needed for the heart to pump effectively. This reduced blood flow can cause chest pain or discomfort that lasts anywhere from one to fifteen minutes. This chest pain is commonly known as angina. Symptoms of angina also include pain in the arms, neck, and back, tiredness, sweating, dizziness, and anxiety. The pain is commonly described as a squeezing or heaviness in the center of the chest.

Many people can lower their chances of making angina worse by lowering high blood pressure, lowering high cholesterol levels, and losing weight. Aspirin may be taken every day to help reduce the ability of the blood to clot and lower your risk of getting a heart attack. Nitrates are a class of medications that help widen the coronary arteries to provide more blood flow to the heart muscle. Dosage forms for nitrates vary and can present as sprays, creams, patches, tablets, and tablets that dissolve under the tongue. Beta blockers (Tenormin) and calcium channel blockers (Norvasc) are other medication types that can help reduce angina by reducing blood pressure. Ranolazine (Ranexa) may be added to other medications to help treat the chronic, stable form of angina.

Sunday, June 16, 2013

Prevention & Treatment for Shingles

Shingles (also known as herpes zoster) is a viral infection that causes a painful skin rash. It is caused by the same virus that causes chickenpox during childhood. After a person is infected with chickenpox, the virus remains in the nerves without causing any symptoms. It can reactivate years later due to a weakened immune system from age, other diseases, and stress. Shingles may be contagious to individuals who have never had chickenpox or the chickenpox vaccine. A rash often develops and may appear as circular bands on the body, usually the torso. The rash can tingle and itch and then progress to painful clusters of blisters which contain fluid, form a scab, and may leave scars after healing in 2 to 4 weeks. Some people may experience persistent pain, which is called postherpetic neuralagia.

The herpes zoster vaccine (Zostavax) is given as a single injection for people 50 years and older to only prevent the infection. If a person does become infected with shingles, oral antiviral medications such as acyclovir (Zovirax), valcyclovir (Valtrex), or famciclovir (Famvir) are often prescribed to shorten the course of the disease. Gabapentin (Neurontin) and pregabalin (Lyrica) can be prescribed to decrease the pain.

Sunday, June 9, 2013

Relief from Psoriasis

Psoriasis is a skin condition that causes red, raised, scaly patches known as plaques. The plaques result from an increased production of skin cells and occur anywhere on the body including the knees, elbows, and scalp. Psoriasis can also progress to the joints to cause swelling and tenderness and is referred to as psoriatic arthritis. Psoriasis is considered an autoimmune disease, which means that the immune system inappropriately attacks the body instead of protecting it. Symptoms vary and include itching and pain where the plaques occur. Certain triggers, such as stress, injury to the skin, and medications, can cause flare.

Mild cases of psoriasis can be treated with over-the-counter medications to relieve itching, but moderate to severe cases require prescription drugs. Calcipotriene (Calcitene, Dovonex, Sorilux), a form of vitamin D, is available as a prescription cream, ointment, or foam to treat psoriasis plaques on the scalp or other parts of the body. Methotrexate (Trexall) is an oral prescription medication for treatment of severe psoriasis that slows the rate of skin cell growth. A group of medications known as biologics are used when a person has not responded to other treatments. The biologics block the body’s ability to attack itself. Biologics must be injected and include adalimumab (Humira) and etanercept (Enbrel).

Sunday, June 2, 2013

Prescription and OTC Drugs for Obesity

Obesity is a common, chronic condition that describes a person with excess body fat. Unhealthy eating habits, lack of physical activity, genetics, and certain diseases can all contribute to an individual’s weight. If not controlled, obesity can lead to diabetes, high blood pressure, high cholesterol, heart disease, and arthritis. A person is determined to be obese based on their body mass index (BMI), which is calculated using weight and height. A healthy BMI is 18.5-24.9, while an individual is considered overweight at 25-29.0 and obese if their BMI is over 30. Prescription medications are used to aid weight loss when a person’s BMI is over 30 or if it’s over 27 and they have one or more health problems associated with obesity. Phentermine (Adipex-P, Phentercot, Suprenza) and diethyl-propion are prescription medicines that suppress the appetite. Phentermine is also available in a combination tablet with topiramate (Qsymia), a medication used for seizures that has been shown to cause weight loss. Another medication, orlistat (Xenical), reduces the body’s absorption of fat from foods and also must be prescribed by a physician; however a lower strength formulation is available over-the-counter (Alli). Lorcaserin (Belviq) is a prescription drug that makes a person feel full.

Sunday, May 26, 2013

Dandruff: Fighting the Flakes

Dandruff is a skin condition in which there is itching and flaking of the scalp. The itching from dandruff may be so intense that the scalp can become red or swollen. The flaking can be more visible on darker hair and clothing, which can be embarrassing for some. However, dandruff is a very common condition. Fortunately it is not contagious. Some potential causes of dandruff include dry scalp, excess oil production on the scalp, infrequent shampooing, and the scalp’s reactions to hair products. A fungi organism naturally found on scalps, Malassezia, can also cause dandruff, if the fungus grows out of control. Skin disorders such as psoriasis and eczema can also be associated with dandruff.

If a physician suspects the cause of the dandruff is fungal, the anti-fungal shampoo ketoconazole (Nizoral) can be prescribed. It is also available over-the-counter (OTC) in a lower strength. Selenium sulfide (Selsun Blue, Tersi Foam), also OTC or prescription depending on the strength, can help to reduce flaking The OTC shampoos Head and Shoulders and Selson Salon contain zinc pyrithione, which can also kill fungi and reduce flaking. Another option to reduce dandruff flakes is coal tar (Neutrogena T-gel, Ionil-T). More severe cases of dandruff may be prescribed cilopirox shampoo (Loprox).

Sunday, May 19, 2013

What to Do About This Skin Rash

Eczema is the medical term used to describe an itchy, inflamed, non-contagious skin rash. The most severe form is called atopic dermatitis. This skin rash is commonly diagnosed in young children and can sometimes be a life-long condition. It usually affects the insides of a person’s elbows, back of knees, and the face. A less severe form is contact dermatitis. This results when the skin comes directly in contact with substances that may irritate the skin such as household chemicals, soaps, fragrances, and tobacco smoke or if a person has an animal, plant, or food allergy.

Treatment involves avoiding things that may irritate the skin, moisturizing dry areas, and medications that decrease the itching. Steroids such as hydrocortisone and betamethasone (Beta-Val) can be applied directly to the skin to control the itching. Some steroids are available over-the-counter while certain others require a prescription. Antihistamines like diphenhydramine (Benadryl) block chemicals that trigger itching and can be taken orally or applied to the skin. Tacrolimus ointment (Protopic) and pimecrolimus cream (Elidel) are prescription products used to suppress the immune system that causes flare ups. They are sometimes used when other medications have not worked for atopic dermatitis.

Sunday, May 12, 2013

Treatment of Nerve-Related Pain

Neuropathy is a generalized term for a condition that occurs when nerves are damaged. Typically, neuropathy is a result of injury, nerve disease, or improper care of long-lasting diseases that can cause nerve damage. High blood pressure, diabetes mellitus, alcohol abuse, AIDS (Acquired Immune Deficiency Syndrome), and carpal tunnel syndrome are a few conditions that may increase the chances for nerve damage. Some types of chemotherapy medicines may also cause neuropathy. Symptoms of neuropathy include tingling or burning sensations in one or both parts of the body, numbness, or complete loss of feeling.

While there is no cure for neuropathy, treatment includes proper management of chronic disease and reducing the symptoms of neuropathic pain. Gabapentin (Neurontin) and pregabalin (Lyrica) are anti-seizure medications that help reduce this type of pain. Topiramate (Topamax) is an anticonvulsant medicine that may lessen neuropathy. Tricyclic antidepressants (Desipramine, Amitriptyline) have helped some people with neuropathic pain, but many people cannot tolerate the bothersome side effects. The addition of NSAIDs (Aleve, Advil) and Tramadol (Ultram) may also help lessen nerve-related pain.

Sunday, May 5, 2013

Preparing for Springtime Allergies

The biggest culprit associated with springtime allergies (Allergic Rhinitis) is the pollen that falls from trees. The condition is commonly known as hay fever. Histamine is a molecule that is released in our bodies to fight allergens (like pollen). When histamine is released it triggers an allergic reaction. Allergies can affect your day-to-day activities and lead to complications of sinus infections, sleep problems, and reduced performance at school or work.

Certain measures can be taken to limit total time outdoors where pollen can cause allergic reactions. For example, windows in the car and home should be closed, outdoor pets should not enter the bedroom, and showering is recommended immediately after being outdoors to limit pollen on your hair and clothes. Fluticasone propionate (Flonase) is a prescription nasal spray to help ease nasal symptoms. Pseudoephedrine (Sudafed) is a nasal decongestant that best relieves a stuffy nose, but it can raise your blood pressure and cause problems sleeping. Antihista- mine medications are available over-the-counter (OTC) for allergy symptom relief; Benadryl can cause dry eyes and severe sleepiness, but Clarinex and Allegra have a minimal effect on sleeping patterns. Allergy shots can provide long-term relief of allergic rhinitis symptoms.

Sunday, April 28, 2013

Medications Used for Seasonal Depression

Seasonal depression, also known as seasonal affective disorder (SAD), is a depression that occurs during certain times of the year. It is most commonly associated with the beginning of fall and lasting during winter months (“winter blues”), but may occur in the spring and summer seasons as well. Symptoms include a lack of energy, feeling drowsy during the day, increased sleeping, anxiety, lost of interest in usual activities, cravings for sweets or carbohydrate-rich foods, and weight gain. The exact cause of seasonal depression is unknown, but can be contributed to an imbalance of certain chemicals in the brain. A lack of sunlight, which can disrupt the body’s internal clock, is a possible cause, hence light therapy is a treatment often used for SAD.

A variety of antidepressants can be prescribed to also help treat SAD. Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac, Sarafem), sertraline (Zoloft), and paroxetine (Paxil) help to balance serotonin, a chemical in the brain than can affect mood. Medications such as venlafaxine (Effexor) and duloxetine (Cymbalta) alter both the levels of serotonin and norepinephrine, another chemical in the brain that can affect how someone feels. Bupropion (Wellbutrin XL) can also be prescribed for individuals who have a history of SAD.

Sunday, April 21, 2013

Treatment Options for Head Lice

Head lice is an infestation of very small insects in the hair and on the scalp. The condition is most common in young school-aged children, but can affect people at any age. The lice themselves are parasites that feed on human blood every 4-6 hours to survive; however they do not transmit any infectious disease. Female lice can lay up to 10 eggs (also known as nits) per day. These eggs, which hatch in about a week, appear as tiny white specs and can be passed to other people via head-to-head contact and sharing of infested head coverings, combs/brushes, or pillowcases. Intense itching of the head, scalp, and back is a sign that a person may be infected.

The nits can be removed by using a fine-toothed lice comb on wet hair. Medications known as pediculicides are effective in killing lice. Some only kill the adult lice while others kill the adult lice and nits. Permethrin 1% (Nix Creme Rinse) and pyrethrum extract with piperonyl butoxide (Rid) are available over-the-counter. Prescriptions are required for other pediculicides such as malathion 0.5% (Ovide) and spinosad (Natroba). Pediculicides are available both as shampoos, creams, lotions, and sprays. Bedding, clothing, and head coverings should also be washed thoroughly and treated.

Sunday, April 14, 2013

What To Do About Dry Eyes

Dry eye syndrome occurs when the eye cannot make enough tears. Tears are necessary for clear vision by providing moisture to the eyes and washing away particles. Common causes of dry eyes include direct sun exposure, smoking, second-hand smoke exposure, dry workplace, previous eye surgery, or burns. Hormone replacement therapy, certain antihistamines (Benadryl), and certain antidepressants (Elavil) can dry out the eyes as a side effect. Symptoms of dry eyes include frequent, watery tearing of the eye, light sensitivity, and blurry vision.

A doctor should be consulted for severe problems that include vision loss, swelling, or painful eyes. Artificial tears are available over-the-counter and provide the best solution for dry eyes. There are many different brands to try. Thicker artificial tears last longer and may momentarily cause blurry vision when compared to the thinner artificial tears. Artificial tears come in preservative and preservative-free forms. For people who frequently use them, it is recommended to use a preservative-free formula. For people who may sleep with their eyelids partially open, artificial tear ointments used at bedtime has been shown to improve morning vision. Restasis is a commonly prescribed anti-inflammatory eye drop prescribed for severe dry eyes.

Sunday, April 7, 2013

Management of Secondary High Blood Pressure

High blood pressure can be a reflection of a person’s diet, genetics, and stress. Secondary hypertension, however, is high blood pressure that is caused by another medical condition or medications themselves. Such medical conditions include sleep apnea, disorders of the endocrine system, kidney disease, and preeclampsia. Medications than can significantly increase a person’s blood pressure include anti-inflammatory drugs such as corticosteroids (Prednisone), nonsteroidal anti-inflammatory drugs (Aleve, Motrin), decongestants containing pseudoephedrine (Sudafed), weight loss medications (Phentermine), birth control pills, and migraine medications (Imitrex).

Your doctor will need to correct the condition first in order to properly lower your blood pressure; in some of these cases, surgery may be a treatment option. If the cause is a endocrine disorder called hyperaldosteronism, medications referred to as aldosterone antagonists (Spirono- lactone, Eplerenone) are preferred. Angiotensin converting enzyme (ACE) inhibitors (Lisinopril, Enalapril) are best suited to lower blood pressure in most people who have kidney disease. If you are on a medication that will raise your blood pressure, your doctor may choose to reduce the dose or stop the medication all together.

Sunday, March 31, 2013

Fungal Infections of the Nails

Fungi are living organisms that grow in warm, moist places. Similar to other small organisms such as bacteria, they can cause infections in humans. A commonly seen condition caused by fungi is called fungal nail infections. These occur primarily on the nails of the hands and feet. Fungus can enter the skin through small cuts and exposure through walking barefoot, public showers, or sharing personal items with someone who may already be infected. Nail fungal infections will appear as white or yellow spots or streaks on the nails and the color will darken or deepen as the infections progresses. They can cause peeling and thickening of the nails and separation of the nail from the skin.

Prescription oral medications are the most effective treatments for fungal nail infections. Terbinafine (Lamisil), itraconazole (Sporanox), fluconazole (Diflu-can), and griseofulvin (Grifulvin) kill or stop the growth of different types of fungi. For those who are unable to tolerate oral antifungal medications due to side effects or interactions with other medications, they may be prescribed a drug called ciclopirox (Penlac). This antifungal comes as a solution that is applied like nail polish to the affected nails. However, in general, topical medications may only treat mild cases.

Sunday, March 24, 2013

Management of Iron-Deficiency Anemia

Iron is an important nutrient the body needs to make healthy red blood cells. Anemia is a condition in which the amount of red blood cells in the body is low. Iron-deficiency anemia occurs when a low iron level causes the body to make less blood or smaller red blood cells. Some causes of iron-deficiency anemia include long menstrual periods, a vegetarian diet, peptic ulcer disease, or the long-term use of medications such as aspirin or ibuprofen. Symptoms of this condition include feeling tired, frequent headaches, and difficulty concentrating. In severe cases, very low iron levels may cause brittle nails, shortness of breath, and pale skin color.

The best treatment for iron-deficiency anemia is with iron replacement. Iron- rich foods include liver, meats, chicken, turkey, egg yolks, dried lentils, fish, peanut butter, and greens like spinach. Iron supplements are often taken to maximize the iron storage in the body. Over-the-counter products containing ferrous sulfate (Feosol, Slow FE), ferrous fumarate (Femiron, Hemocyte, Ircon), or ferrous gluconate (Ferate, Fergon) are commonly taken one to three times. Common side effects of iron therapy are nausea and dark stools. For severe anemia, intravenous iron therapy can be administered by a healthcare professional in a medi- cal facility.