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Pharmaceuticals

Kent Richardson

2005-07-01 12:17:00

: Why is pill splitting getting so much news?

ANSWER: Despite garnering a lot of attention recently, pill splitting is not new.  What is new is the way insurance companies are treating it.  Several large insurers are offering to cut a patient’s co-payment in half if patients will cut their pills in half.  In fact, United Healthcare is even giving away pill-splitters to encourage the practice.QUESTION: Does the patient benefit?ANSWER: On the surface, this seems like a winning proposition for the patient – have a doctor prescribe a double-strength dosage, then cut the pill in half and save 50% on the cost.  But the practice has drawn a lot of criticism – both from drug manufacturers and health care professionals.  It is easy to understand the motivation of the drug manufacturers – profit.  With a flat pricing scheme – meaning that, for example, a 20 mg dosage is priced the same or very similar to a higher 40 mg or 80 mg dosage – the drug manufacturer is receiving only half of the revenue.  Health care professionals, on the other hand, are not concerned about profits, but about the safety of the practice.QUESTION: Why are health care professionals concerned?ANSWER: Some medications will not work as intended if split in half – those with enteric coatings, extended-release formulations, a narrow therapeutic window, or a short half-life-to-dosing ratio.  However, other medications are just as effective when taken as a whole tablet or if a higher dosage is split in half.  It is essential that you consult your doctor and pharmacist when considering splitting any medications.QUESTION: How should I split my pills?ANSWER: The most common objection to pill splitting is the inaccuracy of it.  Study after study has shown that tablets split with razors, knives, or even special consumer operated tablet splitters are not uniform and often fail uniformity tests.  The result is inconsistency in the half-tablets – for example, you may get 60% of the whole tablet in one half-tablet and 30% of the whole tablet in the other half-tablet, with the remainder being lost to crumbling.  Again, it is very important to consult with your doctor and pharmacist to determine if your therapy will be adversely affected by such variations in your dosing.QUESTION: Are any devices available that can split pills more precisely?ANSWER: One local company is using computerized, state-of-the-art equipment that splits Lipitor® 80mg tablets into 10mg or 20mg fragments that pass the United States Pharmacopoeia guidelines for whole tablets.  This is far more precise than a typical hand operated pill splitter that can only cut a pill in half... that splits Lipitor® tablets.

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Pharmaceuticals

Kent Richardson

2005-05-01 09:03:00

: How does a bone mineral density (BMD) scan work? 

ANSWER: In BMD scanning, the energy of x-ray beams that are passed through bones is absorbed, and what is not absorbed is detected on the other side of the body.  The greater the mineral content of the bones, the denser the bones, and the more energy is absorbed with less "exiting" energy detected.  The amount of radiation energy per "picture element" of the scan (pixel) is detected and converted into a measurement known as the areal density.  Through a series of calculations, bone density can be calculated for the specific bone in question.  The process of BMD scanning is really quite simple for the patient.  Basic BMD measurement requires the patient to be "on the table" for about 2 minutes.  The patient is undressed to light clothing, and no metal piercings can be present.  The whole skeleton may be examined, or a specific area, including the lumbar spine, L3 vertebra, or total upper femur.The need for BMD screenings is apparent, in that one-half of all postmenopausal women will have an osteoporosis-related fracture during their lives, including 25 percent who will develop a vertebral deformity and 15 percent who will suffer a hip fracture.  Risk for fracture increases steadily as bone density declines.

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Pharmaceuticals

Kent Richardson

2005-02-01 11:24:00

: Are Herbal Medicines Safe?

ANSWER:  The market for dietary supplements, including herbal medicines and other botanical remedies, is growing tremendously in the United States.  Of the nearly 18 billion dollars spent on dietary supplements, approximately $4 billion of it was for herbs and other botanical products.There are, however, concerns about the lack of regulation and oversight of these products.  While most perceive that botanical products are safe because they are "natural" products, some of them are potentially toxic and may not be what they seem to be.  According to the December 19, 2002 issue of the New England Journal of Medicine, in the past year the Food and Drug Administration issued warning about potentially harmful effects to the kidney and/or liver, and cancer-causing effects of the botanical products containing Kava, comfrey, and aristolochic acid.  These are herbal remedies used widely in the United States.One of the major problems with herbal products is the lack of consistency in their composition and biologic activity.  Because of variations in the plants themselves and the methods by which they are harvested and processed, many botanical products do not contain the amount of the compound stated on the label.  As such, their potency and activity in the body may vary.  Secondly, some herbal products contain heavy metals or prescription or over-the-counter drugs that are not indicated on the label.  In 1998, the California Department of health stated that about one-third of the Asian patent medicines sold in California were adulterated, or contained undeclared drugs or heavy metals.Another concern is that botanical medicines, if taken with prescribed medications, can change the way the prescribed medications work.  These herb-drug interactions are potentially serious, and are especially noteworthy in situations where people take many medications for chronic diseases.  Consumers of botanical products should purchase these products where credible and authoritative information about the products is available.  Be aware that promotional claims for products on the Internet may be misleading, with potentially serious consequences.  Tell you physician and pharmacist of any herbal medications that you may be taking for assistance in choosing products based on sound medical evidence.

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Pharmaceuticals

Kent Richardson

2005-02-01 11:14:00

: My grandson wants to try out for the football team next year and he says he needs to start taking some body building supplements.  Are these supplements dangerous?

ANSWER: Well that depends on which supplements.  If these supplements contain steroids or precursors of steroids they can be dangerous.  In fact, the Food and Drug Administration (FDA) has begun to come down hard on companies that manufacture and distribute products that contain the most popular muscle building steroid, androstenedione, commonly known as "andro".  These companies have been asked to quit distributing the products and the FDA has threatened serious consequences for those that fail to comply.Androstenedione, when ingested orally, is converted to testosterone in the liver and circulates in the body, increasing both male and female sex hormone levels.  This drug is particularly popular with athletes and others who take the supplement to build muscle and enhance athletic performance.These anabolic steroids are top choices for teenagers who want to become stronger or perform better.  It is estimated that 1 million 12 to 17-year olds have taken potentially dangerous drugs and supplements.  Children who use these products may undergo early onset of puberty and experience premature cessation of bone growth.  Long-term consequences of androstenedione use in men include testicular atrophy, impotence, and feminization.  Women are at risk for menstrual abnormalities, blood clots, and breast and endometrial cancer.  Although illegal, these drugs are available on the Internet or in body building gyms.  Other popular choices in teens are ephedra and creatine.  The FDA has banned ephedra and has announced plans to ban the use and sale of supplements containing ephedrine alkaloids.  Ephedra has been linked to heart ailments and strokes, and there is little evidence that it is effective for anything other than short-term weight loss.  Creatine is a dietary supplement that is thought to enhance the body's ability to add muscle mass.  However, there is limited data to support these claims.Most young people do not know the negative side effects of these substances or believe that the benefits outweigh the risks.  The development of muscle mass, overly aggressive behavior, depressions, and irritability are clues to start asking about steroid or supplement use.

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Pharmaceuticals

Kent Richardson

2005-01-01 09:20:00

: You hear varying opinions.  Just how bad of a deal is it to drink sweetened sodas and other drinks if you're a little overweight?

ANSWER: A study recently published in the Journal of the American Medical Society suggests that some of the simplest and best advice that can be given to overweight individuals is to stop drinking sweetened sodas.  In the study conducted by Harvard University's School of Public Health in Boston, sweetened sodas and fruit drinks were linked to obesity and type 2 diabetes.The study tracked the medical records and dietary habits of 91,000 female nurses for eight years.  The research team compared nurses who drank less than one sugar-sweetened soda a month to those who consumed one or more sodas daily.  Regardless of whether the women were obese or not and whether they were physically active or not, those who consumed more soda and other sugared drinks were linked to diabetes.  Women consuming the most soda had an 83% increased risk of type 2 diabetes as compared with those drinking the least.  Fruit punch was linked to a doubled risk of diabetes as well, whereas 100% fruit juice was not.Soft drinks have a high content of rapidly absorbable carbohydrates derived form high-fructose corn syrup.  Corn syrup affects blood glucose in a manner similar to sucrose, and sweetened drinks cause a rapid and dramatic increase in both glucose levels and insulin concentrations.  Nurses in the study who had a stable pattern of soft drink consumption did not gain weight.  However, those who went from one drink a week to one or more a day gained almost 20 pounds over the eight-year period.  In addition, those with a higher intake of sodas were more likely to be less active, smoke more, and drink more alcohol.The American Beverage Association attacked the findings, citing an unhealthy lifestyle rather than over-consumption of a particular beverage as the culprit for increasing the risk of diabetes.  An endocrinologist at Boston University responded, saying that soft drinks contribute 7.1% of the total energy intake and the largest single source of calories in the U.S. diet.  Whether a coincidence or not, the rise in obesity and diabetes parallels the increase in sweetened soft-drink consumption in the United States.

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Pharmaceuticals

Kent Richardson

2004-10-01 15:07:00

: I recently had a pharmacist suggest an alternative to a prescription written by my doctor.  Although I appreciated that they were looking out for me, is it any of their business to question a doctor's decision?

ANSWER: From the way your question is written, I can tell that you do not have a personal relationship with a pharmacist.  While it is extremely important to have a personal relationship with your doctor, it is also very important to have a personal relationship with your pharmacist for many reasons, some of which are listed below.   In order for your pharmacist to do his or her job, you should get all of your prescriptions filled at the same pharmacy. Whenever you pick up a prescription at your community pharmacy, the information is entered into a computer database, which immediately checks the new prescription against your current medications and alerts pharmacists about possible interactions between drugs.  You should also tell your pharmacist of any disease states that you might have such as diabetes, high blood pressure, asthma, etc. so that he or she can also check for drug/disease state contraindications.You may go to more than one physician and your cardiologist may not know what your family physician has prescribed and vice versa.  Your pharmacist then becomes the only professional who can make sure that prescriptions from two different doctors do not interact in a negative way.If you have insurance that covers your prescriptions, your pharmacist is able to suggest alternative medications that may result in a lower co-payment. Your physician is usually unaware of the many requirements and restrictions that insurance companies place on your prescription drug benefit.  Your pharmacist, on the other hand, is in direct contact with your insurance company via the pharmacy computer system and can determine what drugs are covered and what your co-payment will be.  Keep in mind that whenever a pharmacist suggests a change to a prescription written by your doctor, the pharmacist will first discuss the suggested change with you and then will contact your doctor's office to make sure that the change is all right with your doctor as well.  Pharmacists will never change a prescription without contacting and getting permission from the prescribing physician first.If you do not feel that it is possible to develop a personal relationship with a pharmacist at your current pharmacy because the pharmacists are too busy or just don't seem to want to take the time, you should look for a pharmacy where you will be given the opportunity to talk to a pharmacist directly in a private setting.  Finally, never hesitate to ask questions of your physician or pharmacists.  After all, it is your health and wellbeing at risk.

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Pharmaceuticals

Kent Richardson

2004-10-01 14:42:00

: What is the difference between generic and brand-name drugs?

ANSWER: When a product is listed under the brand name, which is the name under which the product was originally sold, it means that the brand-name is protected by a patent for up to 20 years. When the patent expires, other manufacturers can produce the generic equivalent of the brand and sell it under its generic, or chemical, name. Generic drugs are made with the same active ingredients and are available in the same strength and dosage form as equivalent brand-name products. Each generic drug is laboratory tested to ensure that the same amount of drug will be absorbed into the bloodstream as with the brand-name drug. The difference is really only in the name, and in the price. Often, you can save as much as 90% over the cost of brand-name medications. Generics average 40-60% less than brand-name drugs. Currently, nearly 45% of all prescriptions in the US are filled using generic drugs. Increased savings through the use of generics could free up considerable income for the elderly, many of whom are on fixed incomes, as seniors represent over 20% of the US population and the average person over age 65 uses more than three prescriptions monthly. Generics have been shown to be as safe as brand-name drugs for the elderly as well as for children.In 1997, up to 80% of generic drugs approved by the FDA (Food and Drug Administration) were manufactured by companies that also make brand-name drugs. The US government strictly regulates the manufacturing process of all drugs, and all manufacturers meet the same standards. The FDA inspects drug manufacturers and recalls any marketed products that do not meet production standards. Since 1984 no generic drug has been approved in the US unless it has been shown to have the same amount of active drug absorbed at the same rate as the brand-name drug. The American Medical Association, the largest organization of medical doctors in the US, states that generic drug products are acceptable for use by the American public. Most hospitals routinely use generic drugs for treatment of their patients. Ask your physician or pharmacist if any of the prescription medications you are currently taking can be filled with a generic alternative. By using generic drugs whenever possible, you can reduce your prescription drug costs while maintaining the same strength, dosage and quality as the brand-name drug.

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Pharmaceuticals

Kent Richardson

2004-09-01 10:57:00

: What is the difference between myacins and antibiotics?

ANSWER: The lay term "myacins" or "mycins" refers to a class of antibiotics called Macrolides.  In this group are drugs such as azithromycin, clarithromycin, dithromycin, erhthromycin and troleandomycin.  So, there is no difference between mycins and antibiotics as the mycins are antibiotics.QUESTION: What are beta blockers? Are they all the same?ANSWER:  Beta blockers are drugs used to treat hypertension (high blood pressure), and arrythimias (irregular heart beats).  They act by blocking adrenergic beta receptors thus the name "beta blockers".  While nearly all beta blockers lower blood pressure they are not all the same.  The newer agents tend to be more selective for the cardiac (beta-1) receptors and, therefore, create fewer side effects.  Most of the generic names for beta blockers end with "olol" such as propranolol, atenolol, metoprolol, nadolol, etc.

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Pharmaceuticals

Kent Richardson

2004-08-01 11:51:00

Question:  My mother has trouble remembering to reorder her prescriptions. What is the best solution?

ANSWER: This is a very common problem and not just for seniors. All of us live in this extremely busy world and, many times, we simply don't remember to take care of details such as reordering prescriptions for drugs we take every day. Another problem is that we don't remember to take our medications every day. Both of these situations can decrease the effectiveness of our drug therapy and can be quite dangerous.  Of course, as we age, we do have more difficulty remembering such details and we take more medications, as we get older. That means that this lack of compliance with our drug regimen is a more serious problem for seniors.  There are several possible solutions. You might order your mother's medications on her behalf and check to see that she takes them as she should but that is a tremendous and time-consuming responsibility. You might also purchase "pill organizers" which are small boxes separated into compartments that are labeled with a day of the week or month and the time of day that each dose should be taken.Some pharmacies offer programs to help you insure that your mother always has the medication she needs. If forgetting to reorder is the main problem, the best solution is to find a pharmacy that offers an automatic refill program. Secondly, if you want to reorder prescriptions on your mother's behalf, you may want to use a pharmacy that allows you to do so via the Internet. Finally, you may want to look for a pharmacy that has a comprehensive compliance monitoring program that will alert the pharmacist if a patient on the program has not refilled a maintenance prescription when due. All of these programs can be very valuable and help provide peace of mind to concerned family members like you. Also, in this busy world, it is very important to find a pharmacy where you can get personal attention and don't get lost in the hectic shuffle that is apparent in many pharmacies today. Try to find a pharmacy with more of an office setting where you can have a relaxed and private discussion with a pharmacist.  Together, all of these programs and suggestions should make it much easier for you and your mother to feel confident that she is getting the most out of her medication therapy.

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Pharmaceuticals

Kent Richardson

2004-07-01 10:05:00

Question:  I'm confused with all the misinformation out there concerning the Medicare Discount Drug Card. How am I supposed to make an informed decision?  Do I even need to sign up for a card?

ANSWER:  First of all, let's cut through the confusion. There is not just one discount card. There are 73 different cards approved by Medicare that are offered by a variety of insurance companies, HMOs, pharmaceutical companies and others who routinely administer prescription drug benefits. Some cards are available nationwide, while others only work in certain states or at particular pharmacies. All of the cards offer different discounts on different medications. To make matters worse, the companies can change which drugs they offer and the discounts they offer on the drugs at any time without any warning to cardholders.While companies can make as many changes as they wish, seniors have to choose one card and stick with it until the end of the year. Come December, they can decide to renew their current card or get a different card for 2005. The average American over age 65 takes an average of six prescription drugs. It's completely possible that seniors searching for the perfect discount card will not find a card that offers a discount on each of their six prescriptions. It's almost a guarantee that comparing the discounts available will be extremely difficult and frustrating. How am I supposed to make an informed decision?Talk to your pharmacist- Your pharmacist may be the only person you need to talk to in order to make an informed decision. Your pharmacist can tell you what cards are accepted at their pharmacy, give you specific details and benefits of those cards, and tell you why they chose to accept the cards they do. Compare Card Benefits of those Discount Cards accepted by your pharmacy- Compare all discount cards available at your pharmacy, looking for the one that covers most of your medications, or covers your most expensive medication. Also, make sure that you save enough to cover the initial cost of the discount card. If you still want more information on Discount Cards through Medicare- Contact Medicare to find out which discount cards are available and get information on each one. Ideally, get this info from the Web at http://www.medicare.gov/. You can call 1-800-MEDICARE, but many callers report waiting for more than 20 minutes to speak to anyone, or receiving a recorded message stating that all lines are full. Call the Company Offering the Discount Card- Each card/company has a toll-free number associated with it. Call this number and verify that the drugs and discounts are actually offered by the company. There have been numerous reports that information on the Medicare Web site is wrong or already outdated. Do I need to sign up for a card?If you are a lower income senior and you qualify for the $600 annual credit, there is no question that the discount cards will benefit you. If you don't qualify for the $600 annual credit, you will probably find that the savings are minimal on brand name prescriptions and there are little or no savings on generic drugs.  If you receive retiree benefits from an employer or a union, or if you belong to a state funded drug program, you may not be eligible for the Medicare card and it  probably won't save you much, if any, money on your medications anyway.  So, the best advice is to find a pharmacy that gives you good prices on generic drugs and use the Medicare Discount Card for brand name prescriptions.  A word of caution: Many folks who are eligible for these cards are receiving promotional materials for specific cards. Make sure that any card you choose has the Medicare-approved logo and is accepted by your pharmacy.