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Healthy Transitions

Healthy Transitions. Common Side effects and Drug Interactions. Gabriela Dimitrievski, PharmD Brian Hoff, PharmD Katie Sandison, PharmD. Take Control of your Health!. Bring your medications into your doctor appointments

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Healthy Transitions

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  1. Healthy Transitions Common Side effects and Drug Interactions Gabriela Dimitrievski, PharmD Brian Hoff, PharmD Katie Sandison, PharmD

  2. Take Control of your Health! • Bring your medications into your doctor appointments • Keep all of your healthcare providers informed of any changes to your health • Keep an updated medication list • Include Over-the-Counter medications • Include herbal supplements • Know why you are on your medications • Talk to your healthcare providers • Ask questions!

  3. Over-the-Counter (OTC)Medications Tylenol NSAIDs (Motrin/Advil/Aleve/Aspirin) Cough and Cold Anti-diarrheals and Laxatives Herbal Remedies

  4. Tylenol • Generic name: acetaminophen • Primary Use: pain or fever • Maximum dose: do not exceed 4,000 mg per day (your doctor may recommend less) • Products that contain acetaminophen: • Vicodin/Lortab/Percocet • Multi-symptom cough and cold products • Tylenol PM • Toxicity: liver damage • Can occur when taken in large amounts or over long periods of time • Keep out of reach of children • Cautioned use in those who regularly consume alcohol

  5. NSAIDs • Non-steroidal anti-inflammatory drugs (NSAIDs) • Examples: • Ibuprofen (Advil, Motrin) • Naproxen (Aleve) • Aspirin • Primary Use: Pain, inflammation, fever • Following the dosing tables on the package • Adverse effects: • Overuse and high doses can decrease the protective effects in the stomach and intestines • Aspirin: prevents blood clotting (even 81 mg ‘baby’ aspirin) • Note: aspirin should not be used in children and teenagers due to risk of Reye’s Syndrome

  6. Cough and Cold • Antihistamines: Benadryl, Claritin, Zyrtec • Benadryl can cause drowsiness, best taken before bed • Claritin and Zyrtec are non-drowsy and are recommended when symptom relief is needed during the day • Cough and mucus: Mucinex (guaifenesin) and Delsym (dextromethorphan) • Mucinex thins the mucus and is best taken with a full glass of water • Delsym: some patients experience drowsiness, dizziness, headache • Decongestants: Sudafed (pseudoephedrine), Sudafed PE (phenylephrine) • Sudafed is found behind the pharmacy counter with purchase limits • Sudafed can increase heart rate and blood pressure • Sudafed PE is safer for patients with high blood pressure not well-controlled by medications, healthy diet, and exercise **Caution: over-use of multi-symptom formulations can be dangerous, discuss with your pharmacist or physician

  7. Anti-diarrheals • Metamucil (fiber) • Can help naturally thicken stool • Loperamide (Imodium A-D) • Pepto-Bismol: liquid or tablets • These can be used when diarrhea lasts greater than 6 hours • Cautions: • Do not use these medications if you have bloody diarrhea, fever, or severe diarrhea • Some diarrhea is caused by infection and should be treated by your doctor, not with OTC medications • Pepto-bismol can possibly turn your tongue and stool black • Overuse of anti-diarrheals can lead to constipation Laxatives • Metamucil (fiber) • Safest and most natural way relieve symptoms of constipation • Can take hours to days for effect • Stool Softeners: Docusate, Colace • Can take hours to days for effect • Stimulants: Senna, Biscaodyl • Quicker onset, more powerful laxatives, use with caution • Avoid mineral oil and herbal remedies for constipation • Suppositories or enemas can also be used • Glycerin suppositories are the safest treatment for small children and newborns

  8. Herbal Remedies • Herbal supplements are regulated by the Food and Drug Administration (FDA) as dietary supplements • Not regulated as drugs or foods • The FDA does not evaluate the use of dietary supplements for the specific diseases they may claim to treat • Many herbal medications can interact and cause side effects like prescription drugs • Caution should be taken when using these products • For safety, starting herbal supplements should be discussed with your physician or pharmacist

  9. Herbal Remedies • Class A, B, and C recommendations • A = data allows us to assume use is beneficial • B = incomplete data allows us to accept the possibility of a beneficial relationship • C = conflicting or lack of data to establish a beneficial association with it’s use • In general, medications in Class A have stronger evidence for use and are more likely to be recommended by a physician or pharmacist

  10. Herbal Remedies

  11. Herbal Remedies • Caution: ‘G-herbs’ = increased risk of bleeding • Ginger – Class B use for nausea • Garlic – Class A use for high blood pressure and cholesterol • Ginkgo – Class A use for Alzheimer's dementia • Ginseng – Class B use for improving mental performance • Drug-interactions in the liver • Echinacea – Class B use for Cold symptoms • Garlic – Class A use for high blood pressure and cholesterol • Black Cohosh – Class C use for menopause • Red Yeast Rice – Class A use for cholesterol • St. John’s Wort – Class A use for mild-moderate depression • Saw Palmetto – Class A use for BPH • Milk Thistle – Class B for liver disease and cirrhosis

  12. Gastroesophageal Reflux Disease (GERD) • Many treatment options available both over-the-counter and by prescription • Most common prescription agents: • Histamine2-receptor antagonists (H2RAs) • Proton pump inhibitors (PPIs) • Agent usually chosen based on degree of symptoms

  13. Gastroesophageal Reflux Disease (GERD) • Histamine2- receptor antagonists

  14. Gastroesophageal Reflux Disease (GERD) • Common side effects: • Headaches • Tiredness • Sleepiness • Dizziness • Constipation or diarrhea • If elderly: • Confusion, especially at higher doses and with decreased kidney function • Memory problems, disorientation, fall risk

  15. Gastroesophageal Reflux Disease (GERD) • Drug interactions: • Medications that require an acid environment to work: antifungal medications, calcium carbonate, iron, and some HIV medications • Cimetidine (Tagamet) specifically has many drug interactions

  16. Gastroesophageal Reflux Disease (GERD) • Proton Pump Inhibitors

  17. Gastroesophageal Reflux Disease (GERD) • Common side effects: • Headache • Dizziness • Diarrhea • Constipation • “Acid rebound” • Increased risk of osteoporosis/fractures with long-term use • Limit use!

  18. Gastroesophageal Reflux Disease (GERD) • Drug interactions: • Medications that require an acid environment to work: antifungal medications, calcium carbonate, iron, and some HIV medications • May lead to increased levels of methotrexate, phenytoin, raltegravir, saquinavir, tacrolimus, voriconazole, and warfarin • Omeprazole (Prilosec), and possibly others, should not be used together with clopidogrel (Plavix)

  19. High Cholesterol • “Statin” medications • Atorvastatin (LIPITOR) • Simvastatin (ZOCOR) • Rosuvastatin (CRESTOR) • Pravastatin (PRAVACHOL) • Lovastatin (MEVACOR, ALTOPREV) • Fluvastatin (LESCOL) • Pitavastatin (LIVALO)

  20. High Cholesterol • Possible side effects of statins: • Digestive problems: • Nausea • Gas • Diarrhea • Constipation • Blood sugar increases • Memory loss or confusion • Usually reversible when medication is stopped • Increased risk of cataracts

  21. High Cholesterol • Serious side effects: • Muscle pain and damage • Higher doses of medication • Age > 65 years old • Decreased kidney function • Untreated hypothyroidism • Use of fibrates • Liver damage • Unusual tiredness or weakness • Loss of appetite • Abdominal pain • Dark-colored urine • Yellowing of the skin or eyes

  22. High Cholesterol • Statin drug interactions Shapiro and Brown, RxPrep CourseBook 2013 ed.

  23. High Cholesterol • Simvastatin • Doses of 80mg/day should be restricted to patients who have been stable on this dose (> 12 months) without evidence of muscle toxicity • Rosuvastatin • May increase effects of warfarin • Dose limits with cyclosporine, ritonavir-boosted protease inhibitor treatment, and gemfibrozil • Use with other cholesterol/lipid lowering medications, such as fibrates and niacin, may increase risk of muscle pain and damage

  24. High Cholesterol • Fluvastatin • Closer monitoring when used with warfarin • Pitavastatin • Minimal interactions • Should not be used with cyclosporine • Dose limits with erythromycin and rifampin use • Monitor when used with warfarin

  25. Warfarin (COUMADIN) • Uses: • Prevention and treatment of blood clots and clots in the lungs • Prevention and treatment of clots and associated complications in patients with atrial fibrillation and/or heart valve replacement • Decrease in the risk of death, recurrent heart attack, and clot events like stroke or systemic clotting after a heart attack

  26. Warfarin (COUMADIN) • Major side effects of warfarin = bleeding risk • Severe bleeding • Bruises that come about without an injury • Prolonged/frequent nose bleeds • Black stools or bleeding from the rectum • Importance of monitoring to help prevent bleeding complications

  27. Warfarin (COUMADIN) • Other important side effects: • Hives, rash, itching • Chest pain, pressure • Nausea, vomiting • Fever or flu-like symptoms • Joint or muscle aches • Diarrhea • Tingling or numbness in any part of the body

  28. Warfarin (COUMADIN) • Less serious side effects: • Gas • Feeling cold • Fatigue • Pale skin • Changes in the way food tastes • Hair loss

  29. Warfarin (COUMADIN) • Drug interactions • Warfarin interacts with MANY medications

  30. Warfarin (COUMADIN) • Common Interactions • NSAIDs • Aspirin, ibuprofen, naproxen, etc. • Use with warfarin can increase bleeding risk • Nutritional and natural/herbal products as big culprits of drug interactions • Vitamin K • Green, leafy vegetables • Do NOT have to avoid; key is to stay consistent

  31. High Blood Pressure – Beta Blockers • Common Side Effects • Fatigue, depression: usually worse within the first few weeks of taking • Dizziness • Cold hands • Can make it more difficult to realize when your blood sugar is low if you have diabetes – be cautious with insulin, check your blood sugar often

  32. High Blood Pressure– ACE Inhibitors • Common Side Effects • Dry cough – If this occurs, call your physician, as this is a common side effect that will not taper with time • Potassium and Kidney levels may change – your physician will monitor this • Dizziness • Avoid Excess Over the Counter NSAIDs- Motrin, Aleve, Advil, etc.

  33. High Blood Pressure– Diuretics (Water Pills) • Common Side Effects • Frequent Urination – take in the morning and earlier in the day to avoid waking up at night • Electrolytes (potassium, calcium, sodium) may change, your doctor will monitor • Dizziness • NSAIDS may decrease their effectiveness through their actions on the kidney

  34. High Blood Pressure – Calcium Channel Blockers • Amlodipine (Norvasc) • Can cause swelling in the lower legs • Dizziness • Verapamil (Calan), Diltiazem (Cardizem) • Constipation • Drug Interactions – MANY, consult your healthcare provider before starting any new medication • Cholesterol reducing medications (statins) • Transplant medications (tacrolimus, cyclosporine, everolimus) • Anti-arrhythmic drugs (amiodarone, sotalol) • Many others!

  35. Diabetes - Insulin

  36. Diabetes- Other Drugs

  37. Diabetes- Low Blood Sugar • Blood sugar level <70 mg/dL • What do you do? • Take in 15 grams of quick acting carbohydrate/sugar source • Ex: ½ cup juice or regular soda (not diet), quick dissolving candy (NOT sugar-free), glucose tablets, 2 tablespoons raisins • Wait 15-20 min, re-check blood sugar • Eat a normal snack to keep sugar steady

  38. Tips for Improving Medication Use • Pillboxes • Help with organizing your medications • Make complicated regimens less frustrating • Keep an updated medication list • Pharmacists and physicians can help you update any time you have your medications changed • Bring all of your bottles in to your physician, including OTCs and herbals • Ask questions – no thought too small!

  39. Questions

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