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Self Care Pharmacy Blog

Weighing in on Liquid Measurement Error

December 5th, 2014

By Bryan Feldmann, PharmD student

If someone were to ask you what the difference was between a teaspoon and a tablespoon, would you know what to say? You might have prescriptions from your doctor or medications you bought over-the-counter that tell you to take a number of tablespoons or teaspoons of the medication. A teaspoon will usually be abbreviated as “tsp” and tablespoon as “tbsp.” Because the two abbreviations look very similar, it can be easy to mix them up at a first glance. This can be a big problem, because it is so important that meds are taken exactly as directed.

You may already know what teaspoons and tablespoons are, but many people do not. Tablespoons and teaspoons are two different units of measurement. Similarly to gallons and liters, teaspoons and tablespoons are both used for determining how much volume something has (in other words, how much space it takes up). You will usually see units of volume used when your medication is a liquid.
So, how do these two similar units of measure differ? To begin, a teaspoon is smaller than a tablespoon. You can remember this by thinking of how big a table is compared to a cup of tea. In fact, tablespoons are three times larger than teaspoons. Now, just think about how dangerous it might be if someone accidentally took three times the amount of drug they were supposed to by mistake. According to a new study published by the American Academy of Pediatrics (medical care of children and teens) there are more than 10,000 calls to the poison control center every year because of errors patients made in how much of a liquid medicine they took.1 Just imagine the horror of the parents and caretakers being forced to call the emergency number because of an adverse reaction to a medication error. Since liquid medications are usually given to children, the study also specifically measured how many times parents made a mistake when pouring medicine for their kids. When they were supposed to measure with either teaspoons or tablespoons, they accidentally measured incorrectly 40% of the time, or 2 out of every 5 times!1 What can be done to fix this?

Teaspoon (tsp) and tablespoon (tbsp.) look so alike it is no wonder people can mix them up, but there is another common way to measure volume— the milliliter, or “mL.” A milliliter looks and sounds nothing like a teaspoon or a tablespoon, so it would stand to reason that people would not confuse it with anything else. There are 5 milliliters (mL) in a teaspoon, meaning there are 15 mL in a tablespoon.2 So milliliters are also useful for being more precise, since not everything must be in multiples of 5 milliliters. In another study, parents who had to measure medications in teaspoons or tablespoons were compared to those who measured in milliliters.3 The parents who were asked to use teaspoons and tablespoons were about twice as likely to make a mistake.3 287 single parents or pairs of parents were studied to get these results.3 This is a very small sample when compared to how many parents there are giving medications to children in the country, so more research should still be done.

Just mixing up the units is not the only reason these forms of measurement are so problematic, however. Many homes have kitchen teaspoons and tablespoons spoons just for measuring in teaspoons and tablespoons, but a study in the International Journal of Clinical Practice showed that the spoons that people have differ drastically from one another and are not accurate.4 Another study, published in the Archives of Pediatric and Adolescent Medicine, which is itself published by the American Medical Association, found that oral syringes and droppers are the best tools to use to measure volume and avoid error.5 300 parents were asked to measure out one teaspoon of acetaminophen with dosing cups, dosing spoons, oral syringes, and droppers. 70% of the parents made an error when it came to using the dosing cups with printed markings, and 50% made an error when using dosing cups with etched markings. More than a third of just these mistakes alone would have been highly dangerous overdoses if this study were not conducted in a controlled environment. According to the Institute for Safe Medical Practices’ reporting on this study, “Parents who make mistakes when using dosing cups are often confused about the differences between teaspoons and tablespoons.”6 Mistakes were only made 6% of the time when using a dropper, 10% of the time when using an oral syringe, and 14% of the time when using a dosing spoon. Keep in mind that a dosing spoon is different than a kitchen teaspoon or tablespoon, in that it is accurately calibrated to hold the amount it purports to, unlike the others, which have been shown to vary from spoon to spoon. So we can rest assured that it would be much safer to measure a number of milliliters in a liquid measuring device such as a dropper instead of simply trusting in one of these spoons. Additionally, it is not very easy to measure the exact amount of medication such that it is lying flat at the brim of the spoon without making a mess. This could be much easier if a dropper or oral syringe was used.

It would be great if milliliters replaced teaspoons and tablespoons on all drug labels over time, but at the moment we will likely continue to encounter all three units of measure. Armed with the knowledge of how much each unit represents and being careful when you’re reading instructions will decrease your chances of committing a liquid medication measurement error. As a future pharmacist, I would recommend always using a measuring cup or another device such an oral syringe over a spoon to measure tablespoons and teaspoons, even if the spoons say they are designed specifically for that purpose. Share these important tips with friends and family and always be careful in order to guarantee positive outcomes for yourself and your loved ones. And if you are a health care provider follow the link here to see ISMP’s recommendations for preventing liquid medication errors.

Have you ever mixed up tablespoons and teaspoons? Have you seen someone else mix them up? What steps will you take to avoid liquid medication mistakes?

References

  1. Schmidt C. Child medication measurements confuse parents. cnn.com  http://thechart.blogs.cnn.com/2014/07/14/child-medication-measurements-confuse-parents/. Published July 14th, 2014. Accessed November 6, 2014.
  1. Teaspoon v. tablespoon: What’s the difference? Ismp.org https://www.ismp/org/consumers/teaspoon.asp Updated 2014 Accessed November 6, 2014
  1. Yin H, Dreyer B, Ugboaja D, et al. Unit of measurement used and parent medication dosing errors. American Academy of Pediatrics. 2014;134(2).
  1. Falagas ME, Vouloumanou EK, Plessa E, Peppas G, Rafailidis PI. Inaccuracies in dosing drugs with teaspoons and tablespoons. Int J Clin Pract. 2010;64(9):1185.
  1. Shonna Yin H, Mendelsohn AL, Wolf MS, et al. Parents’ medication administration errors: role of dosing instruments and health literacy. Arch Pediatr Adolesc Med. 2010;164(2):181-186.
  1. Use an oral syringe or dropper to measure children’s medicines, not a cup.ismp.orghttps://www.ismp.org/newsletters/consumer/Issues/20100105.asp. Published June 2010. Accessed 12/02, 2014.

Lather, Rinse, and Repeat

December 2nd, 2014

By Logan Conkey, PharmD Student

Students are in the swing of things now that fall has begun. Students are at a higher risk of spreading sickness to others because of the environment they are in.  October is here and this month initiates flu season as well as a time where more illness is being shared.1 To prevent the spread of illness, the CDC recommends cleaning hands frequently, including after using the restroom.2 Many people do not like to wash their hands and a survey reported by the American Society for Microbiology reported 1 in 5 teenagers and adults claimed they do not wash their hands after they use the restroom.3 With so many germs being passed around, students often become sick and have to miss school. Recently, a group of researchers in New Zealand wanted to see if there was a relationship between the amount of school days missed due to illness and hand hygiene that included hand sanitizer combined with normal and frequent hand washing.

CNN Health published the article; Hand sanitizer doesn’t help in schools in August this year.4 The article was based on a study that took place in elementary classrooms in New Zealand and compared students who hand washed only and students using alcohol based hand sanitizer along with normal hand washing. All classrooms were taught proper washing techniques to ensure a standard practice and the alcohol sanitizer was provided to make certain it was the same strength throughout. The trial was conducted in 68 elementary schools, during the winter term, with children ages 5-11 The control group was instructed only to use regular hand washing with soap and water when cleaning their hands. The intervention group was instructed to wash their hands with soap and water and include the use of an alcohol-based sanitizer after they coughed, sneezed, and before meals. The outcome was to be determined by comparing the amount of total days students missed due to illness only. The results suggested there was not a significant difference between the groups regarding total days missed. The study did not look at specific illnesses such as flu when collecting data and the study may have been limited because there was a flu epidemic during this season. Another limitation included parental direction and whether the parents were instructing students to differ from the provided procedure. Some students also complained about the taste of the sanitizer on their hands when eating and this believed to have made the children less compliant when using it. The complaints came from a handful of schools and the sanitizer was replaced with an equivalent.5

The CDC says hand washing with soap should be the first option and hand sanitizer should be used if soap and water are not available. Alcohol-based sanitizers do not eliminate all forms of germs.6 It is confirmed that proper hand washing and/or the use of alcohol-based hand sanitizers has shown to reduce the risk of infection from certain viruses.7 Alcohol based sanitizers must be strong enough to be effective. Not all sanitizers are created the same and the recommended strength should be at least 60%.8 Other studies performed in the classroom regarding the used of alcohol based hand sanitizers has not persuaded researchers to consider them beneficial enough to place high priority on them and that hand hygiene education is the largest benefactor.9

The study performed in New Zealand provides proof we should not be putting a high priority on placing alcohol-based hand sanitizer in classrooms. Parents should encourage proper hand hygiene and instruct children when the most important times are to wash hands. If hand washing is not an option then hand sanitizer is a good second choice. While there does not seem to be a great benefit to sanitizer in the classroom, there have been no reported risks or problems with using it. The parent or teacher must decide if they want to incorporate sanitizer. There is no way of eliminating illness in children but parents and teachers can work together to improve the health of the classroom.

Are you and your students taking the proper precautions to prevent sickness?

 

References

  1. The Flu Season. CDC Website. Available at: http://www.cdc.gov/handwashing/when-how-handwashing.html. Accessed October 3, 2014.
  2. Preventing Seasonal Flu Illness. CDC Website. Available at: http://www.cdc.gov/flu/about/qa/preventing.htm. Accessed October 3, 2014.
  3. Hand Sanitizer doesn’t help in schools. CNN Health Website. Available at: http://thechart.blogs.cnn.com/2014/08/12/hand-sanitizer-doesnt-help-in-schools/?iref=allsearch. Accessed October 3, 2014.
  4. Bratsis M. Flu Season: The Best Defense. Science Teacher [serial online]. October 2012;79(7):68. Available from: Education Research Complete, Ipswich, MA. Accessed October 3, 2014.
  5. Priest P, McKenzie J, Audas R, Poore M, Brunton C, Reeves L. Hand Sanitiser Provision for Reducing Illness Absences in Primary School Children: A Cluster Randomised Trial. Plos Medicine [serial online]. August 2014;11(8):1-14. Available from: Academic Search Complete, Ipswich, MA. Accessed October 3, 2014.
  6. When & How to Wash Your Hands. CDC Website. Available at: http://www.cdc.gov/handwashing/when-how-handwashing.html. Accessed October 3, 2014.
  7. Prazuck T, Compte-nguyen G, Pelat C, Sunder S, Blanchon T. Reducing gastroenteritis occurrences and their consequences in elementary schools with alcohol-based hand sanitizers. Pediatr Infect Dis J. 2010;29(11):994-8.
  8. Roy K. Rethinking the use of hand sanitizers. Science Scope [serial online]. September 2009;33(1):74-76. Available from: Education Research Complete, Ipswich, MA. Accessed October 3, 2014.
  9. Meadows E, Le Saux N. A systematic review of the effectiveness of antimicrobial rinse-free hand sanitizers for prevention of illness-related absenteeism in elementary school children. BMC Public Health [serial online]. January 2004;4:50-11. Available from: Academic Search Complete, Ipswich, MA. Accessed October 3, 2014.

Electronic cigarettes: effective, or just the new “cool” sensation?

December 1st, 2014

By Samuel Tesfaye, Pharm.D. Student.

Electronic cigarettes (e-cigarettes) are becoming increasingly popular in the U.S. despite lack of evidence regarding their safety.1 According to the National Tobacco Survey, e-cigarette use in both the youth and adult population has nearly doubled from 2011-2012.2 Many smokers of conventional cigarettes are using e-cigarettes as an aid to help them quit smoking. Unlike conventional cigarettes that release smoke, e-cigarettes are battery-powered devices that deliver nicotine through emission of a vapor.3 The vapor within the e-cigarettes is generated by heating a solution made up mostly of propylene glycol or glycerol.1

Several reasons support this increased popularity of e-cigarettes, especially among the youth. E-cigarettes can easily be carried around in the pocket and come in a variety of different flavors, which makes them appealing to the user.3 There is also a “coolness” associated with e-cigarette use likely arising from aggressive advertisement of e-cigarettes on national TV and other social media.3 The lack of the appealing qualities in other treatment methods, such as nicotine patches, offers little incentive for youths to use anything other than e-cigarettes.

Because e-cigarettes are relatively new products, research on the long-term health consequences of these products is lacking. Despite this limitation, a few of the studies conducted have indicated that substances contained in the e-cigarettes are harmful to the body. Propylene glycol, the main ingredient of e-cigarettes, is one example of these harmful substances. When propylene glycol is heated, it forms propylene oxide, which has been linked to respiratory irritation, central nervous system impairment, and even various types of cancer.1

A recent article in JAMA Pediatrics evaluated the benefit of e-cigarettes in helping smokers quit.2 The researchers employed a cross-sectional analysis from the National Youth Tobacco Survey data (NYTS). The NYTS was conducted on a representative sample of US middle and high school students from all 50 states between 2011 and 2012. The number of students surveyed were 17, 353 in 2011 and 22, 529 in 2012. Respondents were asked a series of questions about their cigarette smoking habits and which product(s) they use (conventional, e-cigarette, or both). The researchers found that e-cigarette use did not discourage the use of conventional cigarettes. This suggests that e-cigarettes are not effective in helping smokers quit. Moreover, it was also found that e-cigarettes led to instances of nicotine addiction and an increased risk of switching to conventional cigarette smoking (for those who hadn’t used traditional cigarettes prior to e-cigarettes). This study is not without limitations, however. Because the survey was entirely self-reported, the information obtained may not be valid and accurate due to the fact that those who took the survey may not have been completely truthful. For instance, they may smoke more than what they reported. Additionally, their conclusion cannot be generalized to the general public because the sample only included middle and high school students.

Contrary to the findings in this article, one study has reported that e-cigarettes are effective in helping smokers quit. Some healthcare providers are even recommending e-cigarettes to their patients. A recent study conducted in North Carolina examined physician’s attitude toward the use of e-cigarettes.4 The researchers reported that over two thirds (67.2%) of the physicians indicated that e-cigarettes are a helpful tool for patients wanting to quit smoking.4 More surprisingly, 35.2% of physicians said that they have recommended them to their patients.4 This study tells us that e-cigarettes are gaining momentum not only among the public but also among health care providers.

Smokers wishing to quit have a variety of nicotine replacement therapy products from which to choose, including inhalers, lozenges, chewing gum, and nasal spray.7 Smokers can also use prescription medications such as bupriopion and varenicline, as these medications have been proven to be safe and effective.7 Maintaining a healthy support network is also one way smokers can quit smoking. Socializing with people, exercising, going to movies, and doing outdoor activities can help people quit smoking.8 Seeking professional counselling from a primary care physician or pharmacist might also help smokers quit smoking. Pharmacists can play a pivotal role in helping people quit smoking by providing patients with the health consequences of smoking and the benefits of quitting, as well as assisting the patient is selecting an appropriate nicotine replacement product. Given the number of number of smoking cessation options that have been proven safe and effective, until further research is conducted on the long-term consequences of e-cigarettes and their safety is established, I believe patients should refrain from using these products.

Do you think e-cigarettes might be an appropriate smoking-cessation aid for you, or someone you know who is wanting to quit smoking?

References

  1. Grana, R., Benowitz, N., & Glantz, S. A. (2014). E-cigarettes: A scientific review. Circulation, 129(19) 72-86.
  2. Dutra L, Glantz S. Electronic cigarettes and conventional cigarette use among U.S. adolescents: a cross-sectional study. JAMA Pediatrics [serial online]. July 2014;168(7):610-617. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 24, 2014.
  3. Trumbo C, Harper R. Use and Perception of Electronic Cigarettes Among College Students. Journal Of American College Health . April 2013;61(3):149-155. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 21, 2014.
  4. Kandra, K. L., Ranney, L. M., Lee, J. G., & Goldstein, A. O. (2014). Physicians’ attitudes and use of E-cigarettes as cessation devices, North Carolina, 2013. PloS One, 9(7).
  5. Pepper, J. K., McRee, A., & Gilkey, M. B. (2014). Healthcare providers’ beliefs and attitudes about electronic cigarettes and preventive counseling for adolescent patients. Journal of Adolescent Health, 54(6), 678-683.
  6. S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2014 October 21].
  7. Electronic cigarettes (e-cigarettes). CA: A Cancer Journal For Clinicians [serial online]. May 2014;64(3):169-170. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed November 2, 2014.
  8. Glynn, T., & Manley, M. W. (1992). How to help your patients stop smoking: A manual for physicians.DIANE Publishing

Magnesium and physical activity – does it make a difference?

December 1st, 2014

By Matthew Johnson, Pharm.D. Student.

Magnesium is a mineral involved in many bodily functions such as muscle and nerve regulation, blood sugar control, energy production, and the making of proteins.Recommended Dietary Allowance (RDA) is the average daily amount needed to meet the body’s needs of a dietary substance for most healthy people.The RDA for magnesium varies by age and gender. For women 19-30 years old it is 310 mg (men 400 mg). For women aged 31 years and older the value is 320 mg (420 mg for males). A deficiency of magnesium can result in seizures, abnormal heart rhythms, low blood calcium and potassium levels, and muscle contractions/cramps. Furthermore, magnesium deficiency has been linked to both lower physical activity and exercise ability.2  This is even more important for the elderly population because of the impact the aging process has on physical activity.Specifically, the aging population is at greater risk for magnesium deficiency than young people due to low dietary intake, reduced absorption, and a greater amount excreted in stools and urine. It is important to note, however, that excessive magnesium intake from supplements may cause diarrhea, abdominal pain, and/or cramping. Furthermore, intake of amounts greater than 5000mg per day can lead to magnesium toxicity and death. 4

The current standard of care for improving physical activity is sufficient aerobic and muscle-strengthening activities.5  The Center for Disease Control and Prevention recommends for adults 65 years and older to do muscle-strengthening activities that work all of the major groups of muscles (hips, back, shoulders, arms, legs, chest and abdomen) on two or more days per week. Muscle-strengthening activities include lifting weights, resistance band usage, push-ups, sit-ups, yoga, and gardening activities such as digging or shoveling. The CDC also recommends that all adults 18 years and older get either 5 hours of moderate-intensity aerobic activity or 2 hours and 30 minutes of vigorous-intensity aerobic activity. Moderate activity is a 5 or 6 on a 10-point scale in which 0 is defined as sitting and 10 is full effort activity. Vigorous activity is a 7 or 8 on this same scale.

A study recently published in the American Journal of Clinical Nutrition looked at the effects of oral magnesium supplementation on physical performance.3  This study only involved healthy elderly women that were involved in a weekly exercise program. There were two groups of healthy women in the study: one group received oral magnesium supplements of 900mg magnesium oxide/day for 12 weeks while the second group did not receive supplements or any other differences in treatment. The purpose of the study was to see if magnesium supplementation would improve physical performance. Short Physical Performance Battery (SPPB) tests were used in part to examine physical performance. A SPPB test involves checking lower limb activities such as walking and balance. The study found better physical performance in the group taking the magnesium supplements. There were no harmful effects seen in either of the groups. One major factor that limited the results of the study was that it only included healthy elderly women that exercised and so the same results may or may not occur in populations such as adolescents, men, or people that do not exercise. A different study published earlier this year in the Journal of Sports Sciences supports the findings that magnesium supplementation can improve physical performance.6

For individuals seeking to improve physical activity, it appears that magnesium supplements in the appropriate RDA range can be taken to boost physical activity performance.  Have you tried magnesium supplements before? If so, what form did you take and did you notice any differences after taking them?

Sources:

  1. S. Department of Health & Human Services, Nation Institutes of Health, Office of Dietary Supplements. Magnesium Fact Sheet for Health Professionals. http://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/ Reviewed November 04, 2013. Accessed October 2014.
  2. Lukaski HC. Magnesium, zinc, and chromium nutriture and physical activity. Am J Clin Nutr. 2000;72(suppl):585S–93S.
  3. Nicola V, Berton L, Carraro S, et al. Effect of oral magnesium supplementation on physical performance in healthy elderly women involved in a weekly exercise program:a randomized controlled trial. Am J Clin Nutr. 2014; 100: 974-981.
  4. Kutsal E, Aydemir C, Eldes N, et al. Severe hypermagnesemia as a result of excessive cathartic ingestion in a child without renal failure. Pediatr Emerg Care. 2007;23:570-572.
  5. Center for Disease Control and Prevention. Physical activity: How much physical activity do older adults needs? http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html. Updated June 17, 2014. Accessed November 2, 2014.
  6. Setaro L, Santos-Silva P, Colli C, et al. Magnesium status and the physical performance of volleyball players: effects of magnesium supplementation. Journal Of Sports Sciences[serial online]. March 2014;32(5):438-445. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed November 12, 2014.

Will treating a fever lead to wheezing?

November 24th, 2014

By Aric Carroll, PharmD Student

A young child is very susceptible to getting sick, and with that sickness often comes fever. How do most parents treat their child’s fever? The answer for the past few decades has been acetaminophen. In many countries around the world, the first line drug approved for treating fever in children is acetaminophen.1 It has been estimated from one study that up to 75% of all children in Western countries are at some time treated with fever reducing drugs such as acetaminophen.2,3 In the United States acetaminophen use without a physician visit is approved for children as young as 2 years old.4,5 In the past decade, a lot of research has looked at a connection between the rise of acetaminophen use and the rise of asthma in young children.6

A recent study from the Journal of Korean Medical Science (JKMS)9 investigated the relationship between acetaminophen use and asthma prevalence, but took it a step further to try to see why acetaminophen use could be associated with the condition of asthma. The study particularly looked at a specific gene for a receptor in the body called toll-like receptor 4 (TLR4). This is one of the first studies to focus on the combination of TLR4 modification and acetaminophen use and the risk of asthma associated with that combination. In past studies, modification of the gene for TLR4 has been associated with a higher prevalence rate of asthma.7 It has been suggested that modification at this particular gene affects how the TLR4 functions. Modifications may cause the body to work harder at dealing with fine particles that are inhaled leading to physical symptoms associated with asthma.8 The authors of the recent JKMS study acknowledge that TLR4 facilitates the symptoms of asthma by contributing to the release of reactive oxygen species, which are molecules that cause excess stress on the body. This excess stress can then lead to the release of cells that cause inflammation, cause the airways to be inflamed, and cause bronchial hyperresponsiveness (BHR) or tightening of the airways. The study suggests that modification of the TLR4 gene could cause the receptor to be more abundant and lead to greater asthma symptoms.9

The study examined 2, 428 children aged between 8 and 13. The parents of each child were asked to fill out a questionnaire, which included questions about whether the child had used acetaminophen, and whether the child had been diagnosed with asthma. Tests were run on each child to determine a forced expiratory volume after a methocholine challenge, which is an indicator of BHR. Methocholine causes constriction of the airways. BHR to methocholine was defined as a PC20 (the concentration of methocholine re-quired to provoke a 20% reduction in FEV1) ≤ 16 mg/mL. Genetic tests were run on each child to determine modification of the TLR4 gene. The results showed that the use of acetaminophen was associated with risk of BHR; however, it was not associated with actual asthma diagnosis. Modification of the TLR4 receptor was not associated with asthma diagnosis or risk of BHR. A combination of acetaminophen use and TLR4 modification was significantly associated with asthma diagnosis as well as risk for BHR. The study concluded TLR4 gene modification may increase the risk of asthma in children who have used acetaminophen.9

While the study had a very large sample size of children, it had limitations that could have affected the study’s results. The study only looked at acetaminophen use in the past 12 months, but did not take into account whether children had used acetaminophen in earlier years. Also, the study looked at patients with a recall of an actual diagnosis of asthma in the children instead of asking about certain symptoms of asthma such as shortness of breath during physical exercise, wheezing, or increased coughing. Many children may have had symptoms of asthma but had never been diagnosed by a physician. The study also did not in any way establish a relationship between dose or duration of acetaminophen use. Acetaminophen use was defined as if they took acetaminophen longer than 3 days in the last 12 months. This was also solely based on patient recall. These limitations are significant and reduced the generalizability of the study. This type of observational study cannot determine a causative relationship. Thus, this kind of research can only suggest potential risks associated with exposure.

While this study, along with others, have evidence to support a relationship between TLR4 modification and asthma, other similar studies have not found this relationship.10 The conflicting evidence on this specific mechanism makes it hard to conclude one way or another whether TLR4 modification is directly linked to asthma symptoms. Also, at this time there seems to be a lack of sufficient evidence to directly link acetaminophen use to asthma symptoms. More prospective research needs to be done looking at acetaminophen use and its relationship with asthma symptoms specifically in combination with TLR4 gene modification. It may be possible that acetaminophen has a greater adverse effect on children who have a TLR4 gene modification which would increase the risk of asthma specifically in those children. With what evidence is available at this time, it is difficult to say that treating a child with acetaminophen will cause them to develop asthma symptoms.

So, what are your thoughts? Even with this possibility of acetaminophen use in children leading to asthma symptoms, do you think it’s still reasonable for acetaminophen to be used to treat a child’s fever?

References

  1. Gonzalez-Barcala F, Pertega S, Silvarrey A, et al. Exposure to paracetamol and asthma symptoms. European Journal Of Public Health [serial online]. August 2013;23(4):706-710. Available from: Food Science Source, Ipswich, MA. Accessed October 15, 2014.
  2. Jensen J, Tønnesen L, Söderström M, Thorsen H, Siersma V. Paracetamol for feverish children: parental motives and experiences. Scandinavian Journal Of Primary Health Care [serial online]. June 2010;28(2):115-120. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 16, 2014.
  3. Sullivan J, Farrar H. Fever and antipyretic use in children. Pediatrics [serial online]. March 2011;127(3):580-587. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 16, 2014.
  4. Reducing fever in children: safe use of acetaminophen. FDA Consumer Health Information. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm263989.htm. Published July 21, 2011. Updated June 6, 2014. Accessed October 15, 2014.
  5. Krinsky, D. L., Berardi, R. R., & Ferreri, S. P. (2011). Handbook of nonprescription drugs: An interactive approach to self-care (17th ed.). Washington, D.C: American Pharmacists Association.
  6. Farquhar H, Stewart A, Beasley R, et al. The role of paracetamol in the pathogenesis of asthma. Clinical & Experimental Allergy [serial online]. January 2010;40(1):32-41. Available from: Academic Search Complete, Ipswich, MA. Accessed October 15, 2014.
  7. Fagerås Böttcher M, Hmani-Aifa M, Vaarala O, et al. A TLR4 polymorphism is associated with asthma and reduced lipopolysaccharide-induced interleukin-12(p70) responses in Swedish children. The Journal Of Allergy And Clinical Immunology. September 2004;114(3):561-567. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 16, 2014.
  8. Kerkhof M, Postma D, Koppelman G, et al. Toll-like receptor 2 and 4 genes influence susceptibility to adverse effects of traffic-related air pollution on childhood asthma. Thorax [serial online]. August 2010;65(8):690-697. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 18, 2014.
  9. Lee S, Kang M, Hong S, et al. Association between Recent Acetaminophen Use and Asthma: Modification by Polymorphism at TLR4. Journal Of Korean Medical Science. March 2014;29(5):662-668. Available from: Science Citation Index, Ipswich, MA. Accessed October 10, 2014.
  10. Hussein Y, Awad H, Shalaby S, Ali A, Alzahrani S. Toll-like receptor 2 and Toll-like receptor 4 polymorphisms and susceptibility to asthma and allergic rhinitis: A case-control analysis. Cellular Immunology [serial online]. 2012;274(1-2):34-38. Available from: Science Citation Index, Ipswich, MA. Accessed October 18, 2014.

Flush Out Your Child’s Allergies!

November 20th, 2014

By Kelly Huston, Pharm.D. Student.

Got allergies? Is your child sneezing and/or have a stuffy, itchy, or runny nose? Flushing the nose out with a saltwater solution may provide some relief. Allergies are the body’s response to a substance that causes these symptoms.1 Because germs can contribute to allergy symptoms, flushing the nose could help by removing germs and by increasing the nose lining’s ability to stop germs from entering the body.2,3 Parents are looking for a simple solution to relieve their children’s allergic symptoms. Rinsing the nose out with a saltwater solution may be the answer they are hoping for.

Currently, self-treating allergies in children less than twelve years old is only appropriate if they have been seen by the doctor. However, if the child is twelve years or older, self-care is appropriate without first seeing the doctor. The best way to treat allergy symptoms in children is to avoid the cause of the allergic reaction. If the child cannot avoid the cause of the reaction, a second option to try before using medications is to flush the nose out with a saltwater solution. If medication is necessary, remember that choosing the medicine focused on relieving your child’s main symptom(s) can greatly help.1

An article published in June 2014 entitled, The Effectiveness of Nasal Saline (seawater) Irrigation in Treatment of Allergic Rhinitis in Children, looked at how effective flushing out the nose with a saltwater solution is at reducing allergy symptoms. The study consisted of sixty-one children between the ages of two and fifteen who were diagnosed with allergies. The individuals were randomly placed in three groups to look at how well fluticasone propionate (a steroid-medication used in the nose), nasal rinsing, and a combination of both methods relieved the symptoms of allergies. The study looked at the ability of each of the three treatments to reduce the symptoms of itchy nose, runny nose, blocked nose, and sneezing. The researchers found that flushing the nose out twice a day had no side effects among any of the children, improved all of the children’s symptoms after three months, and was effective when combined with the nasal medication. They discovered that both flushing out the nose and using the nasal medication caused the children’s symptoms to improve more at four, eight, and twelve weeks, compared to each method done individually. Using both methods made it possible to reduce the amount of medication used to treat the allergies. Using a larger amount of the nasal medication can be costly, but flushing the nose out in combination with this medication may lead to a decrease in the cost of treating allergies. These findings reinforce the idea that flushing out the nose with saltwater can effectively relieve the symptoms of allergies. However, this study is limited. A good scientific study will include a group (called the control group) that does not receive any type of treatment in order to see if the treatment that the other group is receiving is really as good as the researchers think it will be. This study did not have a control group. Another limit of the study was that it only looked at one nasal medication and did not look at other medications used to treat allergies.3 Previous studies have looked at the effectiveness of flushing out the nose. In fact, two studies conducted in the years 2000 and 2012 concluded that flushing the nose is effective at reducing allergy symptoms.4,5

Currently, there are several different methods of rinsing out the nose such as a Neti Pot, battery powered pulse water device, bulb syringe, and squeeze bottle. The proper technique of flushing out the nose is important because, if done inappropriately an infection may result.6 This procedure can be done one to two times a day or as needed to relieve symptoms.7 Individuals should wash their hands and make sure the device is dry and clean before following the procedure below. Specific directions may vary between methods, but they generally include:

  • Over a sink, learn your head sideways and facedown to avoid getting the solution in your mouth.
  • Keep your mouth open, place the spout of the device that is filled with the saltwater solution in the top nostril, so that the liquid comes out the other nostril
  • Once finished, blow your nose. Lean your head to the other side and facedown. Then repeat this procedure for the other nostril.6

Mild side effects may include slight stinging. Stop using this treatment and see the doctor if a headache, fever or nosebleed occurs.6 Also, if this treatment does not improve allergy symptoms, the use of a medication may be an option.1 If concerns or questions come up, please speak with a pharmacist or doctor.

Given this information, will you flush out your nose, or a loved-one’s nose with saltwater solution to relieve symptoms in the future?

References:

  1. Krinsky DL, Berardi RR, Ferreri SP, et al. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 17th ed. Washington, D.C.: American Pharmacists Association; 2012.American Rhinologic Society. Nasal/Sinus Irrigation. http://care.american-rhinologic.org/irrigation Updated August 2012. Accessed October 29, 2014.
  2. Chen J, Jin L, Li X. The Effectiveness of Nasal Saline Irrigation (seawater) in Treatment of Allergic Rhinitis in Children. International Journal Of Pediatric Otorhinolaryngology [serial online]. July 2014;78(7):1115-1118. Available from: Academic Search Complete, Ipswich, MA. Accessed October 30, 2014.
  3. Tomooka LT, Murphy C, Davidson TM. Clinical Study and Literature Review of Nasal Irrigation. Laryngoscope, 2000, 110, 7, 1189-1193, John Wiley & Sons. http://onlinelibrary.wiley.com/doi/10.1097/00005537-200007000-00023/full
  4. Hermelingmeier K, Weber R, Hellmich M, Heubach C, Mösges R. Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis. American Journal Of Rhinology & Allergy [serial online]. September 2012;26(5):e119-e125. Available from:
  5. MEDLINE with Full Text, Ipswich, MA. Accessed October 30, 2014.
  6. U.S. Food and Drug Administration. Is Rinsing Your Sinuses Safe? http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM316649.pdf Published August 2012. Accessed October 27, 2014.
  7. deShazo R and Kemp S. Patient information: Allergic Rhinitis. UpToDate. http://www.uptodate.com/contents/allergic-rhinitis-seasonal-allergies-beyond-the-basics Updated February 2014. Accessed October 30, 2014.

 

The Purple Pill Goes OTC

November 20th, 2014

By Josh Willoughby, Pharm.D. Student

Heartburn is a common health problem that affects 25% of Americans on average each year. It has been reported that in the United States alone, approximately $14 billion is spent annually.[1] Heartburn normally presents itself with a burning sensation in the chest or upper abdomen that moves upward into the throat. There are many different medications for treatment of heartburn, so it is important to know which one is the best option for self-treatment. Recently, the well-known “purple pill” for heartburn became available to patients without the need for a prescription. In late May of 2014, Pfizer Inc. announced the introduction of a new over-the-counter heartburn medication, known as Nexium 24HR.[2] Nexium, the popular “purple pill”, previously had been on the market as a prescription-only medication, but has now made the jump to over-the-counter (OTC), just as competitors Prilosec and Prevacid did years before. The switch to OTC will now allow consumers greater access and more affordable options for treatment of heartburn.

Nexium 24HR is a proton pump inhibitor or PPI, meaning that it blocks acid pumps in the stomach, which are the controlling factors in causing heartburn. PPIs are effective for treating frequent heartburn that occurs at least two days a week. Relief begins in two to three hours, but it may take between one and four days for the maximum effect to set in. Though this medication may have a slower onset of relief compared to antacids, PPIs last the longest out of any OTC heartburn treatment (approximately 12-24 hours). Nexium 24HR currently comes in a delayed-release, enteric coated form, allowing the medication to work in the body where it is needed. Nexium 24HR should be taken 30-60 minutes before meals for full effect. Taking the medication each morning would be the easiest way to ensure that the patient does not forget to take it. It is recommended that the medication be taken once daily for two weeks and then stopped for at least four months. If heartburn continues to occur, contacting the primary physician is suggested.1

Nexium 24HR comes in 22.3 mg strength, compared with the prescription-only 20 mg and 40 mg strengths. Even with the slight difference, compared with the prescription strengths, the 22.3 mg dose is equivalent to 20 mg esomeprazole, the medication’s active ingredient.[3] Nexium 24HR capsules should not be crushed or chewed. This will cause the medication to be released before it reaches the small intestine, where it needs to be activated. Nexium 24HR should not be taken by patients who have trouble swallowing food, are vomiting blood, or have black or bloody stools. Those who have lightheadedness, sweating, dizziness, or chest pain should not take Nexium 24HR and should contact a doctor. Nexium 24HR should not be taken by patients younger than 18 years old. Patients taking warfarin, clopidogrel, cilostazol, antifungals, anti-yeasts, digoxin, diazepam, tacrolimus, HIV medications, or methotrexate should ask a doctor before starting Nexium 24HR.[4]

Since prescription-strength Nexium originally came on the market in 2002, it quickly surpassed the other PPIs in sales through heavy marketing by AstraZeneca. The “purple pill” became the most purchased PPI over its competitors Prevacid (Lansoprazole) and Prilosec (Omeprazole). Based on Consumer Report’s data before the release of Nexium 24HR, Lansoprazole 20 mg and Omeprazole 20 mg (both OTC) were the cheapest effective PPI options.[5] Currently, a box of Nexium 24 HR costs about $18, while Omeprazole 20 mg only costs around $13 for a box of 28 capsules. Clinical evidence has shown no proof that Nexium is more effective than Prilosec (Omeprazole) in treating heartburn. In fact, both medications are nearly identical in their chemical structures. However, research studies have found that Nexium 20 mg and 40 mg are slightly more effective than Prilosec 20 mg in healing the esophagus, but no tests have been done to compare against Prilosec 40 mg.[6]

Because Nexium has not been tested against the higher strength of Prilosec, it remains unknown whether or not it is a better treatment option. Due to the fact that Nexium and generic Prilosec (Omeprazole) are almost identical in structure and have similar effectiveness, one should pause before choosing the more expensive option, Nexium. Most likely due to increased advertising, Nexium has become the preferred PPI on the market over the past decade. However, based on the current scientific and clinical data, I would recommend generic Prilosec OTC (Omeprazole) over Nexium 24HR to patients on the basis of increased cost savings. Paying more for a medication that has not been conclusively proven to be better than another medication is really not in anyone’s best interest. Hopefully, future studies will discover whether or not these medications significantly differ in efficacy, so that both medical professionals and patients alike will be better informed. With this information, what proton pump inhibitor would you recommend or choose for treating yourself and why?

References

  1. Heartburn and Dyspepsia. (2012). In D. Krinsky et al (Ed.), Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care (17th ed., pp. 219-228). Washington DC: American Pharmacists Association.
  2. Pfizer Brings Frequent Heartburn Relief Over-the-Counter with New Nexium 24HR. (2014, May 27).
  3. Esomeprazole (Lexi-Drugs). (2014, May 1).
  4. Nexium 24HR. (2014, May 27).
  5. Consumer Reports, Using the Proton Pump Inhibitors to Treat Heartburn and Stomach Acid Reflux, 1-15. (2013).
  6. Zablocki, E. (2004). Proton Pump Inhibitors are the Preferred Treatment for Ulcers. Managed Healthcare Executive, 48-49.

Eat more, lose more?

November 18th, 2014

By Stephanie Cailor, PharmD Student

You have probably heard the common dietary recommendation that you should eat more fruits and vegetables as a part of a healthy diet. WebMD provides some simple diet tips including one that correlates specifically with this theme. They explain that by “eating more fruits and vegetables, you shouldn’t feel as hungry because these nutrient-rich foods are also high in fiber and water, which can give you a feeling of fullness,” a claim that is supported by much research.1, 2 So how exactly does fiber play a role? Fiber is a component of food that is difficult for the body to digest. Two types of fiber exist: soluble fiber, such as that found in citrus fruits, strawberries, celery, and green beans, and insoluble fiber, found in foods such as broccoli, cabbage, and grapes. Soluble fiber retains water and slows digestion in the stomach and intestines; whereas, insoluble fiber works by adding bulk to the stool in order to speed up the passage of food through the stomach and intestines.3 For this reason,  among others, the World Health Organization recommends that adults eat a minimum of 400 grams of fruit and vegetables per day to prevent health conditions such as obesity.4 To bring this number into perspective, roughly half of each plate should be filled with fruits and vegetables. Further examples and information regarding serving sizes can be viewed at www.choosemyplate.gov/food-groups/.5 While the task of eating more fruits and vegetables may seem simple, is this general recommendation to help lose weight failing to tell us the whole story?

The claim that adding fruits and vegetables to the diet can help with weight management may be correct, but only increasing fruit and vegetable consumption may not lead to weight loss. A recently published meta-analysis reviewed the results of 7 research studies on this subject.6 Each of these studies looked at the impact of increased dietary intake of fruits and vegetables on weight loss; however, none saw a significant effect. One study involving 90 adults utilized an 8 week intervention that added either 0 grams, 300 grams, or 600 grams of fruits and vegetables to daily diet. The study concluded that groups increasing their fruit and vegetable intake lost some additional weight, but the amount was not statistically significant.7 Another study looked at adult women who increased the intake of their fruits and vegetables to 9 servings a day. The body weight of these patients changed very little, with no statistically significant reduction in weight loss over the course of the study.8 There are a few reasons why the included research studies may show the shared conclusion of no significant weight loss due to eating more fruits and vegetables. Some of the studies may not have looked long enough to see the effects of eating more fruits and vegetables on body weight. Others may have not had a large enough increase in fruits and vegetables in the diet to show any weight loss effects. Accordingly, more research needs to be done on this topic before a definitive statement can be made.

Overall, this meta-analysis concludes by stating that while eating more fruits and vegetables does promote a healthy lifestyle, in order to lose weight, other efforts are necessary to achieve desired outcomes.6 For example, adding fruits and vegetables without cutting out other unhealthy foods, primarily those with high calorie counts, will not provide desired weight loss effects.9 Other supporting research emphasizes that significant weight loss results can be seen by reducing caloric intake and balancing the diet with fruits and vegetables.4, 10

As a future pharmacist, I believe that eating more fruits and vegetables as a part of a healthy diet is beneficial due to their overall low caloric content and the fiber they contain. To lose weight, though, it is important to reduce the amount of unhealthy foods in the diet. Being healthy is a lifelong pursuit that does not consist of simply changing one bad habit. Alongside a healthier diet, it is also important to be physically active. For physical activity to provide health benefits, adults should spend 150 minutes per week doing moderate intensity aerobic activity (such as walking) and at minimum 2 days per week completing muscle strengthening activities, which includes strength training or endurance exercises.11 Small steps towards a healthy lifestyle for some people could mean adding one new vegetable to their plate tomorrow or not buying chips at their next trip to the grocery store. Others may choose to take a walk around their neighborhood every day for the next week. What are some unhealthy lifestyle and diet habits that you could change today to help you get on track for weight loss?

References

  1. Smith, M. W. (2014). 15 Best diet tips ever. Available from: http://www.webmd.com/diet/ss/slideshow-best-diet-tips-ever. Accessed on October 17, 2014.
  2. Tohill, B. C. (2005). Dietary intake of fruits and vegetables and management of body weight. World Health Organization.
  3. Dugdale, D. (2012, September 2). Soluble and insoluble fiber: MedlinePlus Medical Encyclopedia Image. Retrieved November 1, 2014.
  4. Amine, E., Baba, N., Belhadj, M., Deurenbery-Yap, M., Djazayery, A., Forrester, T & Yoshiike, N. (2002). Diet, nutrition and the prevention of chronic diseases: report of a Joint WHO/FAO Expert Consultation. World Health Organization.
  5. Dietary guidelines for Americans, 2010. (2010). Washington, D.C.: U.S. Dept. of Health and Human Services, U.S. Dept. of Agriculture.
  6. Kaiser, K. A., Brown, A. W., Brown, M. M. B., Shikany, J. M., Mattes, R. D., & Allison, D. B. (2014). Increased fruit and vegetable intake has no discernible effect on weight loss: a systematic review and meta-analysis. The American journal of clinical nutrition, 100(2), 567-576.
  7. Whybrow S, Harrison CL, Mayer C, James SR. Effects of added fruits and vegetables on dietary intakes and body weight in Scottish adults. Br J Nutr 2006;95:496–
  8. Maskarinec G, Chan CL, Meng L, Franke AA, Cooney RV. Exploring the feasibility and effects of a high-fruit and -vegetable diet in healthy women. Cancer Epidemiol Biomarkers Prev 1999;8:919–
  9. Sacks, F. M., Bray, G. A., Carey, V. J., Smith, S. R., Ryan, D. H., Anton, S. D., … & Williamson, D. A. (2009). Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. New England Journal of Medicine, 360(9), 859-873.
  10. Wing, R. R., Hill, J. O. (2001). Successful weight loss maintenance. Annal Review of Nutrition, 21(1):323-341.
  11. Physical Activity Guidelines Advisory Committee. (2008). Physical activity guidelines advisory committee report, 2008. Washington, DC: US Department of Health and Human Services, 2008, A1-H14.

Training Programs to Prevent ACL Tears Could be the Answer to an Athlete’s Prayers

November 18th, 2014

By Kaysie Brittenham, PharmD Student

Are specialized training programs the solution to the alarming number of ACL (Anterior cruciate ligament) tears among young athletes? ACL tears continue to be a major issue among children and teens participating in competitive sports such as basketball, soccer, volleyball, and gymnastics. There are approximately 200,000 (1 in 1,750) ACL injuries every year, a majority of which occur in patients 15-45 years of age with young females at greatest risk.5 The ACL is one of four important ligaments in the knee. It runs through the center and provides stability when athletes are cutting, pivoting, stopping, or landing from a jump. Ligaments in the knee connect bone to bone at the joint and act like strong ropes to hold the bones together and maintain joint stability. They can tear from the force of a hit or from an awkward movement putting more force on the ligament than it can tolerate.2

ACL injuries have both immediate and long term debilitating effects. After an ACL tear, athletes are often less likely to return to athletics and tend to experience greater problems later on in life. Surgery, lengthy rehabilitation, early development of joint problems, chronic pain, and disability are all possible effects from ACL tears. Additionally, there are many financial, emotional, and psychological effects. Currently, ACL reconstruction surgery uses grafts to replace the ligament. These grafts come from tendons (strong tissues connecting muscle to bone) in the knee or in the back of the leg of either the patient or a deceased donor. The procedure typically lasts no more than a few hours. However, rehabilitation can be quite lengthy. Each person recovers differently, with some experiencing more difficulty than others. Complete recovery typically takes 9 months of rehabilitation. Muscles take a long time to regain strength and the affected knee often requires painful physical therapy to recover range of motion and stability. Sadly, some people are never the same after surgery and continue to experience problems such as a noticeable limp, joint pain, or fear of reinjuring themselves. Despite improvements in surgery and rehab, ACL injury prevention strategies are being stressed more and more. The hope is that these programs will combat the high occurrence of these detrimental injuries. Recent studies have suggested that specific training programs can lower the risk of ACL injury by as much as 70 percent.1 These training programs are believed to strengthen lower leg muscles, improve core stability, and help athletes avoid dangerous knee positions.1

Training programs are being stressed predominantly in young female athletes. “The largest numbers of ACL injuries occur in female athletes ages 15 to 20.”1 In fact, females are 4-6 times more likely than males to experience a torn ACL.3 The prevalence of ACL tears among young female athletes after puberty is thought to be a result of developmental changes. As body size increases, muscles in females do not generally develop and increase in strength as they do in males.1 Additionally, girls tend to jump and land differently than boys. Girls generally use their leg muscles unevenly, land with straight knees, and have legs that differ in strength. “These imbalances, which become more pronounced after puberty, put girls at greater risk of tearing their ACLs.”2 However, with the help of training programs, it is believed that these tendencies can be altered.

Physicians and athletic trainers are stressing the idea of ACL tear prevention. Many believe that specialized training programs, consisting of simple exercises that alter the way athletes run, jump, and land, can significantly reduce the risk of ACL injury. These programs have demonstrated numerous benefits and though they are not one hundred percent effective, initial research shows promise.2 Training programs may only take a few minutes a day to implement and could include a combination of drills such as jogging, skipping, lunging, or other bodyweight exercises.2 Consciously practicing a technique over and over causes muscle memory to kick in when the athlete cannot focus all of their attention on technique.3 One study conducted by Dr. Cynthia LaBella, showed that “a 20-minute program of specialized warm-ups, strengthening drills and plyometrics (explosive jumping exercises) cut down dramatically on ACL injuries compared to girls who did not perform the drills.”2 LaBella’s research has led to the development of KIPP (Knee Injury Prevention Program) which is now one of many ACL injury prevention programs.

Since KIPP’s development, many schools have adopted the program or others similar to it.2 Evidence has shown that multi-component programs are more successful than single-component programs in decreasing the occurrence of ACL injures. Exercises within these programs include plyometrics, balance and core control, strength training, agility training, spatial awareness, and muscle memory training.3 Many programs differ with respect to number and types of exercises and the frequency and duration of training.  A pooled analysis, however, looked at all current studies on these training programs and concluded that the most effective programs combined 3 key components. These included core and lower leg muscle strengthening, plyometrics, and repeated enforcement of proper technique.4 Additionally, the most effective programs trained athletes for a minimum of twice per week for 6 weeks and included preseason and in-season training.4 Though more research needs to be done, evidence suggests there are benefits in utilizing ACL injury prevention programs.

Talk with your doctor if you have questions or are interested in learning more. They can help athletes and parents locate a qualified instructor and provide you with more information.4 Athlete’s tend to have a mindset that they’re invincible, but all it takes is one wrong movement. Is it worth being proactive and possibly preventing such a common and destructive injury? As a future health care provider, I strongly suggest that young athletes, particularly females, consider these training programs. I’ve seen first-hand the negative effects of ACL injuries and greatly support efforts to reduce their occurrence. Additionally, I would recommend that pharmacists encourage patients with possible ACL tears to have it looked at by qualified athletic trainers or sports medicine physicians. Based on their assessment an MRI may then be necessary to confirm a tear. If MRI results demonstrate a torn ACL, it is important for athletes to see a specialized orthopedic surgeon with high success rates in ACL reconstruction.

References

  1. Preidt R. Training Programs Protect Young Athletes From ACL Tears: Report. HealthDay Consumer News Service[serial online]. April 28, 2014: Available from: Consumer Health Complete – EBSCOhost, Ipswich, MA. Accessed October 26, 2014.
  2. Torn ACLs continue to ravage high school athletes. Record, The (Kitchener/Cambridge/Waterloo, ON)[serial online]. September 9, 2014: Available from: Points of View Reference Center, Ipswich, MA. Accessed October 26, 2014.
  3. Laible C, Sherman O. Risk Factors and Prevention Strategies of Non-Contact Anterior Cruciate Ligament Injuries. Bulletin Of The Hospital For Joint Diseases[serial online]. January 2014;72(1):70-75. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed October 26, 2014.
  4. Dharamsi A, LaBella C. Prevention of ACL Injuries in Adolescent Female Athletes. (cover story). Contemporary Pediatrics[serial online]. July 2013;30(7):12. Available from: Publisher Provided Full Text Searching File, Ipswich, MA. Accessed October 30, 2014.
  5. Kim, Jennifer. Anterior Cruciate Ligament Injury. Sports Medicine. http://orthosurg.ucsf.edu/patient-care/divisions/sports-medicine/conditions/knee/anterior-cruciate-ligament-injury-acl/. Last Updated January 2009. Accessed November 9, 2014.

 

Poised Poses for more Z’s

November 17th, 2014

by Rachel Bull, PharmD student

Poor sleep quality is one of the most common health complaints in older adults today.  It is approximated that more than 80% of older adults experience sleep disturbance to some degree, while 50% note the common recurrence of sleep disturbance.1 Insomnia can be defined as, “having trouble falling or staying asleep, waking up too early and cannot return to sleep, or not feeling refreshed after sleeping”.2 The identification of the presence of insomnia is often quite obvious while the cause of the insomnia can be more difficult to identify.  The cause of insomnia can range greatly and is often not the primary disorder rather a response to an underlying issue.  The most common causes of insomnia are stress and anxiety.  Other causes can include a medical illness, poor sleep habits, or other sleep disorders such as sleep apnea and narcolepsy. The standard of care for insomnia is the practice of reestablishing a normal sleep cycle which can be accomplished with sleep hygiene practices such as exercise, a nonprescription sleep aid, or a prescription sleep aid.2 These treatments still pose barriers such as not being completely effective for all patients, therefore alternative treatments for insomnia are still being pursued.  Also, many over the counter sleep aids come with barriers of their own including the body building tolerance against antihistamines which are commonly found in these sleep aids, feeling groggy or unwell the next day, potential medication interactions, and a list of side effects associated with each sleep aid such as dizziness, dry mouth, and daytime sleepiness being the most common among all sleep aids.3 Recently an up and coming trend for treating insomnia has been focused on using the practice of yoga.  Yoga has been found to naturally strengthen the body by improving physical strength and flexibility, reducing stress, improving breathing patterns, and enhancing mental focus.4

A recent publication in Alternative Therapies by Health & Medicine explored the effects of yoga as a treatment for insomnia.1 Alternative therapies, such as yoga, have been proposed to be a safe alternative from the standard of care such as sleep aids and provide a treatment with little adverse events.  This waiting-list controlled trial study was conducted at Shaare Zedek Medical Center in Jerusalem, Israel and looked at how participating in yoga classes twice weekly as well as recommended home-based practices would affect older adults with complaints about insomnia.  The study included 67 participants who were 60 years and older. Sixteen of the participants were assigned to the waiting list control group while the other 43 participants were assigned to the yoga intervention group and 7 participants dropped out for various reasons.  The results concluded that overall the practice of yoga by older adults was shown to be a safe treatment and led to improved sleep quality and duration.  The study found that just 25 minutes of yoga per day for 12 weeks led to improved sleep status. A limitation presented by the authors was that there was not a single method of measuring the outcomes instead a wide range of measuring methods were used.  Another limitation would be the compliance of the participants throughout the study. This was evident with only 10% of participants maintaining the practice compliance level.1

There has been previous research done on this topic over the years. Another study showed yoga can positively affect insomnia by improving sleep efficiency and sleep duration.4 The study provided the participants with yoga training and instructed all participants to maintain daily yoga practice for eight weeks.  The participants kept sleep diaries for two weeks before the yoga practices began and for the entire eight week study to record the amount time spent asleep, number of times they woke up during the night, and the time spent sleeping between waking periods.  The study also noted that the cause of insomnia has commonly been linked to anxiety and depression.4 Another study published in the Indian Journal of Psychiatry found that 60 minutes of yoga daily for 6 months led to improved sleep quality among the elderly aged 60 years and older.5 This study supports the conclusion that the practice of yoga improves sleep quality while noting that further research should be conducted on this alternative therapy because of its great potential to treat insomnia.5

Yoga still offers barriers such as potential injury and the fact that the elderly population should not first attempt yoga on their own without seeking advice from their primary care provider. On the other hand, yoga can be more financially friendly than some medications offered to treat insomnia.  The benefits of yoga naturally target the most common causes of insomnia, which prove to be another reason why the practice of yoga should be utilized as a treatment for insomnia. Yoga can easily be incorporated into a basic lifestyle change by finding a yoga class at a local gym or fitness center or in the peace of your own home by using instructed yoga videos for just 30 minutes a day.

Are these poised poses worth a try? Do you think specifically yoga treats insomnia or simply exercise in general?  Is yoga the answer to your sleepless nights?

 References

  1. Baharav A, Cahan C, Cohen M, Halpern J, Kennedy G, Reece J. Yoga for improving sleep quality and quality of life for older adults. 2014; 20(3):37-38-46.
  2. Melton, C. K. Insomnia, Drowsiness, and Fatigue. In: R. R. Daniel L. Krinsky, Handbook of Nonprescription Drugs An Interactive Approach to Self-Care. Washington, DC: American Pharmacists Association; 2012: 867-876.
  3. Mayo Clinic Staff. Sleep aids: Understand over-the-counter options. Mayo Clinic Web site. http://www.mayoclinic.org/healthy-living/adult-health/in-depth/sleep-aids/art-20047860. Published 12/10/2011. Updated 2014. Accessed 11/15, 2014.
  4. Khalsa, SBS. Treatment of Chronic Insomnia with Yoga: A Preliminary Study with Sleep-Wake Diaries. 2004; 29(4):269-278.
  5. Basavaraddi IV, Gangadhar BN, Hariprasad VR, et al. Effects of yoga intervention on sleep and quality-of-life in elderly: A randomized controlled trial. 2013; 55:364-365-368.