NATIONAL HANDWASHING AWARENESS WEEK, DECEMBER 5th-11th

Elizabeth Bentley, PharmD Candidate 2011

“No part of human skin is spared from bacteria. Bacterial counts on the hands range from five thousand to five million colony-forming units per square centimeter.”¹

—Atul Gawande in Better: A Surgeon’s Notes on Performance

Tired of missing classes and finals because you have a bad case of the sniffles? In the midst of the cold and flu season, National Handwashing Awareness Week (December 5 to 11) emphasizes the importance of keeping your hands clean to prevent nasty infections. In addition to getting a seasonal flu vaccine, handwashing is a powerful weapon in stopping the spread of disease.

The Centers for Disease Control and Prevention stress the need to wash hands to lower the incidence of infections of all kinds.² Roll up your sleeves, and get out the soap and water:

·       Before preparing a meal

·       After handling raw meat

·       After changing a diaper

·       After coughing, sneezing, or blowing your nose

·       After going to the bathroom

·       After touching an animal or anything in its immediate surroundings

In addition to making handwashing a habit, it’s essential to complete your task in the right way.² Using soap and warm water, rub your hands together to make a good lather that completely covers your skin. Try to keep this up for 15 to 20 seconds, or approximately the time it takes to sing “Happy Birthday” twice. Beatles fans may want to try repeating the refrain to “Let It Be.” During this time, interlace your fingers to reach all the creases.³ Let the water run again, and rinse your hands thoroughly. After drying with a paper towel, take that same towel to turn off the faucet.

Alcohol-based hand sanitizers are good options when you can’t get to a sink.² Simply apply the product to one palm, and rub both hands together until dry. Make sure the product contains at least 60% alcohol, because anything less than that won’t be effective.⁴ It’s important to know that these products do not eliminate all bacteria and are not effective if hands are visibly dirty.² In these cases, it’s best to find a sink and scrub up.

Dr. Will Sawyer, who has been promoting infection prevention for more than a decade through his Henry the Hand Foundation, emphasizes the 4 principles of hand awareness.⁵ This goes a step beyond mere handwashing. 1) Always wash your hands if they are dirty and before you eat a meal. 2) Don’t cough into your hands. 3) Don’t sneeze into your hands; use the crook of your elbow or a tissue instead. 4) Don’t put your fingers in your eyes, nose, or mouth.

So remember: Before you ask Aunt Martha to pass the pumpkin pie this holiday season, make sure you’ve both washed your hands.

For More Information

Centers for Disease Control and Prevention: http://www.cdc.gov

Henry the Hand Foundation: http://www.henrythehand.com

World Health Organization: http://www.who.int

References

1. Gawande A. Better: A Surgeon’s Notes on Performance. New York, NY: Picador; 2007.

2. Centers for Disease Control and Prevention. Wash your hands. http://www.cdc.gov/features/handwashing/. Accessed December 2, 2010.

3. World Health Organization. Five moments for hand hygiene. http://www.who.int/gpsc/tools/Five_moments/en/index.html. Accessed December 2, 2010.

4. Franklin D. Hand sanitizers, good or bad? New York Times. http://www.nytimes.com/2006/03/21/health/21cons.html. Published March 21, 2006. Accessed December 3, 2010.

5. Henry the Hand Foundation.  Henry the hand—champion handwasher: national handwashing awareness week. http://www.henrythehand.com/pages/content/hwaw.html. Accessed December 2, 2010.

 HEALTHY SKIN

Xin Zhang, PharmD Student, Class of 2014

Nikki Herlich, PharmD Candidate, Class of 2011

When the Chicago winds blow in December, that usually signifies another tough winter season, so it's is a good time to talk about how to protect your skin when the weather gets cold and the heaters turn on. We will focus on two topics:  dry skin and sunburn.

Dry Skin

In winter, the air outside loses humidity, and the steady use of heaters inside makes the air even drier. Dry air leads to dry skin.  We need to protect the skin’s balance between water and oil to prevent dryness.¹

What can I do to prevent dry skin?

To bring the skin’s water and oil content back into balance, a cleanser or a moisturizer is helpful.² A mild cleanser, like Cetaphil, helps to remove excessive oil from the skin while avoiding irritation.^2,3  Soaps that are closer to neutral pH and have higher oil content are also less drying.⁴ Examples of these are glycerin soaps or unscented Dove (fragrance is irritating to sensitive skin). Bathing 2-3 times per week in tepid water, not hot, with bath oil for 3-5 minutes is helpful to treat dry skin as well, but longer than 10 minutes is drying.^1,4 Avoid products containing alcohol and the alkali metals sodium and potassium because when mixed with water they are harsh on the skin.

A moisturizer helps to trap and maintain water content in the skin. Of the moisturizers, ointments are thicker, more occlusive options whereas lotions and creams are lighter lubricating agents.⁴  Avoid gels as they are drying.  When choosing a moisturizing product, you should pay attention to the active ingredients. Products like Eucerin are emollients that help lubricate the skin. Some ingredients, such as urea, glycerin, and alpha hydroxy acids, function by absorbing water from their surroundings. Thus, they work best after bathing when the skin is still wet.⁵ If you have sensitive skin, consider a fragrance-free moisturizer because fragrance may cause irritation or allergy.⁶

A healthy lifestyle is also important in preventing dry skin.⁵ The association is not clear, but data suggest a healthy diet keeps skin young and fresh. For that reason, remember to drink plenty of water every day. In addition, you should try to include sufficient amounts of vegetables, fruits, and whole grains in your diet. Take steps toward quitting smoking. Smoking is harmful for your skin because of the exposure to a variety of toxins. Since stress also causes wear of the skin, managing your stress level is good for your mind and your skin. Schoolwork is a major source of stress for a college student. When possible, you should try to relax and do something you enjoy.

Sunburn

Most people enjoy basking in warm sunshine, and sunlight is necessary for Vitamin D development, calcium absorption, and bone development.⁷ Unfortunately, excessive exposure to sunlight, especially ultraviolet (UV) light, may result in sunburn, accelerated aging of the skin, or even skin cancer.⁸ People tend to pay less attention to sunburn risk in winter. However, the sunlight and its accompanying ultraviolet radiation can be just as strong in winter as it is in summer. Snow actually reflects UV light, which increases the risk.⁹ A cloudy day does not mean you should go outside unprotected.

How can I prevent sunburn?

Sunburn prevention can be as simple as seeking shade and wearing long-sleeved clothing while outdoors.⁸ In August 2010, the American Academy of Dermatology installed shade structures in two parks in Chicago.¹⁰ The new structures, at 4712 W. Belmont and the corner of Lincoln and Addison, are part of the Academy’s Be Sun Smart^Ò initiative to reduce the incidence of skin cancer. The skin not covered by shade should be protected by sunscreen, the key to prevent sunburn. Despite skin type, a broad-spectrum, water resistant sunscreen with at least sun protection factor (SPF) 30 is recommended year-round by the American Academy of Dermatology.⁹ Most people think SPF is the strength of protection a sunscreen provides, but that is a misnomer.  It actually describes the length of time a person can stay in the sun before burning compared to the time it would take to burn without sunscreen.¹¹  SPF 30 should allow a person to stay in the sun 30 times longer than usual before burning, assuming the person reapplies appropriately. To get the glow of tan skin without the risk, use a sunless self-tanning lotion instead of tanning beds.⁵

Some tips for choosing and using sunscreen products

Use of a broad-spectrum sunscreen ensures that you are protected against both UVA (the “aging” UV light) and UVB rays (the “burning” UV light).⁸ When you are choosing a sunscreen product, pay attention to the active ingredient(s) in it. For example, avobenzone is a common active ingredient for chemical protection, while zinc oxide is a common active ingredient for physical protection. Both are good options that work in different ways; chemical sunscreens absorb the sun’s rays while physical sunscreens reflect the sun’s rays.¹² The chemical p-Aminobenzoic acid (PABA) used to be a common active ingredient; now most sunscreens are PABA-free because of its potential to induce allergic reactions.¹³

For optimal protection, you should remember to apply sunscreen within 15 minutes to half an hour before going outside.¹² Don’t forget to apply a sufficient amount, which is about one ounce for the whole body.⁹ Reapply your sunscreen every 2 hours, or after swimming or perspiring heavily.¹²  A water-resistant sunscreen lasts longer than normal sunscreens if you are perspiring or swimming, but even a water-resistant sunscreen needs to be reapplied often, since its activity is lost if you are in water for more than 40 minutes.⁹

When should I see a dermatologist?

If you have any concerns, do not hesitate to see a doctor. If your dry skin is resistant or you have any cause for worry, like bleeding or infection, contact your physician.⁶ He or she will assess your skin and work with you to develop an effective treatment plan. See a dermatologist if you see any new moles or changes in existing moles as these may be signs of skin cancer.⁸ When caught early, skin cancer has a good prognosis. You can look for changes in moles at home using the ABCDE model.¹⁴ If any of these pertain to you, make an appointment with a dermatologist immediately: 

·      
A   A – Assymetry

·        B – Border irregularity

·        C – Color variation

·        D – Diameter greater than 6mm

·        E – Evolving and Elevated

References

1. American Academy of Dermatology. Dry skin & keratosis pilaris. http://www.aad.org/public/publications/pamphlets/skin_dry.html. Accessed October 27, 2010.

2. American Academy of Dermatology. Cosmeceutical facts and your skin. http://www.aad.org/public/publications/pamphlets/general_cosmeceutical.html. Accessed October 27, 2010.

3. Cetaphil. Cetaphil cleansers:  ingredients. http://www.cetaphil.com/Products/GentleSkinCleanser.aspx. Accessed October 28, 2010.

4.  Scott SA, Martin RW III. Atopic dermatitis and dry skin. In:  Berardi RR, McDermott JH, Newton GD, Oszko MA, Popovich NG, Rollins CJ, Shimp LA, Tietze KJ, eds. Handbook of Nonprescription Drugs. 16^th ed. Washington, DC:  American Pharmacists Assocation; 2004:811-830.

5. American Academy of Dermatology. Dermatologists share top 10 tips for healthy skin, hair, and nails. http://www.aad.org/public/healthy_skin.html. Accessed October 27, 2010.

6. Mayo Clinic. Moisturizers: options for softer skin. http://www.mayoclinic.com/health/moisturizers/SN00042. Published December 16, 2008. Accessed October 27, 2010.

7. Bringhurst F, Demay M, Krane S, Kronenberg H. Bone and mineral metabolism in health and disease. In: Fauci A, Braunwald E, Kasper D, Hauser S, Longo D, Jameson J, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 17th ed. http://www.accessmedicine.com.proxy.cc.uic.edu/content.aspx?aID=2882031.

8. American Academy of Dermatology. The sun and your skin. http://www.aad.org/public/publications/pamphlets/sun_sun.html. Accessed October 27, 2010.

9. American Academy of Dermatology. Facts about sunscreens. http://www.aad.org/media/background/factsheets/fact_sunscreen.htm. Accessed October 27, 2010.

10. American Academy of Dermatology. Making the outdoors safer in America: American Academy of Dermatology donates shade structures to Chicago Park District and 37 other organizations. http://www.pwrnewmedia.com/2010/aad_2010_summer_meeting_00805/downloads
/Shade_Structure_2010.pdf. Published August 5, 2010. Accessed October 27, 2010.

11.  Desimone EM II. Prevention of sun-induced skin disorders. In:  Berardi RR, McDermott JH, Newton GD, Oszko MA, Popovich NG, Rollins CJ, Shimp LA, Tietze KJ, eds. Handbook of Nonprescription Drugs. 16^th ed. Washington, DC:  American Pharmacists Assocation; 2004:929-953.

12. Schwartz RN, Corporon LJ. Skin cancer. In:  DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 7^th ed. New York, NY: McGraw-Hill; 2008:2311-2330.

13. Bickers D. Photosensitivity and other reactions to light. In: Fauci A, Braunwald E, Kasper D, Hauser S, Longo D, Jameson J, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 17th ed. http://www.accessmedicine.com.proxy.cc.uic.edu/content.aspx?aID=2868622.

14. American Academy of Dermatology. ABCDEs of melanoma detection. http://www.aad.org/public/exams/abcde.html. Accessed November 5, 2010.

Raising Diabetes Awareness

By: Amanda Hodges, PharmD Candidate 2012

University of Illinois at Chicago College of Pharmacy

November is American Diabetes Month. Currently in the U.S., 23.6 million, or 7.8% of the population have diabetes and approximately 5.7 million people do not know they have the disease. Diabetes has become the seventh leading cause of death in the U.S. There are 2 forms of diabetes, Type 1, previously known as juvenile diabetes, and Type 2, which is more common. Patients with Type 2 diabetes either do not produce enough insulin or the cells ignore the insulin. Insulin is a hormone that is released from the pancreas and its release is necessary for the body to be able to use glucose or energy. When food is ingested, the body breaks down sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can lead to a numerous symptoms and diabetic complications. Some symptoms include increased thirst, frequent urination, increased hunger, weight loss, fatigue, and blurred vision. Some long-term complications include heart disease, stroke, kidney disease, nerve damage, eye problems, and amputations.

A variety of risk factors increase the likelihood that a patient will develop Type 2 diabetes. Some of these risk factors include:

• Age - people over 45 years are at higher risk
• People with a family history of diabetes
• People who are overweight
• People who do not exercise regularly
• Certain ethnic groups such as Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans, and American Indians
• Women who had gestational diabetes while pregnant or women who had a baby weighing 9 pounds or more at birth

The goal of diabetes treatment is to control blood glucose levels, reduce long-term complications, and maintain a good quality of life. The first step in managing diabetes is for patients to modify their lifestyle by adjusting and maintaining a proper diet and exercising regularly. A nutrition plan that involves monitoring carbohydrate intake by carbohydrate counting or exchanges is recommended. In addition, patients should consume a diet high in dietary fiber/whole grains, fruit and vegetables, and low in saturated fats. For physical activity, 150 minutes per week of moderate-intensity aerobic exercise and resistance exercise 3 times per week to target all muscle groups is recommended; however, patients who have not exercised in the past should receive clearance from their physician and start slow with their exercise routine.

If a patient’s diabetes is not controlled by diet and exercise, he/she may be started on medications; however, it is important to continue to follow an exercise and diet plan to maximize the effect of prescribed treatments. A variety of oral and injectable treatments for diabetes are available including: metformin, sulfonylureas (e.g., glyburide, glipizide), thiazolidinediones (e.g., pioglitazone), alpha-glucosidase inhibitors (e.g., acarbose), insulin secretagogues (e.g, repaglinide), dipeptidyl peptidase-4 (DPP-4) inhibitors (e.g., sitagliptin), and insulin. The healthcare provider will decide what the best medication or combination of medications is needed. He or she should discuss proper dosing, administration, and common adverse reactions with the patient. One serious reaction to be aware of is low blood glucose, known as hypoglycemia, which can occur with some prescribed therapies. Symptoms of hypoglycemia include sweating, shakiness, weakness, hunger, dizziness, heart palpitations, blurred vision, and confusion.

Depending on the treatment plan the healthcare provider initiates, patients will most likely be monitoring blood glucose levels at home. It is important to know how often blood glucose levels should be checked at home, the range of acceptable values, and the specific factors that may impact blood glucose levels. For example, blood glucose readings may change in response to food intake, physical activity, medication administration times, acute illnesses, alcohol intake, and stress.

Careful monitoring of blood glucose is necessary to prevent long-term complications. In addition, other monitoring such as routine physical examinations, eye and foot examinations, blood tests to assess long-term markers of glucose control, cholesterol levels, and kidney function, and dental care can help minimize complications.

Amanda Hodges, PharmD Candidate 2012

Additional information about diabetes can be accessed at:

www.diabetes.org

www.cdc.gov/diabetes/consumer/

www.ndep.nih.gov/index.aspx?redirect=true

Breast Cancer Awareness

Breast Cancer Awareness
By Amy St. George, PharmD Candidate 2011
University of Illinois at Chicago College of Pharmacy

UIC Pharmacy

Every year in October we celebrate National Breast Cancer Awareness Month (NBCAM). 1 The NBCAM organization has been a leader in promoting awareness of breast cancer, and in 2009 they celebrated 25 years of awareness, education, and empowerment. According to the Center for Disease Control (CDC), after non-melanoma skin cancer, breast cancer is the most common form of cancer in women.2 Breast cancer is the number one cause of cancer death in Hispanic women and the second most common cause of cancer death in white, African-American, Asian/Pacific Islander, and American Indian/Alaska Native women. The American Cancer Society estimates that in the United States in 2010 there will be about 207,090 new cases of invasive breast cancer in women, and about 54,010 new cases of carcinoma in situ.3 They also estimate that about 39,840 women will die from breast cancer.

The chance of a woman having invasive breast cancer some time during her life is about 1 in 8. Breast cancer does not just affect women; men can also get this devastating disease. According to the American Cancer Society, about 1,970 new cases of invasive breast cancer will be diagnosed in men, and about 390 men will die from breast cancer this year. The outlook for men with breast cancer was once thought to be worse than that for women, but recent studies have not found this to be true. In fact, men and women with the same stage of breast cancer have a fairly similar outlook for survival. Breast cancer death rates have been going down. This is probably the result of finding the cancer earlier and better treatment. Currently, there are more than 2.5 million breast cancer survivors in the United States.

Risk factors for breast cancer

There are many risk factors for breast cancer that you may be able to control to decrease the chance of developing breast cancer; however, there are also some factors that you are not able to control.5 Table 1 describes both controllable and non-controllable breast cancer risk factors.

Table 1. Risk factors for breast cancer.5

Risk factors you CAN control

• Weight and diet
• Exercise
• Alcohol consumption
• Smoking
• Use of hormone replacement therapy
• Recent oral contraceptive use
• Stress and anxiety

Risk factors you CAN’T control

• Gender
• Age
• Race
• Family/personal history of breast cancer
• Radiation therapy to the chest
• Exposure to estrogen (ages at menarche and menopause or environmental exposure)
• Pregnancy and breastfeeding
• Diethylstilbestrol exposure-an estrogen-like hormone given to women to prevent miscarriages; daughters born to women who took this medication during pregnancy may be at a higher risk for breast cancer.

Early detection through screening

Screening for breast cancer is crucial for early detection. The earlier that breast cancer is detected the easier it is to treat.2 There is no such thing as a “normal” breast and lumps can be a normal occurrence in some women due to menstruation, changes in weight, having had children, or changes in breast tissue associated with age.

When screening for breast cancer, there are 3 main tests that can be performed: a self breast exam, a clinical breast exam by a physician or nurse, and a mammogram.2 Scheduled mammogram screenings should be done every 1 to 2 years after the age of 40. Although clinical breast exams are not as effective as a mammogram at detecting breast cancer, they do provide some benefit in detecting changes in breast tissue. These exams should be done as part of a routine health examination for all women, starting in their 20s and 30s.3 Monthly self breast exams are also important for all women, starting in their 20s, to determine what is normal for each woman. If you have a strong family history of breast cancer (eg, mother or sister) or had chest radiation therapy at a young age, regular mammogram screenings may need to begin earlier, before 40 years of age.

Diagnosis and Treatment Options

If a diagnostic test is needed, several options are available: breast ultrasound, diagnostic mammogram, magnetic resonance imaging (MRI), or a biopsy. If a breast cancer diagnosis is made, a health care professional will diagnose the stage of cancer based on the spread of the cancer cells within the breast or to various parts of the body.2 Treatment of breast cancer is based on the stage and type of the breast cancer. Possible treatment options include surgery, chemotherapy, and radiation. There are 5 stages of breast cancer and some stages are divided into classes within the stage. The 5 stages are 0 to IV, with I to III having stage rankings of A, B, or C within the stage. Table 2 describes breast cancer stages; the earlier the stage of cancer at detection, the greater chances of successful treatment.4

Table 2. Breast cancer stages.4

Stage 0 Class None Description Abnormal cells in the lining of the breast (ductal) or in the lobules of the breast (lobular). Referred to as carcinoma in situ.

Stage 1 Class A Description Cancer has formed and the tumor is 20 mm or smaller and confined to the breast.

Stage 1 Class B Description Either a cluster of cancer cells (0.3 to 2 mm) found in the lymph nodes or a tumor 20 mm or less and a cluster of cells found in the lymph nodes.

Stage 2 Class A Description A large tumor (20 to 50 mm) hat has not spread to the lymph nodes or a tumor less than 20 mm that has spread to the lymph nodes.

Stage 2 Class B Description A large tumor (20 to 50 mm) that has spread to the lymph nodes or a tumor greater than 50 mm that has not spread to the axillary lymph nodes

Stage 3 Class A Description Cancer is found in the axillary lymph nodes or lymph nodes near the breastbone

Stage 3 Class B Description Any size tumor that spread to the chest wall or skin of the breast

Stage 3 Class C Description Any size tumor that spread to chest wall and lymph nodes above or below the collarbone

Stage 4 Class None Description Cancer that has spread to other organs of the body

How to be involved

Being involved in education and awareness for breast cancer should not stop at the end of October. There are many ways to get involved and help spread the word all year long. The NBCAM website (http://www.nbcam.org/help_promote_nbcam.cfm) lists ways to be involved in your community or workplace to promote awareness of breast cancer. More ways to contribute to breast cancer awareness and a search for a cure can be found at the Susan G. Komen for the Cure website (http://ww5.komen.org/MakeADifference/ImHeretoMakeaDifference.html?itc=emoentpnt:3). Get out, get involved, and support the thousands of people that are affected each year by breast cancer.

References

1. National Breast Cancer Awareness Month. NBCAM 25 years. http://nbcam.org/index.cfm. Accessed August 3rd, 2010.
2. Centers for Disease Control and Prevention. Breast Cancer. http://www.cdc.gov/cancer/breast/basic_info/index.htm. Accessed August 3rd, 2010.
3. American Cancer Society. Breast Cancer. http://www.cancer.org/Cancer/BreastCancer/index. Accessed August 3rd, 2010.
4. National Cancer Institute. Breast Cancer Treatment (PDQ). http://www.cancer.gov/cancertopics/pdq/treatment/breast/patient. Accessed August 3rd, 2010.
5. Breastcancer.org. Lowering Risk for Everyone. http://www.breastcancer.org/risk/everyone/. Accessed August 3rd, 2010.

Let's Talk About Prescriptions!

October is Talk About Prescriptions Month, focusing on safe medicine use messages for consumers and healthcare providers.

Did you know that 2 out of every 3 office visits to the doctor end with
a prescription being given? This adds up to over 3.5 billion prescriptions
dispensed from pharmacies each year, which means that if you go to the doctor
this year, you will more than likely be given a prescription. Since it
has become so common to prescribe medication, it is important
to make sure you understand why you’re getting the
medication and what it will do for you.

Your UIC pharmacists are there to help you! You can call them and ask
them questions or ask them in person when picking up your prescriptions.

Here is a list of questions you can ask the pharmacist to better understand your medication and how it will affect you:

•What is this medication and what is it used for? If there is an
addition or change to your usual regimen, ask about the reason for the change.

•How and when do I take this medication? And for how long?

•Do I need to take it on an empty stomach or with food? Can I take this
with my other medications and over-the-counter and herbal supplements?

•What should I do if I miss a dose?

•What does “as needed” mean?

•What side effects can occur from taking this medication?

•How will I know if it’s working?

•How come the name on this medication is different from what the doctor
prescribed?

This happens often. Brand name drugs are commonly seen written on prescriptions, but in the pharmacy they may be dispensed as a generic equivalent.

•How and where should I store this medication?

•May I have written information about my prescription? If you prefer
large print or a language other than English, let the pharmacist know.

•Can I fill out a patient profile form that includes over-the–counter
and herbal medications as well as my prescription medications to keep on
file?

This is a great way to provide all necessary information to ensure
you get the best care.

So now that you have asked all the questions and you have your
prescription, here are some tips for the future:

•Read the label and take the medication exactly as prescribed for the
entire time you are supposed to take it.

•If you take more than one medication, it is important to be organized.
Know what your medications look like, what each one is for, and be able to
tell them apart. Pill containers available at the pharmacy make it much
easier to organize your medications by day and time of administration.

•When you need a refill, it is better to get it while you still have a
few pills left so that way you remain on schedule and don’t miss doses.

•If you have children in your home do not take medications in front of
them and store medications out of their reach and sight.

•If you are traveling ask your doctor or pharmacist to adjust your
schedule to accommodate your change in schedule. Also, carry your
medications with you and do not keep them in checked luggage.

•If you need to buy your medications online, make sure the pharmacy is
state-licensed with licensed pharmacists answering questions and
overseeing the pharmacy. Also, look for a Verified Internet Pharmacy
Practice Site (VIPPS) seal on the website so you know it is accredited.

•If you are required to have blood work or lab tests done while taking your medication make sure you know where you can go and how often the tests should be done.

•Keep notice of expiration dates on your medications.

If they are expired, almost all medicines can be thrown away in the household trash after mixing them with some unpalatable substance (e.g., coffee grounds) and sealing them in a bag or other container. Drug take-back programs for disposal can be another good way to remove unwanted or expired medicines from the home and reduce the chance that someone may accidentally take the medicine.
.
For more information on how to use medications safely, these sites can help:

www.talkaboutrx.org/
www.fda.gov
www.bemedwise.org
www.consumermedsafety.com


Written by: Amanda Hodges, Pharm.D. candidate (P3)
University of Illinois, College of Pharmacy

High Cholesterol: More than a Middle-Age Problem

By Georgeanna Rechner, PharmD Candidate 2011

University of Illinois at Chicago College of Pharmacy

UIC Pharmacy

The phrase “high cholesterol” is usually associated with middle-age, heart attacks, or obesity. However, high cholesterol doesn’t develop overnight – it takes years to develop high cholesterol and starts sooner than one would expect. Twenty percent of 12 to 19-year-olds have higher than normal cholesterol levels, and 85% of 21 to 39-year-olds have fatty streaks in the arteries that supply the heart with blood.^1,2 To help increase awareness of cholesterol and how to prevent the damage high cholesterol will inevitably cause if unmanaged, the National Heart, Lung, and Blood Institute has designated September as National Cholesterol Education Month.

How does cholesterol cause damage?

Cholesterol is not a bad thing as long as levels stay within the normal range; in fact, the body makes most of the cholesterol it needs.³ Not only is cholesterol found in many foods, the body also produces cholesterol from some of the saturated and trans fats found in food. The body also uses cholesterol to produce vitamin D and hormones, like testosterone and estrogen. As cholesterol levels increase, more can incorporate into blood vessels and decrease flexibility, eventually leading to atherosclerosis or hardening of blood vessels. Plaques of cholesterol also form within blood vessels and may eventually slow or block the flow of blood to vital organs. Chest pain, heart attacks, and strokes occur when blood vessels in the heart or brain become partially or completely blocked, which can negatively impact quality of life and are major causes of death and disability in the United States.

What can I do to prevent high cholesterol?

Before taking steps to manage cholesterol, it is good to know baseline laboratory values so progress can be measured. It is recommended that individuals 18 years and older have their cholesterol measured every 5 years as long as the results are within normal limits.^1,4 If levels are higher than normal, cholesterol should be checked more frequently. Low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides should be tested along with total cholesterol (referred to as a lipid panel). Lipoproteins contain cholesterol and the proteins needed to help the oily cholesterol mix well with blood.³ Total cholesterol measures free cholesterol and any cholesterol found in LDL and HDL. Low-density lipoprotein, the “bad” cholesterol, causes atherosclerosis and the formation of plaques by depositing cholesterol into tissue. High-density lipoprotein, the “good” cholesterol, counteracts the effects of LDL by removing cholesterol from tissue. Triglycerides are another form of fat found in the blood that contributes to total cholesterol. Cholesterol tests or lipid panels can either be fasting (i.e. after abstaining from food or drink for at least 9 hours prior to the test), or non-fasting. If a non-fasting test measures total cholesterol to be >200 mg/dL or HDL <40>4 Table 1 lists the desired levels for a lipid panel in young adults. If levels are higher than normal, alterations in lifestyle may lower levels before medication is needed. Initiating these changes slowly will increase the likelihood that these changes will last a lifetime.^3,4

Table 1. Desired lipid panel results.

Goal Levels (mg/dL)
LDL*	<130
HDL
Women	>50
Men	>40
Total Cholesterol	<200
Triglycerides	<150
*Low-density lipoprotein goal for young adults in good health; if you are being treated for any condition, speak with your healthcare provider about your personal LDL goal.

What about diet—what should I avoid?

· Less than 7% of daily calories should come from saturated fats, and 25% to 35% of daily calories should come from total fat.

o A 2,000 calorie diet should include 13 grams of saturated fat or less daily.

· Consume less than 200 mg of cholesterol per day.

· Consume approximately 10 to 25 grams of soluble fiber per day to prevent absorption of fats and cholesterol from other foods.

· Table 2 lists some of the foods that have high amounts of saturated fat, trans fat, and cholesterol that should be avoided as much as possible and foods high in fiber and unsaturated fats that can help lower cholesterol levels.

Table 2. Selection of foods associated with worsening or improving cholesterol levels.

Foods to Avoid					Beneficial Foods
Saturated fats					Fiber
	fatty meat					whole grain breads, pastas
	skin-on poultry					oatmeal
	whole milk products					barley
	coconut oil					whole fruit
	palm oil					whole vegetables
						beans
Trans fats						lentils
		hydrogenated vegetable oil				chick peas
		stick margarine/shortening				black-eyed peas
		crackers
		cookies			Unsaturated fats
		doughnuts				nuts
		french fries				avocados
		fried chicken				tuna
		potato chips				mackerel
						salmon
Cholesterol						olive oil
		egg yolks				canola oil
		shrimp				sunflower oil
		whole milk products				peanut oil
		butter				safflower oil
		ice cream				soybean oil
		cheese
		organ meats

What are the benefits of exercise?

· Lowers LDL, raises HDL, and decreases weight

· You should do 30 minutes of aerobic exercise per day, 5 to 7 days a week

· Start slow—not all 30 minutes has to be done at once and exercise can be distributed throughout the day.

What is a healthy weight?

· The number of inches around the waist can be used as an indicator for risk of heart disease–women should be less than 35 inches and men should be less than 40 inches around the waist.

· A body mass index (BMI) of 18 to 24.9 kg/m² also indicates a healthy target weight. A free BMI calculator is located here.

Get started now!

As another semester begins, class assignments, exams, and increasingly busy schedules may prevent you from going to the gym or eating healthy foods. Fortunately, starting new habits now can reverse any damage that may have already been done and prevent any consequences of high cholesterol in the future. High cholesterol can no longer be thought of as a disease of the middle-aged and obese. Addressing the issue of high cholesterol as a young adult is a way to protect your health for years to come.

By Georgeanna Rechner, PharmD Candidate 2011

University of Illinois at Chicago College of Pharmacy

References

1. Gooding HC, de Ferranti SD. Cardiovascular risk assessment and cholesterol management in adolescents: getting to the heart of the matter. Curr Opin Pediatr. 2010;22(4):398-404.
2. Berenson GS, Srinivasan SR, Bao W, Newman WP III, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med. 1998;338(23):1650-1656.
3. National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services. Your Guide to Lowering Cholesterol with TLC. Bethesda, MD: National Heart, Lung, and Blood Institute; 2005. NIH publication 06-5235. Available at: http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf. Accessed July 19, 2010.
4. National Cholesterol Education Program Expert Panel. The third report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. JAMA. 2001;285(19):2486-2497.

2 Student Pharmacies For You

Hi! Welcome to Fall Semester 2010 at UIC! We want to tell you about UIC Pharmacy* and two of the student preferred locations we have around campus to serve you. With all you have going on, we want to make your student life a little easier and a little healthier!

As a UIC student, you know (or should know!) there are two locations for the UIMC Family Medicine Center. The Family Medicine Center is where you must go to receive the student health services that are included in your student health fee**. You will also go to the Family Medicine Center for other health care needs if you chose Campus Care*** or other accepted insurance plans. Wait. What does this info have to do with UIC Pharmacy you ask?

I’ll tell you!

One of the student preferred pharmacies we want to tell you about is University Village Pharmacy (UVP). Located on the South campus at 722 W. Maxwell St, UVP is right down the hall from the primary location of the Family Medicine Center. Right down the hall. How easy is that?

Same goes for the Taylor Street/EEI Pharmacy. (EEI stands for Eye and Ear Infirmary). Located on the West side of Campus at 1855 W. Taylor St, it is steps away from the Family Medicine Center at 1801 W Taylor. And the nice thing is, you don’t even have to go outside to get there from your doctor appointment, you can take an internal walkway and be there just as quickly as walking outside as Winter approaches.

Besides location, how do these student preferred pharmacies make your student life a little easier?

The pharmacists and technicians in both of the student preferred pharmacies are pros! Since we dedicated two of our pharmacies to focusing on the student, they are very aware of student needs! When visiting your doctor, please ask them to electronically send your prescription to the pharmacy to save you time so you can be on your way in no time!

They have seen and heard just about every student health insurance situation. They will find ways to work with you if you max out your prescription benefit, or, if you have Campus Care insurance, they have the ability to work with your UIMC docs, if you like, to figure out the best prescription solutions if ever there is an issue. They go the extra mile to make sure you get the prescriptions and care you need!

You really can talk to the pharmacists. The info is going nowhere! They want you to be healthy and informed about things like birth control and offer private counsel on any meds you receive. Confidentiality is guaranteed! So go ahead, don’t be afraid to ask questions!

For the many students that have Campus Care insurance at UIC, we can help keep more cash in your pocket when you pick up your Rx. Go to a non-UIC Pharmacy and you will have to pay the total cost of the prescription upfront, fill out forms and get reimbursed later. Go to one of our two student preferred pharmacies and you’ll pay only the co-pay! More money left in your pocket to go to Hashbrown’s for breakfast or to Drum and Monkey for appetizers!

Plus, students receive a 10% discount on all over-the-counter items like aspirin, contact solution, personal care items, first aid needs etc...

So come check us out and see for yourself!

Have a healthy semester,

* www.uicpharmacy.com

** http://chicago.medicine.uic.edu/departments___programs/departments/fammed/student_health/services/

*** http:// www.uic.edu/hsc/campuscare/