What is Glaucoma?

UIC Pharmacy Blog Topic:  Glaucoma.

What is glaucoma?

-        Glaucoma is defined as a multi-factorial, complex eye disease with specific characteristics such as optic nerve (nerve inside the eye) damage and visual field loss.There are about 2.2 million Americans with glaucoma but only half are aware of their disease. While increased pressure inside the eye (called intraocular pressure or IOP) is usually present, even patients with normal range IOP can develop glaucoma.

Why is it important to diagnosis glaucoma early?

-        Glaucoma is important to be diagnosed early because it may not have any symptoms. Anyone can have glaucoma and only an eye exam by a physician can tell you whether you are at risk for or have glaucoma. If left untreated, glaucoma may lead to reading impairment, and it is possible that the condition may lead to irreversible partial or even complete vision loss.

What causes glaucoma?

-        Glaucoma can be caused by many different factors. It is known that inheritance is a significant cause of glaucoma, and having a family member with glaucoma increases your risk. Some medications and disease states may also cause glaucoma. For example, steroids can cause glaucoma and conditions such as diabetes, blood pressure abnormalities, heart diseases, eye injuries, and inflammation in the eye can all lead to glaucoma. In addition, some over-the-counter (OTC) drugs can also affect glaucoma. Be sure to ask your pharmacists about the safety of OTCs medications if you have glaucoma.  

What are some other risk factors for glaucoma?

-        Age over 60

-        Race (e.g., African-Americans, Latinos)

-        Increased IOP

-        Those who are severely nearsighted

-        Those with a thin cornea

-        Not having an eye examination

What types of glaucoma are there? Are there any signs and symptoms?

-        The 2 most common types of glaucoma are open-angle glaucoma and closed-angle glaucoma (also called angle-closure glaucoma, narrow-angle glaucoma, or acute glaucoma). Open-angle glaucoma is the most common form and is a slowly progressing disease. Typically, there are no signs or symptoms that patients feel. The patient may feel that there is a small loss at the side of the vision initially (peripheral vision), but until a significant amount of vision is lost, it is unlikely that patients will realize they have glaucoma. Also, this type of glaucoma may/may not have IOP elevation.

-        On the other hand, closed-angle glaucoma is a very serious disease that needs immediate medical attention. The damage to the optic nerve occurs quickly and the symptoms are very noticeable. This type of glaucoma is associated with blurred and cloudy vision, eye pain, headache, nausea and vomiting, and sudden sight loss. Also IOP is generally markedly elevated in closed-angle glaucoma.

Is glaucoma treatable?

-        Unfortunately, there is no treatment for vision that is already lost. The goal of therapy is to slow or prevent further vision loss by using medications or performing surgeries.

ü  Pharmacologic treatments vary and include medication classes such as the cholinergic agonists (e.g., Isopto Carpine, Isopto Carbachol); prostaglandin analogs (e.g., Xalatan, Lumigan);  α₂-agonists (e.g., Iopidine, Alphagan) ; β-antagonists (e.g., Betimol, Timoptic, Betoptic); carbonic anhydrase inhibitors (e.g., Trusopt, Azopt); and combination agents (e.g., Cospot, Combigan). 

ü  The physician may start prostaglandin analogs as a first-line treatment because of their convenience and minimal side effects. β-antagonists are usually the next most commonly used treatments. If your physician decides that you are not a candidate for these 2 treatments, your physician may choose to use either a carbonic anhydrase inhibitor or α₂-agonist as a first-line option.  Any of these drug classes can be used as additive, second, or third-line agents as well. To make it more convenient, the physician may prescribe a combination product especially when you need more than 1 medication.

ü  Surgery can also be performed either at the same time with drug therapy or when drug therapy does not respond well. Ask your physician about further surgical information.

Can I prevent glaucoma?

-        Yes! You can prevent damage from glaucoma by having regular eye exams. The Glaucoma Research Foundation recommends an eye exam for glaucoma every 2 to 4 years before age 40, 1 to 3 years from age 40 to 54, 1 to 2 years from age 55 to 64, and 6 months to 1 year after age 65. If you are at high risk for glaucoma, an eye exam should be performed every 1 to 2 years after age 35. Keep in mind that the earlier the diagnosis and treatment, the better the prevention from damaging the eye. Studies have also shown that moderate routine exercise can lower IOP. Some of the recommended exercises include walking or jogging at least 3 times weekly. If you are involved in dynamic physical activity, wear protective eyewear to prevent eye injuries since it can put you at a higher risk for developing glaucoma. 

Proper use of eye drops

-        What is the best way to put my eye drop medications into my eye?

                        i.         Wash and dry your hands.

                       ii.         Shake if a suspension, and open the cap.

                     iii.         Tilt your head backward and use your index finger to pull down the outer part of the eyelid gently to form a pocket for a drop.

                      iv.         Make sure that the tip of the dropper does not touch anything, and place the tip of the dropper near the pocket and then look up to drop into the pocket.

                       v.         Let your finger go and gently close eye to increase the availability of the drug into the eye. Do not close tightly as this may push drug out of the eye.

                      vi.         While eyes are closed, gently press the inner side of the eye with your finger. This will minimize the drugs going to other parts of the body.

                    vii.         Close the bottle and store as directed.

-        Why is it important to not touch the tip of the dropper?

ü  Contacting the tip of the dropper with the eye or any other material may contaminate the medication with bacteria, and this may result in a serious eye infection.

-        I have more than 1 eye drop medication. Can I put them in at the same time?

ü  No. Our eye only holds a small amount of fluid at one time. Therefore when more than 1 drop or other medications are needed to be dropped into the eye, wait more than 5 minutes to administer (10 minutes desired).

-        Can I wear contact lenses with my glaucoma eye drop medications?

ü  Many of the glaucoma eye drop medications have preservatives, such as benzalkonium chloride, and they may be absorbed by soft contact lenses. When dropping medication into your eyes, remove contact lens and the lens can generally be reinserted after 15 minutes. However, there are some drugs that interact with contact lens and it is not recommended to wear contact lens when you are on glaucoma eye drop medication therapy. Ask your pharmacist for more details.

Where can I learn more about glaucoma?

-        American Academy of Ophthalmologists: http://www.aao.org

-        Glaucoma Research Foundation: http://www.glaucoma.org

Prepared by: Min-sik Shin, UIC PharmD Candidate, Class of 2012

UIC Pharmacy

10 Ways to Prevent Medication Errors

Any time a healthcare professional, patient, or consumer experiences an unintentional event that could have been prevented in regards to medication or medication use, which may or may not have resulted in patient harm, it is considered a medication error.¹ Each year, more patients die from potentially preventable medications errors in the U.S. than from Acquired Immune Deficiency Syndrome (AIDS), breast cancer, or even motor vehicle accidents.  As a patient, it is important to be thoroughly informed about the medications you are taking and why you are taking them.  In doing so, you will be better able to not only take care of yourself, but also help prevent errors that may possibly have harmful consequences.

As a patient and a consumer, there are 10 simple things you can do in order to help prevent medications errors.  Unfortunately, not all medication errors are preventable, but by following these steps, you can help to keep yourself and your loved ones safe and iof you ever have questions please stop into UIC Pharmacy or consult your UIC pharmacist.

1. Make sure to tell your doctor and pharmacist all of the medications you are taking.²

This includes over the counter and herbals products, such as vitamins and minerals, not just prescription medications. Many medications may interact with each other, but those interactions cannot be caught if your healthcare provider is not aware of everything you are taking.  It may also be helpful to keep a medication list handy, including the name (both brand and generic), dose, and what you are taking it for, so that you can quickly supply your healthcare provider with this information, instead of trying to recall it from memory.

2. Make sure your doctor and pharmacist are aware of any potential allergies you may have.²

This includes allergies to both medications and to foods.  It is also important to let your healthcare provider know if you have taken a medication in the past that resulted in an adverse reaction.  By providing this information, you can help to prevent taking similar medications that may produce a similar effect.  Be sure to also tell your healthcare provider the type of reaction you experienced with these medications, whether it may have been an upset stomach, rash, or difficulty breathing.  All of this information can help to determine the severity of the reaction.

3. Know the reason why you are taking each medication.³

Often times, individuals start taking medications prescribed to them by their doctor without knowing exactly why they are taking them. It is necessary to know the importance of each medication you are taking, if it is appropriate, and how it is impacting your health. In doing so, you can take charge of your health, and play an active role with the healthcare team. If you receive a medication from a pharmacy and you are not sure why you are taking it, be sure to ask. Also, never take a medication from a friend or family member that was not prescribed for you.^4,5 The dose or the medication itself may not be appropriate or it may interact with other medications.

4. Make sure you can read the doctors handwriting for new prescriptions.²

Historically speaking, doctors may not always have the best handwriting when writing prescriptions for their patients. In order to prevent any misinterpretation of the medication name or dosing, make sure you can read what is written, and confirm that with your doctor. This action alone may be able to prevent a majority of medication errors, where the wrong medication might be dispensed, or the right medication is dispensed, but at an inappropriate dose. If you are not able to read it, chances are your pharmacist might not be able to read it either.

5. Store medications in a safe, secure place.^4,5

Keep medications out of reach from children and pets, for example in an elevated cabinet or a locked drawer. If children do accidently ingest medications that are not intended for them, be sure to call poison control at 1-800-222-1222. It is also important to not store medications in the bathroom medicine cabinet or in places of humidity, heat, or direct sunlight; this could affect the potency and safety of the medication.

6. Keep medications in their original bottles.^4,5

Always keep your medications in their original bottles and take them with the lights on so that you know exactly which medication you are taking.  This will ensure that you are taking the right medications at the right doses. Many medications look very similar, and it is easy to get them mixed up. Also, each time that you take a medication, double check the bottle for the name; the dose; the number of pills per dose; and how to take the medication in order to prevent taking the wrong medication or wrong dose, which could potentially lead to serious negative effects.  

7. Know what to do if you miss a dose.³

It is hard to never miss a dose when taking medications, so it is imperative to know what to do when it happens. Procedures differ depending on how many doses were missed and what medication you are taking.  Some medications recommend taking the dose as soon as you remember, skipping the dose completely and just waiting until your next scheduled dose, or doubling up on the medication for your next dose. It is important to ask your pharmacist what to do in the case of a missed dose in order to prevent under dosing or over dosing your medication.

8. Know what side effects are common with each of your medications.^3-5

It is helpful to know what side effects are common with the medications you are taking, so when you start taking them, you will be aware of what you might expect. Not all patients experience adverse reactions to their medications, but it may be possible. Be sure to report any problems you have to your doctor or your pharmacist; there might be other medication options available for you that might not produce those same side effects, and the pharmacist can work with the doctor to suggest an alternative. Many side effects are fairly common, and may disappear after your body adjusts to the medication.  However, It is also important to be aware of what adverse effects are harmful, and require you to contact a healthcare provider immediately in case they occur. This may also help to prevent false identification of allergic reactions to your medications.

9. Know when and how to take your medications.^3-5

Some medications should be taken in the morning on an empty stomach; some should only be taken with food or after meals; others should be taken at bedtime.  It is vital to know when to take your medication, and how often during the day. Taking your medications at the same time every day may also be very important in terms of efficacy and safety. Also, it is important to know whether your medication can be chewed or crush, or if it needs to be swallowed whole. For example, some long-acting medications work too quickly if they are chewed, and might result in increased absorption and possible toxicity. Other medications might not be effective at all if crushed or chewed, or you might experience adverse effects in these cases. Also, when taking a liquid medication, only use the dosing device that came with it or was provided at the pharmacy; you might want to ask your pharmacist what device would be most appropriate and how to accurately measure. Household teaspoons and tablespoons vary in size, and should never be used.

10. Ask questions and build a relationship with your healthcare providers.²

In order to receive the best treatment available, and to avoid any medication errors, it is important to be able to trust your healthcare providers, and develop a relationship with them. You should be able to ask them any questions you want about your medications or your disease states, and feel confident in the answer they give you. If something does not seem right with your medications, or you are unsure how to take them, ask your pharmacist – that is what they are there for. Often times, medication errors are prevented because the patient questioned something that they knew was not right.

You should take responsibility for your health, and it is important to realize that you are in control. With the guidance and support of your doctors, pharmacists, and other healthcare providers that you may come in contact with, you will know that you are doing all that you can in order to help prevent medication errors from happening to you and those you care about. 

  

References

1. Preventing medication errors. Pharmacist’s Letter. Self-study course #100305. 2010;305.

2. Agency for Healthcare Research and Quality. 20 tips to help prevent medical errors. http://www.ahrq.gov/consumer/20tips.html. Accessed August 8, 2011.

3. About.com. Preventing medication errors.. http://copd.about.com/od/livingwithcopd/tp/avoid-med-errors.html. Accessed August 8, 2011. 

4. Pharmacists.com. Avoiding medication errors. American Pharmacist Association. http://www.pharmacist.com/AM/Template.cfm?Section=Pharmacy_Today2&Template=/CM/HTMLDisplay.cfm&ContentID=3546. Accessed August 8, 2011.

5. Institute for Safe Medicine Practices. Consumers. http://search.ismp.org/cgi-bin/hits.pl?in=517791&fh=80&ph=1&tk=le%26%3FEITrEwu%20e%26%3FEITrEwuz%3A%20%26bbwb%3A%20%26bbwbz%3A%20e%26%3FEITrEwu%3A%20%26bbwb&su=upaaJ%26WWddd.bXFJ.iCLWPi_XfFuCXWeuwqfra.qXJ&qy=nwKWk%26I_kpL%20KQQpQr&pd=1. Accessed August 8, 2011.

By: Lauren Tramutola, PharmD Candidate, 2012

Five Things You Might Not Know About Your Pharmacist and/or Pharmacy

At UIC Pharmacy we want to keep you informed. What you do not know about your pharmacist or pharmacy could have a negative impact on your health. It is well known that pharmacists are one of the most trusted health care professionals in the United States; however, there are many misconceptions regarding the role of the pharmacist and the operations of the pharmacy.¹ In this post, we will discuss 5 things you might not know about your pharmacist and/or pharmacy that could help optimize your health care.

1.     Pharmacists are the drug experts, utilize their expertise!

·       In a survey conducted by the American Pharmacists Association (APhA), only 40% of patients utilized pharmacists as a source for information on health care needs.² It is important to keep in mind that pharmacists are easily accessible and they are trained to counsel patients on medication utilization and safety.

2.     Get to know your pharmacist by name.

Pharmacists can help optimize your health

 ·       Developing a patient-provider relationship with your pharmacist can have a bigger impact on your health care than you think.  In a survey by APhA, 77% of patients do not know their pharmacist by name.³ Those who knew their pharmacist’s name were more likely to talk to their pharmacist about other drugs they were taking, consult the pharmacist about prescription and over-the-counter (OTC) medications, know the active drug in their medications, and read product labels.  It is also recommended that you use the same pharmacy to fill all your prescriptions so that the pharmacist can have an accurate history of your current and past medications to check for drug interactions.⁴ These are small steps you can take to increase medication safety and improve health outcomes.

 3.     Pharmacy drive-throughs are convenient, but they are also potentially dangerous.

 ·       Pharmacy drive-throughs can help stream-line medication dispensing, but you are picking up your medicines, not fast food.⁵ In a study on the impact of pharmacy design and layout, surveyed pharmacists working in locations with drive-throughs generally agreed that drive-throughs create distractions that can decrease efficiency and increase dispensing errors.⁶ Consumers using the drive-through pharmacy service trade face-to-face interaction with a health care provider for convenience.  This interaction is necessary for proper patient counseling.

4.     Why does placing pills in a bottle take at least 15 minutes?

 ·       Filling a prescription correctly is not as easy as it seems.  There are many steps involved in processing a prescription to ensure that you are getting the right medication, and that this medication will be safe and effective.⁷ When a prescription is received at the pharmacy, it must be entered into the computer system, submitted to the insurance company for payment, filled, and correctly verified.  During this process, the pharmacist will check for drug interactions, allergies, and make sure this medicine is prescribed for the correct reason and at the correct dose.  Keep in mind that all of this occurs in the midst of phone calls, faxes, patient counseling, and other customers filling or picking up their medications as well.  A study by the Agency for Healthcare Research and Quality showed that pharmacists played the largest role in preventing medication errors from reaching the patient.⁸ In this study, interventions by pharmacists accounted for 40% of errors prevented, while 19% and 17% were caught by physicians and patients, respectively.

 5.     Your pharmacy is not just for filling your prescriptions.

 ·       Many pharmacies are now offering clinical services in addition to dispensing medications.  These services include immunizations, disease state management programs, health screenings, and medication therapy management.⁹ There have been many studies done on the implementation of disease state management programs in community pharmacies.^10,11 These studies have shown that pharmacists have a positive impact on the management of chronic disease states such as diabetes and high cholesterol.  These programs resulted in improved patient self-care and increased knowledge of disease states.

Now that you know more about your pharmacist and pharmacy, speak to your pharmacist about how to improve your therapy and health in general.  The Institute of Medicine recommends that patients take an active role in their health care to prevent complications associated with medications.¹² Your pharmacist is there to help you!

 References

 1.     Schweers, K. Pharmacists score big in gallup poll-again. The Dose. http://ncpanet.wordpress.com/2009/12/10/pharmacists-score-big-in-gallup-poll-%E2%80%93-again/. Published December 10, 2009. Accessed August 11, 2011.

2.     American Pharmacists Association. Survey reveals most customers do not carry a medication list. http://www.pharmacist.com/AM/Template.cfm?Section=News_Releases2&Template=/CM/ContentDisplay.cfm&ContentID=21152. Published October 1, 2009. Accessed August 11, 2011.

 3.     Consumermedsafety.org. Know your pharmacist…know your medicine.  http://www.consumermedsafety.org/article.asp?id=66. Published January 2006. Accessed August 11, 2011.

4.     MedlinePlus. Getting a prescription filled.  http://www.nlm.nih.gov/medlineplus/ency/article/001956.htm. Updated August 2, 2011. Accessed August 11, 2011.

5.     Abcnews.com. Experts: consumers can protect themselves against pharmacy errors.  http://blogs.abcnews.com/theblotter/2007/04/experts_consume.html. Published April 2, 2011. Accessed August 11, 2011.

 6.     Caldwel E. Survey suggests pharmacies’ drive-through dispensing puts public at risk. Medical News Today. http://www.medicalnewstoday.com/releases/94865.php. Published January 23, 2008. Accessed August 11, 2011.

 7.     Schneider, M. Waiting in the pharmacy:  when patients don’t have patience. Consumer Health Information Corporation. http://www.consumer-health.com/services/WaitinginthePharmacyWhenPatientsDontHavePatience.php. Published 2008. Accessed August 11, 2011.

8.     Sweeny JF. Study:  pharmacists most likely to catch medication errors. Modern Medicine.  http://www.modernmedicine.com/modernmedicine/Clinical+News/Study-Pharmacists-most-likely-to-catch-medication-/ArticleStandard/Article/detail/585783. Published March 9, 2009. Accessed August 11, 2011.

 9.     American Pharmacists Association. You and your pharmacist partners in managing medications. http://www.pharmacist.com/AM/Template.cfm?Section=Consumers1. Updated 2011. Accessed August 11, 2011.

 10.  Mehuys E, Van Bortel L, De Bolle L, et al. Effectiveness of a community pharmacist intervention in diabetes care: a randomized controlled trial. J Clin Pharm Ther. 2010; doi: 10.1111/j.1365-2710.2010.01218.x.

 11.  Yamada C, Johnson JA, Robertson P, Pearson G, Tsuyuki RT. Long-term impact of a community pharmacist intervention on cholesterol levels in patients at high risk for cardiovascular events: extended follow-up of the second study of cardiovascular risk intervention by pharmacists (SCRIP-plus). Pharmacotherapy. 2005;25(1):110-115.

 12.  American Pharmacists Association. Pharmacists providing medication-related care in all patient care settings, improving medication use and enhancing patients’ lives. http://www.pharmacist.com/AM/Template.cfm?Section=Insurers_Benefits&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=135&ContentID=22584. Updated 2011. Accessed August 11, 2011.

By: Lilly Nguyen, PharmD Candidate 2012