Do you have heartburn? Read on...

Gastroesophageal Reflux Disease (GERD) is commonly known as heartburn, is a condition where the contents inside the stomach leak (reflux) back into the esophagus, causing adverse symptoms and/or tissue damage to the esophagus.  Although GERD occurs at all ages, it is most prevalent in people over the age of 40.  There are 2 types of GERD:

1. Symptom Based GERD

·      may exist with or without injury to the esophagus

·      heartburn, regurgitation, painful swallowing, and increased salivation

2. Tissue-Injury Based GERD

·      esophagitis (inflammation of the lining of the esophagus).

·      esophageal strictures (narrowing of the esophagus)

·      Barrett esophagus (changes in the esophagus resulting in the lining of the esophagus to be similar to that of the stomach)

·      esophageal adenocarcinoma (cancer of the esophagus)

CAUSES AND RISK FACTORS

Risk factors for the development of GERD include obesity, pregnancy, certain medications, smoking, and excessive alcohol intake.  In terms of pregnancy, many women experience heartburn for the first time while pregnant, and the symptoms may go away after childbirth.  Some drugs that can lead to GERD include:

·      certain calcium channel blockers (used to treat high blood pressure)

·      drugs with anticholinergic effects (such as tricyclic antidepressants, certain antipsychotics and anthistamines)

·      theophylline (used to open air passages, making it easier to breathe)

·      nicotine

·      certain drugs used to treat Parkinson’s disease

·      progesterone

Although the absolute cause of heartburn is not known, lifestyle choices are commonly associated with GERD.  Foods and beverages suspected to play a role in GERD are:

·      spicy foods

·      acidic foods (such as citrus fruits and tomatoes)

·      chocolate

·      peppermint

·      caffeinated beverages

·      onions and garlic

·      greasy foods

 SYMPTOMS

·      burning sensation in the chest

·      feeling of food being stuck in chest

·      nausea after eating

·      belching

DIAGNOSIS

Diagnosing GERD involves consultation with your physician to discuss current symptoms and your specific medical history.  In preparation of your appointment, it is important to keep track of the frequency, severity, and onset of symptoms, since this information will be very helpful to your physician.  Depending on your symptoms, your doctor may recommend general lifestyle changes and non-prescription or prescription medications. If symptoms are not controlled with these measures, your doctor may direct you to someone who has extensive training in stomach and intestinal disorders, called a gastroenterologist.  This specialist will be able to offer other suggestions for treatment.

TREATMENT

The treatment of GERD falls into 3 categories:

1.     General Lifestyle Changes

·      avoiding foods that contribute to GERD

·      weight loss if obese

·      elevation of the head of the bed to help prevent acid reflux during sleep

2.     Common non-prescription and prescription medications

·      Non-prescription medications (over the counter (OTC) medications)

Ø  Antacids (Tums, Maalox, Rolaids)

Ø  Pepcid AC (famotidine)

Ø  Zantac (ranitidine)

Ø  Prevacid (lansoprazole)

Ø  Prilosec (omeprazole)

·      Prescription medications

Ø  Protonix (pantoprazole)

Ø  Nexium (esomeprazole)

Ø  Dexilant (dexlansoprazole)

Ø  Aciphex (rabeprazole)

3.     Anti-Reflux Surgery

·      fundoplication procedure

Ø  tightening the opening of the diaphragm

Ø  secure area with mesh

Ø  wrap and stitch upper area of stomach around the end of esophagus

 PREVENTION
For obvious reasons, the idea of preventing heartburn from occurring is more attractive to patients than waiting for an episode to come along before starting treatment.  Keeping a food diary and recording when symptoms occur is very useful in helping you determine GERD triggers.  Many people find that certain foods and drinks often cause symptoms, so you should avoid anything that seem to be related to the development of symptoms.  Apart from diet, here are some other tips to keep GERD symptoms at bay:

·      Avoid smoking as much as possible.

·      Try to limit the amount of food you eat at one sitting. Smaller meals are easier for your body to digest than larger ones.

·      Do not lie down soon after finishing a meal.  If you want to relax, remain upright or only slightly reclined.

·      Ask your doctor about medications which can prevent heartburn before it starts.

FOR MORE INFORMATION

American College of Gastroenterology (ACG)
P.O. Box 342260
Bethesda, MD 20827–2260
Phone: 301–263–9000

http://patients.gi.org/topics/acid-reflux/

American Gastroenterological Association (AGA)
4930 Del Ray Avenue
Bethesda, MD 20814
Phone: 301–654–2055

http://www.gastro.org/patient-center/digestive-conditions/heartburn-gerd

Contact your UIC Pharmacist, or stop into UIC Pharmacy

RESEARCH

To participate in a clinical trial, visit www.clinicaltrials.gov to see a list of ongoing research

REFERENCES

DynaMed [database online]. Ipswich (MA): EBSCO Publishing. http://www.ebscohost.com / DynaMed. Accessed October 25, 2011.

Longstreth GF, Zieve D. Gastroesophageal reflux disease. PubMedHealth. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/. Accessed October 26, 2011.

U.S. Department of Health and Human Services. Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD).  National Digestive Diseases Information Clearinghouse (NDDIC). May 2007. Available at http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/#3. Accessed October 25, 2011.

Williams DB, Schade R. Gastroesophageal reflux disease. In: DiPiro JT, Talbert RL, Yee GC

Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8^th

Ed.  http://www.accesspharmacy.com/content.aspx?aID=7977509. Accessed October 26, 2011.

By: Kaitlyn Kalata and Daniel Lee, UIC PharmD candidates, 2015

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

5 Questions You Should Ask Your Pharmacist

A doctor’s visit or a hospital admission can be overwhelming. Large amounts of information presented at one time can leave you with many unanswered medication questions.  Your pharmacist is available to address any of your medication concerns.  Listed below are 5 questions you should ask your pharmacist whenever you receive a new prescription.

1. Why am I taking this medication?

A pharmacist is able to explain how each of your medications works and why you are taking them.^1-3  Pharmacists can also provide information on how to monitor if a medication is working properly.  Seeing a decrease in blood sugar or blood pressure would tell you that your diabetes or blood pressure medications are working properly.  If no improvement in such outcomes is seen, your pharmacist can work with your doctor to suggest an alternative medication.

2. How should I be taking this medication?

Medications have very specific instructions on how they should be taken.  In order for a drug to work properly it is important to understand and follow the instructions.⁴  Directions may include, but are not limited to, how many times a day to take the medication; how much of the medication to take; what time of the day the medication should be taken; and if the medication can be taken with or without food.  At times these instructions can be complicated and difficult to understand.  Several kinds of medication lists are available to provide clarification. ⁵  You should work with your pharmacist to create a list of your medications so that it is easier for you to follow your treatment regimen. 

.3. What common side effects might I experience while taking this medication?

UIC Pharmacists are ready to answer your questions

All medications have side effects; however, most of these effects are mild.  A pharmacist can inform you of common side effects associated with your medications and assist you in managing them.¹  If you are experiencing side effects your pharmacist might suggest writing on a calendar any symptoms you might be having, specifically at what time of day and after using which medication.⁶  Having more information will help your pharmacist find a solution to your side effects. If you are unable to tolerate side effects of any medications your pharmacist will be able to consult your doctor to recommend an alternative medication.¹

4. Could this medication possibly interact with anything?

Foods, vitamins, over the counter medications, and herbal or dietary supplements are agents that may interact with prescribed medications.^1,4,7-9  These agents may lead to the prescription medication having too much or too little of an effect.  To avoid these interactions, it is important to tell your pharmacist about any other agents you are currently taking.  Use one pharmacy for all of your prescriptions so that your pharmacist has a current list of your medications and is able to check for all possible drug interactions.^5,9 If multiple pharmacies must be used, keep a current medication list with you.⁵ A medication list should contain all of the previously mentioned agents and should be presented at each doctor’s appointment or trip to the pharmacy.  By maintaining an up-to-date medication list, drug interactions can be avoided.

5. How can I mange my medications?

Compliance is taking your medications as instructed by your doctor or pharmacist.⁴  If medications are not taken as instructed disease complications and hospitalizations can occur.  However, there are several obstacles that make it difficult to always take medicines as instructed.  Prescription medicines can be expensive and it may be difficult to afford them.  Your pharmacist may be able to offer generic medications that work just as well as brand name drugs, and are usually less expensive.  Cost is not the only obstacle that could prevent medication compliance.  Daily activities may also get in the way of remembering to take medications.  Your pharmacist will be able to offer simple tips on how to remember to take your medications.  Tips include using a pill box to keep track of your weekly medications; setting reminders on your phone or watch; or keeping your pills on your night stand so you remember to take them before going to bed or first thing in the morning.  No matter what obstacle might prevent you from taking your medication, your pharmacist will work with you to design an individualized plan to solve any medication problems.

References

1. American Pharmacist Association. Ask your pharmacist about all your prescription and nonprescription medications. http://www.pharmacist.com/AM/Template.cfm?Section=Patient_Care_Services2&CONTENTID=16495&TEMPLATE=/CM/ContentDisplay.cfm. Updated April 2008. Accessed August 10, 2011.

2. Cerulli J, Zeolla M, Cottrell J. Drug information questions posed to community pharmacy advanced practice experience students. Am J Pharm Educ. 2004;68(3):article 68.

3. Kassam R, Collins JB, Berkowitz J. Comparison of patient’s expectations and experiences at traditional pharmacies and pharmacies offering enhanced advanced pharmacy practice experiences. Am J Pharm Educ. 2010;74(5):article 90.

4. American Pharmacist Association. Making your medications work better. http://www.pharmacist.com/AM/Template.cfm?Section=Patient_Care_Services2&CONTENTID=16496&TEMPLATE=/CM/ContentDisplay.cfm. Updated April 2008. Accessed August 10, 2011.

5. Safe Medication. The importance of keeping a medication list. http://www.safemedication.com/safemed/PharmacistsJournal/TheImportanceofKeepingaMedicationList.aspx. Accessed August 10,2011.

6. Safe Medication. Managing your medications 24/7. http://www.safemedication.com/safemed/PharmacistsJournal/ManagingYourMedications247.aspx. Accessed August 10,2011.

7. American Pharmacist Association. Get your medication check-up. http://www.pharmacist.com/AM/Template.cfm?Section=Consumers1&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=19218. Updated 2009. Accessed August 10, 2011.

8. American Pharmacist Association. Understanding food-drug interactions. http://www.pharmacist.com/AM/Template.cfm?Section=Patient_Care_Services2&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=16497. Updated April 2008. Accessed August 10, 2011.

9. American Pharmacist Association. What you should know about over-the-counter medicines and drug interactions. http://www.pharmacist.com/AM/Template.cfm?Section=Patient_Care_Services2&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=16499. Updated April 2008. Accessed August 10, 2011.

By: Danielle Donzal, PharmD Candidate, 2012