Irritable Bowel Syndrome Awareness Month

Irritable bowel syndrome (IBS)
Stan Nikitin

April is IBS month, and you may be wondering “what exactly is IBS?” IBS stands for irritable bowel syndrome, which is a disorder affecting the large intestine, also called the colon.  It's one of the most commonly diagnosed gastrointestinal conditions, affecting 55 million Americans.  This means about 1 in 6 people have symptoms of IBS!  Women tend to be affected more often than men. The exact cause of IBS is unknown. There are many hypotheses and the causes may include genetics, problems with the intestinal muscles, infections, stress or other psychological factors.^1-3

Symptoms of IBS
The symptoms of IBS usually begin in adolescence or early adulthood, but can occur at any age.  Symptoms can vary in severity, but the good news is that most people with IBS have mild symptoms. Abdominal pain, fullness, flatulence (gas), and bloating that have been present for at least 6 months are the main symptoms of IBS.²  While different people are affected differently, the symptoms can also include:

·       Cramping - pain or tightness in the abdomen

·       Changes in bowel movements

·       Constipation or diarrhea - both can occur, but mostly it is one or the other

·       Mucus in the stool⁴

Symptoms are more likely to occur after meals, can come and go, and may be milder or disappear completely following a bowel movement.

All people are affected differently. For most people IBS is a chronic condition, but symptoms can come and go, improve or worsen, and be present constantly or intermittently.

The symptoms of IBS may seem daunting and scary, but fortunately, do not cause any permanent damage to the colon. For example, IBS does not increase the risk for colorectal cancer. Also, IBS does not cause any inflammation or changes in bowel tissue unlike the more serious intestinal diseases such as Crohn’s disease or ulcerative colitis.⁴


DiagnosisIBS is largely diagnosed based on symptoms.  Your doctor will diagnose IBS based on your symptoms, medical history, and a physical exam.  If any tests are necessary, they are to rule out any other conditions.  The tests may be necessary especially if there is weight loss, rectal bleeding, fever, nausea or recurrent vomiting, abdominal pain that is not completely relieved by a bowel movement, diarrhea that is persistent or awakens you from sleep, or if symptom onset occurs after the age of 50.  Some of the tests can include:⁴

·       Blood tests - check for blood loss or deficiency, inflammation, and Celiac disease (symptoms of which may resemble IBS)

·       Stool analysis - checks for blood in the stool and certain infections (for example, parasites).

·       Sigmoidoscopy or colonoscopy - allows the doctor to look inside the intestine for abnormal growths, bleeding, inflammation, and other irregularities

·       Lactose intolerance test - tests for lactase deficiency. Some people lack the enzyme lactase, which breaks down dairy sugars. Affected people may have symptoms resembling IBS after eating or drinking dairy products. Your doctor may instruct you to avoid dairy products for several weeks to rule out lactase deficiency.

TreatmentWhile IBS is a chronic condition, it is manageable. The focus of treatment is to relieve symptoms. Diet and lifestyle changes can help you manage IBS. More severe forms of IBS may require the use of medications that can help alleviate symptoms.


Diet and Lifestyle ChangesMaking changes to your diet and lifestyle may help relieve IBS symptoms.

Lifestyle changes:

·       Exercise - exercise may reduce anxiety and stress, which in turn may help relieve IBS symptoms.

·       Improved sleep habits – an erratic sleep schedule may worsen IBS symptoms. Improving your sleep habits may help. Try to go to bed at the same time each day and get plenty of sleep to avoid fatigue and potential stress.

Dietary changes:

·       Eat at regular times - try to eat at the same time each day. Do not skip meals. Avoid large meals.

·       Avoid problem foods - avoid foods that you know for certain trigger your IBS symptoms. Avoid fatty foods or ones with high sugar content. Artificial sweeteners (such as sorbitol and mannitol) may be found in sugar-free gum or other foods and can be problematic. Certain foods and drinks stimulate the intestines. Caffeine containing products (coffee, tea, and energy drinks) are notorious for this effect. Carbonated drinks like soda can produce gas. Some other problem foods may include whole grains, chocolate, or alcohol. Vegetables like broccoli, cauliflower, cabbage, and beans can increase gas. Dairy products may cause much discomfort to lactose intolerant people. See lactose intolerance test above.^1,2,4

·       Foods rich in fiber - while fiber-rich foods such as fruits, vegetables, and beans may help with constipation for some people, they can make symptoms worse for others.

·       Drink plenty of water - water is always best. Remember that coffee, tea, alcohol, soda, and dairy products like milk can worsen the symptoms.

MedicationMedication use in IBS should target your most upsetting symptoms. The lowest dose possible that relieves your symptoms is usually recommended. If you are considering using over-the-counter medication, discuss such use with your doctor or pharmacist before selecting one. Explaining your symptoms to your doctor or pharmacist can help the healthcare professional recommend the right medication for you.

Over-the-counter (OTC) medications

·       Immodium (loperamide) - loperamide decreases the frequency of bowel movements, which may be of relief to some with diarrhea, but it does not help with other IBS symptoms.

·       Fiber supplements - fiber supplements such as Metamucil may help with constipation- predominant IBS, but can make symptoms worse for people with diarrhea-predominant IBS.

·       Laxatives - there are various laxative types that work in different ways to help with constipation.  Discuss with your doctor or pharmacist which laxative may be appropriate for you.

Prescription medications

Diarrhea-Predominant IBS:

·       Antispasmodic drugs may help with intestinal spasms and cramping.^2-5 These drugs relax the smooth muscles of the intestine using an anticholinergic mechanism. Some examples of these medications are hyoscyamine and dicyclomine.  Common side effects are drowsiness, dry mouth, blurred vision, constipation, and urinary retention.⁶

·       Cholestyramine may be helpful to people with bile acid absorption problems.^1,3  The mostcommon side effect reported with cholestyramine use is constipation.⁶

·       Lotronex (alosetron) is approved for women only with diarrhea-predominant IBS and has restricted use. It can only be prescribed by a doctor enrolled in a special program.^1,4,5  The most common side effect reported is constipation.⁶

Constipation Predominant IBS:

·       Amitiza (lubiprostone) is approved for women 18 and older only who have constipation predominant IBS. ^{4, 5} Common side effects are nausea, headache, and diarrhea.⁶

Other therapies:

·       Xifaxan (rifaximin) is an oral non-absorbable (acts in the gastrointestinal tract without getting into the bloodstream) antibiotic that may be effective for global IBS symptoms, especially for diarrhea-predominant IBS. ⁷ This drug is minimally absorbed and stays in the intestine. Common side effects are flatulence (gas), nausea, dizziness, and fatigue.⁶

·       For difficult to treat conditions your doctor may prescribe antidepressants. These can include 2 drug classes: tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). These can be helpful in relieving abdominal pain and slowing down intestinal transit time.^1,2,4,5 Common side effects with TCAs are drowsiness, dry mouth, blurred vision, constipation, urinary retention, and weight gain.⁶  Common side effects with SSRIs are headache, sleepiness, insomnia, nausea, diarrhea, and sexual dysfunction.⁶

·       Other treatment options exist such as probiotics, peppermint oil, herbal therapies and acupuncture. While these treatments may be helpful and beneficial to some, there’s little medical evidence about their effectiveness.

What to expectIrritable bowel syndrome can be a chronic, lifelong condition and has no known cure. Many people with IBS learn to manage the condition and still lead active, fruitful lives. Understandably, the condition may not be easy to discuss, but be open about your communication with healthcare professionals. Be informed, ask lots of questions, and remember that healthcare professionals are there to help! Be your own advocate and take charge in the management of your IBS!

For more information:

·       Mayo Clinic 
http://www.mayoclinic.com/health/irritable-bowel-syndrome/DS00106

·       WebMD
http://www.webmd.com/ibs/default.htm

·       WebMD Support Group Message Board
http://exchanges.webmd.com/ibs-support-group

·       National Institutes of Health
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001292

·       U.S. National Library of Medicine Interactive Tutorialhttp://www.nlm.nih.gov/medlineplus/tutorials/irritablebowelsyndrome/htm/index.htm

·       National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/

·       American College of Gastroenterology
http://www.acg.gi.org/patients/ibsrelief/index.asp

References
1. Spruill WJ, Wade WE. Diarrhea, constipation, and irritable bowel syndrome. In: DiPiro JT, Talbert RL, Yee G, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 7th ed. New York, NY: McGraw-Hill; 2008:628-631.2. U.S. National Library of Medicine, National Institutes of Health. Irritable bowel syndrome. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001292. Updated July 7, 2010. Accessed February 24, 2011.

3. WebMD. Irritable bowel syndrome health center. http://www.webmd.com/ibs/default.htm. Updated May 23, 2008. Accessed February 24, 2011.

4. Mayo Clinic. Irritable bowel syndrome. http://www.mayoclinic.com/health/irritable-bowel-syndrome/DS00106. Updated July 29, 2009. Accessed February 24, 2011.

5. Wald, A. Treatment of irritable bowel syndrome. In: UpToDate, Talley NJ (Ed), UpToDate, Waltham, MA, 2011. Accessed February 24, 2011.6. Wickersham RM, ed. Drug Facts and Comparisons. St. Louis, MO: Wolters Kluwer Health; 2011. http://online.factsandcomparisons.com. Accessed March 2, 2011.

7. American College of Gastroenterology. ACG releases evidence-based systematic review on management of irritable bowel syndrome. http://www.acg.gi.org/media/releases/december182008.asp. Published December 18, 2008. Accessed March 14, 2011.

Party Safe this New Year's Eve

2016 is upon us, time to ring in the New Year! Most of us with gather with family and friends to say goodbye to 2015 and hello to 2016 and that starts with a safe New Year's Eve celebration. So we've compiled safety tips for you to follow and Happy New Year to You and your family from all of us at UI Health Pharmacy!

Heading to a bar or event?

• Be mindful of your surroundings and how others are acting, and give a wide berth to those who seem out of control.
• If someone appears intoxicated, keep them from driving and call them a cab to ensure they get home safely, and don’t let them leave with someone they do not know.
• Locate all the exits when you get there just in-case you need to exit quickly.
• Don't leave an open drink on the bar when you go to washroom or dance floor, have a friend watch it or take it with you.

Heading to house party?

• If you drink, don't drive.
• Plan ahead and always designate a sober driver before the party or celebration begins.
• Stay hydrated by alternating alcoholic drinks with water, juice, or soda.
• If you are impaired, call a taxi, use mass transit, or get a sober friend or family member to come pick you up.
• Or, stay where you are until you are sober.
• Take the keys from someone if you think he/she is too impaired to drive.
• Remember “buzzed” driving is “drunk” driving!

Hosting a party at your place?

• Plan ahead by naming a "designated driver." Make this your responsibility as the host.
• Contact a local cab company to provide rides for your guests.
• Serve non-alcoholic beverages as an option to your guests.
• Stop serving alcohol to your guests several hours before the party ends.
• Provide your guests with a place to stay overnight in your home.
• Don't forget about your pets. They are just as much a part of the family as everyone else. If you are using fireworks, anything with loud noises, or fire, be sure that pets are kept at a distance as well as children. None of these are a good mix!

Hope these tips help and Happy New Year!!

International GERD Awareness Week 2015

International GERD Awareness Week

Gastroesophageal Reflux Disease (GERD)

November 23st through November 29th has been designated International GERD Awareness Week for 2015. An estimated 25 million adults experience heartburn daily, and over 38 million annual outpatient visits are related to this disease.1 You may have heard of GERD, or Gastroesophageal Reflux Disease, most likely in association with heartburn, but what is it exactly? The most common definition of GERD identifies it as the symptoms and damage associated with chronic and recurring abnormal backward flow (reflux) of the contents of the stomach into the esophagus. The burning sensation that the reflux can sometimes cause is what is typically referred to as heartburn. While usually not life-threatening, GERD has a significantly negative impact on the quality of life of those living with this condition. In addition, complications of GERD range from erosion of the cells in the esophageal lining to adenocarcinoma (a type of cancer).

What causes GERD?

Between the esophagus and stomach lies a sphincter, or valve, that opens in order for food to pass into the stomach.2 Improper function of this valve allows for the reflux to occur, and can happen for 3 different reasons: (1) the sphincter relaxes at the wrong time, (2) the sphincter weakens, or (3) the pressure in the abdomen is increased. While the cells lining the stomach are protected against its strong acidity, the cells lining the esophagus are not. When frequently exposed to the stomach contents, these cells can become inflamed and even erode in some instances.

Who has GERD?

The disease can occur at any age, but is commonly seen in those over 40. 2 In general, there is no significant difference in its prevalence between men and women, although pregnant women frequently experience GERD due to hormonal changes and increase in abdominal pressure. Those with asthma, diabetes, peptic ulcers, or obesity are also more likely to have GERD. 3 However, the prevalence of the disease is hard to assess for 2 reasons, the first being that there is no gold standard in diagnosing the disease, and second, many patients do not seek medical treatment for their symptoms.1,2

The lack of set criteria for diagnosing the disease makes it hard to characterize and distinguish from other problems such as ulcers and cancer. 4 Therefore, many factors are considered before a diagnosis of GERD is made, including patient family history, an endoscopy to check the lining of the esophagus, or a short trial of certain medications called proton-pump inhibitors (PPIs).

What are the symptoms of GERD?

Like previously stated, heartburn is the most commonly experienced symptom, however others include sore throat, hoarseness, chronic cough, asthma, chest pain, and a sensation of a lump in the throat. It should be noted that while occasional heartburn is fairly common in a healthy population, those with GERD experience it on a much more frequent basis. 

Foods and medications can worsen GERD symptoms

Certain foods and drugs can worsen the symptoms of GERD either by lowering the esophageal sphincter pressure, making it easier to open, or by directly irritating the lining of the esophagus. A list of these foods and medications can be found in Tables 1 and 2, respectively.  

Table 1: Foods that Worsen GERD Symptoms2,4
Decrease Lower Esophageal Sphincter Pressure	·      Onions ·      Garlic ·      Chili Peppers ·      Fatty Meals ·      Carminatives – Peppermint, spearmint ·      Chocolate ·      Coffee, colas, tea
Direct Irritants to Esophageal Lining	·      Spicy Foods ·      Tomato Juice ·      Coffee ·      Orange Juice

Table 2: Medications that CanWorsen GERD Symptoms2
Decrease Lower Esophageal Sphincter Pressure	·      Ethanol ·      Nicotine ·      Caffeine ·      Anticholinergics – group of medications that can affect the transmission of nerve impulses to the gastrointestinal tract, urinary tract, lungs, etc ·      Nitrates – used to treat angina ·      Dihydropyridine calcium channel blockers – used to treat high blood pressure ·      Tetracycline – an antibiotic ·      Theophylline – used to treat asthma and other lung disease
Direct Irritants to Esophageal Lining	·      Iron ·      Potassium ·      Alendronate – for the treatment and prevention of osteoporosis ·      Nonsteroidal anti-inflammatory drugs – pain medications such as  ibuprofen, aspirin,

How is GERD treated?

It is essential to talk to your physician before starting any therapy for GERD, to find out if you are a candidate for self treatment or if you should be under their supervision.^4,5 Certain symptoms such as hoarseness, coughing, weight loss, vomiting, and chest pain are some of the more alarming ones that would warrant physician assisted care. Also, conditions like pregnancy and age younger than 16 or older than 50, should be under a provider’s care when initiating any medications.

Goals of therapy¹
The goals for the treatment of GERD are to:

·      Alleviate or eliminate symptoms

·      Decrease the frequency, recurrence, and duration of GERD

·      Heal any injured esophageal lining

·      Prevent complications

Lifestyle Modifications ^2,3,4

This is usually the first approach to treatment of symptoms of GERD. Some lifestyle modifications include:

·      Elevating the head while sleeping

·      Dietary changes

o   Avoiding foods that can aggravate condition

o   Eating protein rich meals (this helps with esophageal sphincter pressure)

o   Eating small meals

o   Avoid eating 3 hours prior to sleep

·      Reduction in weight

·      Smoking cessation

·      Avoiding alcohol

·      Avoiding tight fitting clothes

·      If possible, discontinuing drugs that aggravate symptoms (always double check with your physician first).

Medications ^1,2,4
Over-the-counter and prescription drugs are available to help treat the symptoms of GERD. The most basic medications are antacids, which work by lowering the acidity of the gastric juices; they are fast acting and fairly harmless. Histamine type-2 receptor agonists (H­₂ antagonist) drugs are relatively effective in alleviating heartburn, and work by decreasing gastric acid production; all are available over the counter. PPI drugs work to reduce gastric acid production over a long period of time and have been found to be somewhat more effective than H­₂ antagonists in treating heartburn. A list of drugs can be found in Table 3.

 

Table 3: Medications Used to Treat GERD1,4,6,7
Drug Class	Drug Name (generic name)	Common Side Effects	Patient Informationa
Antacids	Tums, Rolaids, Gaviscon (Calcium Carbonate)	∙  Stomach upset	∙  Can be used as needed ∙  Have fast onset of action ∙  Should be separated from certain medications by 2 to 4 hours to avoid drug interactions. Discuss with your pharmacist for more information.
H2 Antagonists	Zantac (ranitidine)	∙  headache ∙  constipation ∙  diarrhea ∙  nausea ∙  vomiting ∙  stomach pain ∙  dizziness ∙  rash ∙  breast enlargementc	∙  Patients should contact their prescriber if symptoms persist and they have to use these medications for more than 14 days. ∙  Talk to your doctor if pregnant or breastfeeding. ∙  It is advisable to take these medications a half hour to one hour before a meal. ∙  If planning on taking cimetidine, patients should talk to their prescribers if already on theophylline, warfarin, and phenytoin (these medications interact with cimetidine).
	Pepcid (famotidine)
	Tagamet (cimetidine)b
	Axid (nizatidine)
Proton-Pump Inhibitors	Prilosec (omeprazole)	∙  stomach pain ∙  diarrhea ∙  headache ∙  nausea ∙  constipation ∙  bloating ∙  flatulence	∙  Take half hour to an hour before a meal. ∙  Contact your doctor if you experience any of the side effects.
	Nexium (esomeprazole)
	Protonix (pantoprazole)
	Aciphex (rabeprazole)
	Prevacid (lansoprazole)
	Dexilant (dexlansoprazole)

^a Before starting any medication, be sure to check with your doctor or pharmacist about whether any of them interact with medications you are currently taking; ^b Caution should be taken when using cimetidine because of its susceptibility to numerous drug interactions; ^c Breast enlargement could be experienced with cimetidine.

 If lifestyle changes and medication fail to alleviate symptoms of GERD, a final option is surgery.¹ Several different procedures can be done, but all focus on strengthening the sphincter and reducing reflux.

Conclusion

GERD is a chronic disease that can severely impact the quality of life for those who suffer from it; severe cases can even develop into cancer. However, implementation of lifestyle modifications, along with different medications can help improve and manage this condition. When treatments fail to work, another viable option is surgery.

For more information on GERD visit these resources:

• American Gastroenterological Association:
  http://www.gastro.org/patient-center/digestive-conditions/heartburn-gerd

• UC San Diego Health System:
   http://health.ucsd.edu/specialties/esophageal-center/GERD.htm

• The Mayo Clinic:
  http://www.mayoclinic.com/health/gerd/DS00967

• International Foundation for Functional Gastrointestinal Disorders:
  1-888-964-2001

Written by:

Asha Kalichira, PharmD Student 2014

Milena Babic, PharmD Candidate 2011

References:

1. University of Michigan Health System, Ann Arbor, MI. Gastroesophageal Reflux Disease.  http://cme.med.umich.edu/pdf/guideline/GERD07.pdf.  Updated January 2007. Accessed October 27, 2010.

2. Williams DB, Schade RR. Gastroesophogeal reflux disease. In: DiPiro JT, Talbert RL, Yee G, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 7th ed. New York, NY: McGraw-Hill; 2008: 555-567.

 

3. UC San Diego Health System. Gastroesophageal Reflux (GERD).                  http://health.ucsd.edu/specialties/esophageal-center/GERD.htm. Accessed October 27,      2010.

 

4. Kahrilas PJ, Shaheen NJ, Vaezi MF. American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135(4):1383-1391.

5. Henderson RP, Prince VT. Heartburn and dyspepsia. In: Berardi RR, McDermott JH, Newton GD, Oszko MA, Popovich NG, Rollins CJ, Shimp LA, Tietze KJ, eds. Handbook of Nonprescription Drugs. 14^th ed. Washington, DC: American Pharmacist Association; 2004: 317-348.

6. Micromedex® Healthcare Series [Internet database]. Greenwood Village, CO: Thomson Reuters (Healthcare) Inc. Updated periodically.

7. Kastrup EK,ed. Drug Facts and Comparisons. St. Louis: MO; Wolters Kluwer Health; 2010.

Great American Smokeout

The Great American Smokeout

Since the 1970’s, the 3rd Thursday of November has been the annual date for The Great American Smokeout. This event challenges tobacco users from all over the United States to stop smoking for 24 hours, with the hope that they will eventually stop all tobacco use. Certain states even offer incentives, such as a cold turkey sandwich to those who turn in a pack of cigarettes, or even obstacle courses made of oversized cigarette packs with the slogan, “Do not let smoking be an obstacle to overcome.”

The American Cancer society has sponsored the event since 1977.  For smokers and non smokers, please support your friends and family in kicking the habit.

Did you know?

- Worldwide, tobacco use causes more than 5 million deaths per year, and current trends show that this will increase to 8 million deaths annually by 2030. 1

- Smoking is estimated to increase the risk of dying from chronic obstructive lung diseases (such as chronic bronchitis and emphysema) by 12 to 13 times, along with raising the risk of various cancers and heart disease. 2

- In 2009 it was found that 20.6% of all adults in the U.S are smokers. 3

- Approximately 45% of smokers try to quit each year. 4

- Each day, about 1,000 people younger than 18 years of age begin smoking on a daily basis. 4

- Spit or chewing tobacco is not a safe substitute for smoking. It is also associated with cancers of the esophagus, larynx, and stomach, and an increased risk of heart attacks and other heart diseases.6

- On average, smokers die 13 to 14 years earlier than nonsmokers. 7

- Chicago has the second highest state-local tax rate in the U.S at $3.66 per pack. The tax alone for a pack- a-day smoker can amount to over $1,300 in a year. 8
Tips for quitting tobacco

The addictive mental and physical properties of tobacco are difficult for people to overcome, but not impossible. While some smokers are able to stop ‘cold turkey,’ it is common to need to gradually ease the withdrawal symptoms that stem from smoking cessation or to use alternative measures.

- Decide that you are ready to quit: Quitting smoking is something that requires the correct mindset to begin, and you must be ready and willing to do so. Be aware, however, that each day you smoke you may be increasing your risk of cancer and other diseases.

- Find a friend to help you out: Someone who does not smoke who is willing to be there when you feel like reaching for a cigarette. Avoid friends that will smoke around you, as they will be triggers towards starting up again.

- Ease off tobacco gradually by using nicotine replacement therapy, which provides nicotine that a smoker’s body desires without the other harmful additives found in cigarettes. These are available in various forms such as patches, gums, sprays, inhalers, and lozenges. Nicotine addiction is one of the hardest addictions to break, and the American Heart Association has determined that quitting smoking can be as difficult as quitting heroin and cocaine. 9

- Using some form of nicotine replacement therapy doubles your chances of quitting smoking. 10

- You can buy nicotine gum, patches, and lozenges without a prescription. You do, however, need a prescription to buy nicotine inhalers.

- Consider getting help from group or one-on-one counseling. 11 The longer you meet or talk with others about quitting, the more likely you are to quit smoking. Check out the resources below that are available to you.

Reach out towards others:

If you have friends or family that smoke or you yourself need assistance in quitting, there are many resources to assist you with your needs. Quitting tobacco is a difficult task that many people would like to achieve especially for those who do not always have the support to achieve this goal. Sometimes an empathetic friend that can be relied on is exactly what it takes to kick the habit for good. There are many factors that determine the success of smoking cessation, but sometimes it takes a shove in the right direction to get started.

UIC Pharmacy also offers resources to help you stop smoking. The family medicine center on the UIC webpage has information for students to contact them for meetings on smoking cessation. In addition to this, UIC’s wellness center has information on how to contact the Wellness Advocates Volunteering to Educate Students (WAVES) group, who can offer health information on a variety of topics including smoking cessation. If you are contemplating giving up cigarettes for good, but have questions or need advice on the best way to stop, you can also talk to your physician or local pharmacy for more information about treatments that can be used, including prescription medication. Another resource is the Illinois Tobacco Quitline at 1-866-QUIT-YES where professional staff can assist you with smoking cessation. These resources are available to you throughout the year, and we hope that you at least utilize them after November 18th, when you realize that going a day without tobacco is possible.

Alvin Thomas, PharmD Student 2014

Nick Burge, PharmD Candidate 2011

References:
1. World Health Organization. Report on the global tobacco epidemic, 2009: Implementing smoke-free environments. http://www.who.int/tobacco/mpower/2009/en/index.html. Published December 9, 2009. Accessed October 27, 2010.
2. Centers for Disease Control and Prevention. Surgeon general’s report, 2004- the health consequences of smoking. http://www.cdc.gov/tobacco/data_statistics/sgr/2004/index.htm. Updated July 6, 2009. Accessed October 27, 2010.
3. Centers for Disease Control and Prevention. Vital Signs: Current cigarette smoking among adults aged ≥18 years --- United States, 2009. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5935a3.htm?s_cid=mm5935a3_w. Published September 7, 2010. Accessed October 27, 2010.
4. Centers for Disease Control and Prevention. Smoking and tobacco use- fast facts. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts. Updated September 15, 2010. Accessed October 27, 2010.
5. U.S. Department of Health and Human Services. Results from the 2008 national survey on drug use and health: national findings. http://www.oas.samhsa.gov/nsduh/2k8nsduh/2k8Results.cfm#4.10. Published September 2009. Accessed October 27, 2010.
6. Smokeless tobacco facts. University of Minnesota Division of Peridontology. http://www1.umn.edu/perio/tobacco/smokeless.html. Published December 2, 2008. Accessed October 28, 2010.
7. Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and economic costs --- united states, 1995--1999. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5114a2.htm. Updated April 11, 2002. Accessed October 28, 2010.
8. Campaign for Tobacco-Free Kids. State cigarette excise tax rates and rankings. http://www.tobaccofreekids.org/research/factsheets/pdf/0097.pdf. Published August 3, 2010. Published August 3, 2010. Accessed October 28, 2010.
9. American Heart Association . Nicotine addiction. http://www.americanheart.org/presenter.jhtml?identifier=4753. Accessed October 28, 2010.
10. Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews. 2002: CD000146.
11. Doering Paul L, Kennedy W. K, Boothby Lisa A. Substance-related disorders: alcohol, nicotine, and caffeine. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach, 7th ed: http://www.accesspharmacy.com/content.aspx?aID=3194292.

Blood Pressure Education Month

May is High Blood Pressure Education Month.

"Hypertension is considered the "silent killer" because it can damage the heart, brain, and kidneys without any symptoms. Each day in the United States, nearly 1,000 deaths are associated with hypertension," says the Center for Disease Control (CDC). "National High Blood Pressure Education Month aims to save lives by increasing awareness and educating the public about cardiovascular risks and how to prevent them."

Five of our UI Health Pharmacies listed below have self-monitoring blood pressure machines in the waiting rooms, additionally our pharmacists are trained to provide counseling on high blood pressure disease and the medication used to treat this.

Stop in to one of these UI Health Pharmacies and get your blood pressure checked today:

Outpatient Care Center/OCC

1801 W. Taylor Street/Suite 3B

 312-996-9058

Taylor Street Pharmacy/EEI

1855 W. Taylor Street/1st Floor

312-996-6540

Wood Street Pharmacy

840 S. Wood Street

312-996-6887

University Village Pharmacy

722 W. Maxwell Street/2nd floor

312-355-2345

Mile Square Pharmacy

1220 S. Wood Street

312-413-1767

Measles 101: The Facts You Need to Know

Measles is a highly contagious respiratory illness caused by the measles virus.^1-3  The illness is characterized by fever, cough, runny nose and rash.  Although measles is no longer present regularly in the United States (U.S.), sporadic outbreaks still occur.  The number of cases has been drastically reduced by the measles vaccine.

What are symptoms of measles?

Initial symptoms of measles include fever, cough, muscle aches, pains, stuffy nose, and red eyes.^1-3 After the initial onset of symptoms, Koplik spots (blue-grey spots on a red background) appear inside the mouth.^2,3  A  rash can develop 2 to 4 days after onset of the fever. It can appear first on the head and face, and then spread to the trunk and extremities.^1-3  Symptoms can develop 7 to 21 days after exposure to the measles virus.^1,4

How common is measles?

Since 2000, measles has been declared eliminated from the United States by the Centers for Disease Control and Prevention.¹  However, cases continue to be reported in the U.S. due to an increase in the number of unvaccinated persons and  transmission from other parts of the world.^1-3  As of February 2015, 170 current cases had been reported in the U.S., 15 of which were in the state of Illinois.^5,6 Worldwide, it is estimated that 20 million people are infected with measles each year, and 146,000 die from the illness.¹ 

How is measles diagnosed?

Measles is suspected in patients with characteristic symptoms.^1,2  Confirmatory diagnostic tests include blood, throat, mouth, nose, and urine testing.  Exposure to persons with measles and potential travel should also be considered when evaluating symptoms.

How does measles spread?

Once a measles infection has developed, the virus lives in the lungs, mouth and nose.  It is highly contagious and can be spread by coughing and sneezing.¹  The virus may remain in the air or on a surface for up to 2 hours after an infected person leaves an area.  Spread of measles has been reported in physician offices, daycares, amusement parks, and sports complexes.^1-5  The virus is particularly stable in times of low humidity, which may account for a higher incidence of measles during the winter months.³  It is estimated that 9 out of 10 susceptible people who are within close contact of a person with measles will develop the disease.¹ 

How can measles be prevented?

Measles can be prevented with administration of a measles virus-containing vaccine.^1-3  It is administered as 2 doses of a combined measles, mumps, and rubella (MMR) vaccine.^1-3,7,8  Within 2 to 6 weeks, the vaccine induces production of antibodies against these viruses in 97% of children.⁸  

Persons who are considered protected from measles include the following:⁷  

• Immunization records of 2 MMR vaccine doses
• Documented bloodwork confirming immunity against measles
• Documentation of previous measles infection
• Born prior to 1957

Individuals who do not fall into these categories should consult with a physician regarding their need for measles vaccination. 

In children, the first dose of the MMR vaccine is administered at 12 to 18 months of age, followed by a second dose at 4 to 6 years.^1,2,7,8  Children younger than 12 months do not have a mature immune system and cannot produce an adequate response to the vaccine.^3,7,9  The MMR vaccine is safe and effective, and adverse reactions are generally mild and temporary.^2,7  Serious  side effects are rare, but common adverse reactions include burning, stinging, pain, hardening of skin, and redness at the injection site.⁸  Symptoms that mimic the measles infection with fever and rash are also possible.^3,8  

Very rarely, adverse effects involving the central nervous system may occur; however, the risk of this type of severe reaction is much less with the vaccine than with an actual measles virus infection.⁸  Despite concerns voiced by certain consumer advocate groups, the medical and scientific communities have extensively evaluated all available data and concluded that the MMR vaccine is not linked to autism spectrum disorders or bowel disease.^2,3,7,8,10

In the U.S., each state mandates vaccination of children older than 5 years prior to enrolling in public schools and daycares.¹⁰  There are possible exemptions that different states may offer, which can be classified as medical contraindication, religious, and philosophical.  The submission and review processes for obtaining an exemption vary by state.

How is measles treated?

There is no specific medication to treat infection with the measles virus.^1-3 Treatment of infected individuals is directed toward management of symptoms and prevention of possible associated bacterial infections. Fevers that lead to discomfort can be treated with acetaminophen or a nonsteroidal anti-inflammatory medication, such as ibuprofen.¹¹  It is also important to stay hydrated through consistent fluid intake.  Pharmacists or other medical professionals can be consulted for further recommendations on anti-fever product selection and dosing.

People with measles can spread the virus in the 4 days before and after the onset of rash.^1,2,4  People who have symptoms consistent with measles should remain isolated from others, at least through the fourth day after rash development.  Exposed individuals should notify their local health department if symptoms occur.

Individuals who have been exposed to measles may be eligible for preventative therapy within 3 to 6 days of exposure.^1,2,4  These measures may offer protection or modify the disease course.  Individuals in this situation should contact a physician as soon as the exposure has been identified.  If preventative therapy is given, the patient cannot return to a healthcare setting and must be excluded from high risk settings, such as infant childcare,  for 21 days after the exposure to maintain effectiveness of the preventative treatment.^1,4  Development of symptoms should be monitored for an additional 7 days after the 21 day quarantine.⁴  Healthcare workers who are not immune to measles should be excluded from the healthcare setting from 5 days after the first measles exposure to 21 days after the last measles exposure.^1,4

What are possible complications of measles?

Possible complications include ear, throat, and lung infections, as well as diarrhea.^1,2  Pneumonia is the most common complication of measles that causes death.²  Rarely, complications involving the central nervous system can occur.^1-3  Headaches, seizures, or changes in behavior or consciousness may indicate these complications.  Complications can occur from 2 days to 15 years after exposure to the measles virus.²  Children less than 5 years of age, adults older than 20 years of age, pregnant women, and individuals with a decreased immune system are at the highest risk of developing complications from measles infection.¹ In children, 1 to 2 deaths occur from respiratory or nervous system complications out of every 1,000 cases of measles.

More information about measles can be obtained from the following sources:

•        Centers for Disease Control and Prevention (www.cdc.gov)
•        Illinois Department of Public Health (www.dph.illinois.gov)
•        California Department of Public Health (www.cdph.ca.gov)

Written by:

Alexandra Riskus

PharmD Candidate, 2015

UIC College of Pharmacy

References:

1. Centers for Disease Control and Prevention. Measles (Rubeola): For Healthcare Professionals. http://www.cdc.gov/measles/hcp/index.html. Updated February 24, 2015. Accessed February 24, 2015.
2. Measles. In DynaMed [database online]. EBSCO Information Services. http://web.b.ebscohost.com/dynamed/detail?vid=7&sid=c3c636ac-4abc-4246-ae5d-fee22a0668a4%40sessionmgr115&hid=118&bdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU%3d#db=dme&AN=116399. Updated February 24, 2015. Accessed February 26, 2015.
3. Gershon AA. Measles virus (rubeola). In: Bennet JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philidelphia, PA: Elsevier Saunders; 2015. https://www.clinicalkey.com/#!/content/book/3-s2.0-B9781455748013001624. Accessed February 23, 2015.
4. California Department of Public Health- February 2015 (V.2). Measles Investigation Quicksheet. http://www.cdph.ca.gov/programs/immunize/Documents/CDPHMeaslesInvestigationQuicksheet.pdf. Accessed February 16, 2015.
5. Centers for Disease Control and Prevention. Measles (Rubeola): Measles Cases and Outbreaks. http://www.cdc.gov/measles/cases-outbreaks.html. Updated March 2, 2015. Accessed March 2, 2015.
6. Illinois Department of Public Health. Measles. http://www.dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/measles. Updated February 25, 2015. Accessed February 26, 2015.
7. Jin J. Measles in the United States. [published online ahead of print]. JAMA. 2015. doi:10.1001/jama.2015.1555.
8. Grabenstein JD. Measles, mumps & rubella virus vaccine live. In: ImmunoFacts; Vaccines and Immunologic Drugs.St. Louis, MO: Wolters Kluwer Health; 2012;300-309.
9. Leuridan E, Sabbe M, Van Damme P. Measles outbreak in Europe: Susceptibility of infants too young to be immunized. Vaccine. 2012;30(41):5905-5913.
10. Lawrence O, Gostin JD. Law, ethics, and public health in the vaccination debates: politics of the measles outbreak. [published online ahead of print]. JAMA. 2015. doi:10.1001/jama.2015.1518.
11. Feret B. Fever. In: Berardi RR, ed. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 16th ed. Washington, DC: American Pharmacists Association; 2009:83-94.

Extreme Cold Weather Tips

As we head back into the deep freeze this week, here’s 15 safety tips that we’ve compiled from the American Red Cross and the CDC that you can use to stay safe and warm during the cold weather.

1. Layer up! Wear layers of lightweight clothing to stay warm. Gloves and a hat will help prevent losing your body heat.

2. Don’t forget your furry friends. Bring pets indoors. If they can’t come inside, make sure they have enough shelter to keep them warm and that they can get to unfrozen water.

3. Take a buddy and an emergency kit when you are participating in outdoor recreation.

4.  Work slowly when doing outside chores.

5.  Sprinkle cat litter or sand on icy patches.

6. Remember the three feet rule. If you are using a space heater, place it on a level, hard surface and keep anything flammable at least three feet away – things such as paper, clothing, bedding, curtains or rugs.

7. Leave your home immediately if the CO detector sounds, and call 911.

8.  Keep grills, camp stoves, and generators out of the house, basement and garage.

9.  Turn off space heaters and make sure fireplace embers are out before leaving the room or going to bed.

10. Don’t catch fire! If you are using a fireplace, use a glass or metal fire screen large enough to catch sparks and rolling logs.

11. Protect your pipes. Run water, even at a trickle, to help prevent your pipes from freezing. Open the kitchen and bathroom cabinet doors to allow warmer air to circulate around the plumbing. Be sure to move any harmful cleaners and household chemicals out of the reach of children. Keep the garage doors closed if there are water lines in the garage.

12. Better safe than sorry. Keep the thermostat at the same temperature day and night. Your heating bill may be a little higher, but you could avoid a more costly repair job if your pipes freeze and burst.

13. The kitchen is for cooking. Never use a stove or oven to heat your home.

14. Use generators outside. Never operate a generator inside the home, including in the basement or garage and keep generators 20 feet from the house.

15. Knowledge is power. Don’t hook a generator up to the home’s wiring. The safest thing to do is to connect the equipment you want to power directly to the outlets on the generator.

Hope these tips help you, please share them with family and friends and stay warm!