5 Things You Didn’t Know About Being a Pharmacist

By Michael Shaaw, clinical pharmacist at CHOC Children’s

When most people think about what their pharmacists do at the pharmacy, the first thing that comes to mind might be counting pills. Yes, that is one responsibility of our job, but since pharmacists are one of the most accessible healthcare professional out in the community, here are five facts you might want to know about what we do so that you will be able to get the most out of your encounter with your pharmacist.

It takes a lot of schooling to become a pharmacist

In order to become a pharmacist, one typically would spend about six to eight years in school, including undergraduate course work and obtaining a doctoral degree in pharmacy. In the recent years, many pharmacy school graduates spend an extra one to two years undergoing residency or fellowship training in subspecialty areas such as critical care medicine, emergency medicine, pediatric, geriatric or oncology.

Pharmacists offer many other services beside dispensing your prescription

Aside from filling your prescriptions, a pharmacist can also administer immunizations such as flu vaccines, shingles, and travel vaccines. We can provide medication counseling and medication therapy management to help you better understand and be informed about the medicines that you’re taking in order to better manage your condition. You can also ask a pharmacist for recommendations on over-the-counter products, as well as smoking cessation and other chronic disease monitoring services such as blood pressure and cholesterol levels.

Pharmacists do a lot more than just counting pills

When a pharmacist receives a prescription, he or she will check for any allergy or drug interaction that could potentially do you harm. The pharmacist also makes sure that the dose of the prescribed medicine is appropriate for the stated indication, and raises any concerns to the prescribing physician and provide recommendations when appropriate.

There are pharmacists working in different settings other than retail stores or hospitals

Aside from working in retail or hospital settings, many pharmacists also work in areas such as academia, public health, government, pharmaceutical research, informatics, and managed care. They utilize their knowledge in pharmacology and medicine to further advance our healthcare system.

Pharmacists can save you money

Although pharmacists cannot change your copay set forth by the insurance company, most of the time they can recommend you other medication that’s similar to the one prescribed to you but at a lower cost (such as suggesting a suitable generic in place of a brand name medication). Pharmacists can also provide information about rebates and other cost-saving tips to help lower the cost of the medication

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Know the Dangers of Food and Drug Interactions

By Jennifer Nguyen, clinical pharmacy resident and Grace Lee, clinical pharmacist at CHOC Children’s

Most of us appreciate food for the pleasure of smell and taste, but the food you put in your body, and feed your children, affects far beyond the taste buds. Compounds packed in foods give you energy and provide nutrients to maintain your overall health. However, these compounds also have the potential of interacting with other substances such as medication.

Food and medications can interact at different parts of the body:

  • Absorption: Medications can interact with food when they mix in the stomach. Sometimes this helps the drug get absorbed into the body, but in other cases, medications are blocked from being absorbed and then may be completely ineffective.
  • Metabolism: Foods may affect the levels of proteins in the liver involved with breaking down the drug. This may cause a medication to be metabolized faster or slower than if it was taken alone and influences how long the drug affects the body.
  • Elimination: Ingesting excessive amounts of certain acidic or alkalinic (basic) foods can change the pH levels in the intestines and kidneys, which are organs involved in drug excretion. Changing these environments can speed up or slow down how quickly a drug is eliminated from the body.

Sometimes, the chemical effects of food can enhance or interfere with a medication response. For example, if your child gets a sugar rush from eating sweets while taking a stimulant medication such as Ritalin they may become excessively hyper by this interaction. On the other hand, the side effects from some antibiotics and over-the-counter pain relievers are better tolerated with food in your stomach as a buffer.

Important food and drug interactions you should be aware of for your child are listed in the chart below, organized by food:

Food & Beverages Medications Interaction Symptoms to recognize
Dairy or calcium-fortified juices Some antibiotics:

  • Ciprofloxacin
  • Doxycycline
  • Minocycline
  • Tetracycline
Calcium contained in dairy or juices may decrease antibiotic absorption in the stomach Infection not improving or taking longer to see improvement
Soybean and walnuts

  • Soybean flour can be found in various baby milk formulas
  • Soy is also found in some dietary supplements as a composition of the capsules
  • Levothyroxine
Soybean increases elimination of thyroxine through the gastrointestinal track.   Caution is indicated for patients requiring thyroid hormone therapy Decreased effect of levothyroxine, or low thyroid levels
Caffeine

  • Coffee
  • Soda
  • Teas
  • Chocolate
  • Energy Drinks
Some bronchodilators:

  • Albuterol
  • Theophylline (specifically the once daily, sustained-release formulation)

 

Some antibiotics:

  • Ciprofloxacin
Caffeine can increase side effects of excitability, nervousness, and rapid heartbeat from bronchodilators by mimicking the same effect

Ciprofloxacin slows the  metabolism of caffeine in the liver leading to increasing effects of caffeine on the body

  • Excitability
  • Nervousness
  • Rapid heart beat
  • High blood pressure
Grapefruit juice
  • Fexofenadine (over-the-counter allergy medicine)

 

  • Amlodipine
  • Levothyroxine
  • Carbamazepine
  • Statins (Atorvastatin, Lovastatin, and Simvastatin)

 

  • Amphetamines (Adderall)

 

Grapefruit juice blocks the absorption of fexofenadine in the stomach

Grapefruit juice slows the breakdown of these drugs in the liver,  leading to  longer duration of drug action and side effects

Acidic juices such as grapefruit juice lessen amphetamine absorption in the small intestine.

  • Decreased effect of antihistamine (more allergy symptoms)
  • Increased carbamazepine levels, leading to dizziness, drowsiness, headache
  • Increased amlodipine side effects increased irregular heart beat
  • Increased statin toxicity includes muscle soreness and dark cola colored urine
  • Less drug effect from Adderall
Tyramine-containing foods:

  • Aged-cheeses
  • Salami, sausages, pepperoni
  • Avocadoes, figs, dried fruits (prunes, raisins)
  • Sauerkraut
  • Soy sauce
  • Caffeine
  • Monoamine Oxidase Inhibitors (MAOIs):
    • Phenelzine
    • Tranylcypromine
    • Selegiline
    • Rasagiline
  • Linezolid
  • Isoniazid (TB medication)
Tyramine increases the release of brain chemicals that can boost your blood pressure.

MAOIs block the breakdown of brain chemicals that also have an effect on blood pressure, leading to an additive effect

Linezolid and isoniazid are also MAOIs, in addition to their other antibiotic effects

Sudden, dangerous increase in  blood pressure
Histamine-containing foods:

  • Tuna
  • Tropical fish
  • Isoniazid
Isoniazid blocks the metabolism of histamine in the body. Increased histamine in the body leads to the same effect as having an allergic reaction
  • Headache
  • Sweating
  • Fast or irregular heart beat
  • Flushing
  • Low blood pressure
Foods with high amount of vitamin K:

  • Brussel sprouts
  • Broccoli
  • Kale
  • Spinach

Cranberry juice

  • Warfarin
Foods high in vitamin K counteract the effects warfarin has on clotting, making it less effective
  • Potential for increased clotting
  • Swelling in one arm or leg (from a blood clot)
Food
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):
    • Ibuprofen
    • Aspirin
NSAIDs can cause side effects such as stomach upset or stomach bleeds. Taking food at the same time can help protect the stomach  Stomach upset relief

While most foods have neutral or minimal effect on drug effect, consult your child’s pediatrician or pharmacist before starting a new medication. The best way to avoid drug-food interactions is to take medication with plain water and space medications at least an hour before or after a meal. If food must be used to mask the taste of medication, consult with a pharmacist to determine what is compatible.

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Is It a Cold, Sinus Infection or Allergies?

By Fionna Lam and Tran Nguyen, clinical pharmacists at CHOC Children’s and Dr. Jonathan Auth, CHOC Children’s pediatrician

With the winter season nearing the end and spring season already here, many of us are experiencing nasal symptoms related to the common cold, a sinus infection, or seasonal allergies. Since all these conditions share overlapping signs such as sneezing, nasal discharge and congestion, distinguishing between them may be the first step to selecting the proper over-the-counter remedy for symptomatic relief.

The common cold usually peaks during cold weather and is caused by a viral infection. While children may feel crummy for a few days, most cold symptoms can be managed with over-the-counter medications. Sinus infections, on the other hand, can bring about headaches and facial pain. It can happen after a prolonged common cold when the body is more vulnerable to bacterial or viral infections. Some children may be more susceptible to sinus infections than others due to structural abnormalities in the nose.

Sneezing, nasal congestion, and/or watery eyes are the hallmark symptoms of seasonal allergies. These are due to the body’s immunologic reaction to irritants in the air. This condition usually peaks during spring time when the highest amount of pollens from trees, grasses or weeds are present in the environment. Other common allergens include dust and mold.

The following table compares some common signs and symptoms of common cold, sinus infections and seasonal allergies:

Symptom Common Cold Sinus Infection Seasonal Allergies
Fever/chills +/- * +/-
Sneezing + +/- +
Stuffy/runny nose + + +
Color/consistency of sinus discharge Clear and watery, or thick and colored Thick, yellowish or greenish Clear and watery
Sore/itchy throat + +/-
Cough + ** +/-**
Chest congestion +
Headache/facial pain +
Stiff neck +
Watery eyes +

+    present

+/-  may or may not be present

*Fever and/or chills are more common in children than adults

**Cough may present if post nasal drip present

It’s important to be aware of how long each symptom has been present. Cold symptoms usually start to show improvement in most children in 7-10 days. Sinus infections usually have longer lasting symptoms without treatment, around 10-14 days. Allergies are usually present for weeks or more.

When an infection or allergy occurs, the blood vessels in your child’s sinuses dilate and the tissues tend to swell up, which can lead to pain around the eyes, cheeks and forehead. Mucus production increases during an infection and can cause further discomfort. Small microscopic hairs in our nose called cilia help sweep bacteria and particles from our nose, but when dry air enters our nose, it can damage the cilia by drying them out.

Before resorting to medications, non-pharmacological strategies can be tried first such as introducing moist air with a humidifier, taking warm showers or drinking hot fluids like tea and soup. Keeping the air moist will help prevent drying out the nose passage and prevent mucus buildup.   Applying a warm compress to the face may also help alleviate congestion pain.

A variety of over-the-counter medications can provide targeted symptomatic relief. See the chart below for active ingredients and their role in cold and sinus infections. Learn what to look for when choosing the right over-the-counter medication for your child. While combination products offer the convenience of addressing many symptoms at once, they often contain more than one ingredient. When multiple over-the-counter remedies are taken together, the risk of toxicity increases due to duplication of active ingredients or doubling up on drugs in the same drug class. For example, acetaminophen (Tylenol) is commonly found in many over-the-counter cold and cough medications. Inadvertent overdoses have occurred when parents gave these medications along with Tylenol. To minimize this risk, single ingredient products are recommended whenever possible. Download this guide to acetaminophen for children.

Remember that over-the counter medications are not completely safe and do come with risk of side effects and toxicity if not taken correctly. Talk to your child’s pediatrician or pharmacist before starting a medication regimen.

Active ingredient Purpose Symptoms Treated
Mucous Cough Pain Fever Runny Nose Stuffy Nose
Acetaminophen Pain reliever + +
Ibuprofen, Naproxen Pain reliever + +
Phenylephrine*, Pseudoephrine* To relieve nasal congestion + +
Dextromethorphan** Cough suppressant +
Guaifenesin To loosen up phlegm + +
Saline spray To relieve nasal congestion + +
Mentholated topical ointment To relieve nasal congestion + +
Fluticasone, Triamcinolone (Nasal Spray) To relieve nasal congestion + +
Oxymetazoline*, Phenylephrine*(Nasal Spray)  To relieve nasal congestion  + +

+ present

*Do not use decongestant for more than 3 days as it might make you more congested.

**Discretion should be used when using dextromethorphan as a cough suppressant as high doses can cause hallucinogenic effects and be abused.

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Heart Disease Medications for Children

 By Melody Sun, clinical pharmacist, & Dr. Nita Doshi, fetal cardiologist at CHOC Children’s

About eight in every 1,000 babies in the US are born with a heart defect. In some cases there are known risks such as pregestational or first trimester maternal diabetes, a previous child with congenital heart disease, mother or father with history of congenital heart disease, certain genetic syndromes, or certain prenatal medication exposures. Many cases, however, do not have a known reason. The heart is formed by week 12 of pregnancy, but sometimes, the usual developmental stages of the heart do not occur. Your prenatal care team may refer you to a fetal cardiologist for additional testing and monitoring. Sometimes, the defect does not significantly impact the quality of life, and the child can grow into adulthood without restrictions. It is when the defect causes severe consequences that the child may require surgery and/or long-term medications.

With advancing imaging technology, the majority of significant congenital heart defects may be detected during pregnancy. The state of California’s newborn screening program mandates newborn pulse oximetry screening for detection of congenital heart disease. If diagnosed with significant congenital heart disease, young patients may exhibit the following warning signs and symptoms:

  • Difficulty with feeding and/or poor weight gain
  • Difficulty with breathing
  • Turning blue inside or around the mouth, or in certain areas of the face
  • Cool arms and legs
  • Tiring quickly with exertion or activity

In severe cases of significant congenital heart disease, medical, minimally-invasive (catheterization-based), or surgical therapy may be considered by your child’s cardiology team. Medications may be started before and after the surgery to improve heart and lung function.

Examples of medications that may be recommended to treat a patient with heart disease include:

Medication Intended Use
Aspirin Decreases the risk of clot formation
Furosemide (Lasix), chlorothiazide (Diuril) Reduces the heart’s workload by decreasing the amount of blood volume the heart has to handle
Spironolactone (Aldactone) Helps counteract the loss of potassium from diuretics and may help support heart function
Sildenafil Reduces elevated pressure in the lung arteries
Captopril/enalapril/lisinopril Reduces the resistance and heart’s afterload to improve the heart’s function or to help reduce certain types of valve leakage
Propranolol, Digoxin, Sotatol, Amiodarone Treats rhythm disturbances due to abnormal electrical signals through the heart cells

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Putting a Stop to Opioid Related Hospitalization in Children

By Grace Lee, Sakina Hussain and Alice Kim, clinical pharmacists at CHOC Children’s

Opioids are a type of medication used to treat pain by blocking pain signals to the brain and decreasing the body’s perception of pain. When used appropriately under the supervision of a physician, prescription opioids are safe and effective medications. However, they are not without potentially serious side effects.

“The past two decades have seen a medical industry-wide emphasis on recognition and treatment of pain. This may have resulted in greater customer satisfaction, but it has led to more opioid products available in more homes than ever before,” says Dr. James Cappon, CHOC’s Chief Quality and Patient Safety Officer. “There are local and national increases in both accidental ingestions and poisonings in children and adolescents, and intentional overdoses in adolescents, too often with serious or even fatal results.”

Examining the Increase in Opioid-Related Hospitalization in Kids and Teens

A recent research study from the Yale School Medicine confirms this observation. Over a 16-year period from 1997 to 2012, a total of 13,052 hospitalizations for prescription opioid poisonings in children were identified. The number of young children aged 1-4 years admitted for opioid-related hospitalization (ORH) doubled, while a similar increase was seen among teens aged 15-19 years.

The reasons for these hospitalizations also varied by age group: children ages 1 to 4 were hospitalized primarily for accidental ingestion, while a majority of teenagers took the drugs with the intent to commit suicide or unintentionally overdosed when taking the drugs for recreational purposes, according to the study.

Side effects of opioid use and abuse

Commonly prescribed opioids for moderate pain include hydrocodone, oxycodone or morphine. Potent opioids such as fentanyl are used to treat severe pain related to cancers and other chronic illnesses.

Opioids can cause severe constipation, nausea, stomach upset, rash, drowsiness and confusion. If taken in excess, there is potential for dependence. Opioid overdose can result in dangerously slow breathing, low blood pressure and coma. In particular, opioids and alcohol are a notoriously deadly mixture.

Safeguarding our children

This study underscores the dangers of prescription opioids, which can often be more accessible than street drugs. “While greater awareness around reducing opioid dependence and prescribing is developing in the medical community, it is extremely important that our patients and families partner in keeping our children safe,” says Dr. Cappon.

Safeguarding our children starts with education and developing a healthy respect for these powerful pain killers. Precautions should be taken to store these medications away from children. Parents can also learn to identify signs and symptoms of opioid overdose to in order to seek help as soon as possible. Some practical tips include:

  • Safe storage – keep all medications away from your child’s reach and sight. Store in locked cabinets, if possible.
  • Safety cap – when filling prescription medications at pharmacies, request child resistant caps to be placed on the medication bottles to prevent easy access.
  • Safe administration – when giving medication to you child, double check the directions on the medication label. Liquid medications should be measured accurately when giving to your child. Keep track of how much medication is left over.
  • Safe disposal ­– expired medications or those that are no longer needed should be disposed of properly. The Food and Drug Administration recommends disposing some medicines, including opioids, by flushing them down the toilet or sink. If you are not sure whether your unused medication can be safely flushed, please check online for community drug take back days in your area.
  • Be aware of medication side effects – be familiar with common side effects of opioids such as nausea, vomiting, constipation, urinary retention, dizziness, drowsiness and confusion.
  • Recognize signs and symptoms of overdose – overdose is life-threatening. If you notice any of the following symptoms, call 911 immediately:
    • Pale face
    • Clammy skin
    • Limp body
    • Blue/purple lips and fingernails
    • Choking or gurgling noises while asleep
    • Cannot be awakened or are unable to speak
    • Slow/no breathing or heartbeat
  • Recognize signs and symptoms of inadequate pain control – it is important to control your child’s pain adequately with the right medications. Besides discomfort, inadequate pain control can lead to drug-seeking behaviors. Talk to your provider about the addition of non-opioid medications that can help with pain.
  • Be aware of your child’s physical and mental health ­– studies have shown that there is an increased risk of substance abuse (including opioids) in children with psychiatric disorders. Be involved with your child’s health and have an open discussion to prevent abuse.

For reference, a list of opioids and their brand names:

Opioid Brand Name
Codeine
Fentanyl Actiq, Duragesic, Subsys, Lazanda, Fentora, Abstral
Hydrocodone Lortab, Vicodin, Norco  Hysingla ER, Zohydro ER
Hydromorphone  Dilaudid
Methadone Dolophine
Meperidine Demerol
Morphine MS contin, Kadian, Avinza, Embeda (with naltrexone)
Oxycodone Percocet, Oxycontin, Roxicodone, Oxecta, Xtampza ER, Oxaydo

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Getting your Little Patient to Follow Medication Directions

By Grace Lee, clinical pharmacist at CHOC Children’s

Grace Lee
Grace Lee, clinical pharmacist at CHOC Children’s, offers tips on getting children to follow medication directions.

Medication compliance is defined as how well a patient follows the directions written on a prescription. In a perfect world, we would follow the instructions ordered by our doctors all the time. However, there are many reasons why this doesn’t always happen. Poor compliance can lead to the failure of a treatment plan in many diseases. Also, if the doctor assumes that a patient is taking his or her medications as directed when they actually aren’t, this may lead to unnecessary dose adjustments since the doctor thinks the medication is not working.

Maintaining perfect compliance is difficult but not impossible. While all of us are prone to forget a dose of medication here and there, there are ways to improve our chances of remembering. Consider these tips on improving medication compliance:

  • Try linking medication doses to other daily activities, such as eating meals, brushing your teeth, or going to bed.
  • Create a medication schedule on paper or use a pillbox that contains days or a week’s worth of medication. This is an especially good idea when multiple care takers are involved, or if the child spends time in more than household. Refill the box at the same time every week.
  • Alarms on your watch or smartphone are another way to remind yourself when it’s time to take or give medicine. Many smartphone apps allow you to set reminders to take or give a dose, obtain refills, and even provide drug information.
  • Sign up for automated refill reminders at your pharmacy or consider a mail-order service that can deliver up to 3 months of medication at a time so you don’t run out.
  • If the cost of your medicine makes it difficult to afford refills, speak with your doctor or pharmacist about generic or alternative options.
  • Since compliance dramatically decreases with the complexity of the medication regimen, ask your doctor or pharmacist if the regimen can be simplified by using combination products, longer acting formulations, or if certain drug can be eliminated.

Non-compliance could also result from not understanding the importance of taking the medicine or disliking the side effects.  Having a trusting, open relationship with your health care provider is the best way to overcome these concerns. Be honest with your doctor – if it is unclear why you need a certain medication, clarify it with your prescriber. Often there are other medications that can be tried if a side effect is unbearable. Do not take alternative or herbal medicines, assuming they are safer than your prescription medications, without consulting with your doctor or pharmacist first.

The teenage years are an especially challenging time to maintain medication compliance. Often time parents want to hand over the responsibility of administering medicines to their teen, but they may be forgetful or feel embarrassed to take their medications in front of their peers. Smartphone apps are especially good for this age group. Setting up a support system involving the school nurse or close friends can be useful when you are not around to monitor. If embarrassment is a concern, encourage them to take the medications privately. For parents who want to monitor how well their child is doing keeping up with medications, there are bottle caps that count the number of times a bottle is opened, or devices that record how many times an inhaler has been used. Remind them of the positive rewards to staying healthy, such as the ability to participate in sports, go out with friends, and even drive.

For a higher fee, there are pill bottles that can be programmed to flash or make noises when a dose is overdue, or personalized rolls of presorted medications that come in a dispenser.  Like any habit-forming behavior, the tips on improving medication compliance that will work for an individual or family will vary. The important thing is to develop a plan and stick with it. With the help of your doctor and pharmacist, strong compliance is achievable!

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Antibiotics Aren’t Always the Answer

By Tuan Tran, infectious disease pharmacist at CHOC Children’s

The Centers for Disease Control’s annual recognition of Antibiotics Week, November 14- 20, is a good opportunity to review basic safety practices of antibiotics and educate yourself so that you can protect yourself and your family. Don’t forget:

  • Antibiotics can have reactions and side effects. Harmful effects from antibiotics, such as side effects and allergic reactions, cause 1 in 5 emergency department visits for adverse drug events and lead to 50,000 emergency department visits in children each year
  • Antibiotic resistance is growing. An estimated 2 million illnesses and 23,000 deaths occur each year in the U.S. due to antibiotic-resistant infections. Overuse and misuse of antibiotics are the main drivers of resistance.
  • Antibiotics can only cure infections caused by bacteria. For example, cough and cold illnesses caused by viruses would not be cured by an antibiotic

Parents are an essential part of a child’s care team. You should feel comfortable asking the following questions to your child’s provider when considering an antibiotic:

  • What is the best treatment for my child’s illness? Antibiotics aren’t needed for common illnesses like colds, most sore throats, the flu, and even some ear infections, which are often caused by viruses and do not respond to antibiotics. Sometimes the best treatment is over-the-counter symptom relief.
  • Is this the right antibiotic for the type of infection my child has? If an antibiotic is needed, it’s important to use an antibiotic that is designed to fight the bacteria causing your child’s specific illness. Ask your healthcare professional if it’s the most targeted drug to treat the infection while causing the least side effects
  • What can I do to help my child feel better? Pain relievers, fever reducers, saline nasal spray or drops, warm compresses, liquids, and rest may be the best things to help your child feel better. Ask your healthcare provider or pharmacist what symptom relief is best for your child.
Illness Usual cause: virus Usual cause: bacteria Antibiotic needed?
Cold/Runny nose  NO
 Bronchitis/Chest cold* NO 
 Whopping cough YES 
Flu NO 
 Strep throat YES 
 Sore throat (except strep) NO 
 Fluid in the middle ear** NO 
 Urinary Tract Infection YES 

*In otherwise healthy adults

**Otitis media with effusion

When your doctor prescribes an antibiotic, it’s essential that you take it exactly as prescribed. Follow the directions of your physician and pharmacist, do not skip doses or share the medication, and finish the prescription even if you feel better. Do not save it for later.

There are several things you can do to help prevent infections- starting with receiving an influenza vaccine every year. Aside from getting your flu shot, hand washing is the single most effective way to prevent the spread of pathogens. Scrub for at least 15 seconds when using soap and water. When necessary, cough into a tissue or elbow.

Clinicians at CHOC are committed to optimizing antibiotic use. A multidisciplinary team reviews and monitors antibiotic use to ensure optimal selection, dosing and duration. This reduces adverse events and improves patient outcomes, and slows an emergence of resistance.

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National Prescription Drug Take Back Day is October 22

Orange County parents and caregivers can help prevent prescription drug abuse by anonymously disposing of expired, unused or unwanted prescription medications as part of the U.S. Drug Enforcement Administration’s “National Take Back Day” on Saturday, Oct. 22 from 10 a.m. to 2 p.m. at locations throughout the county.

The most common source for the last prescription pain medication misused by people over 12 years old belonged to a friend or relative, according to the 2015 National Survey on Drug Use and Health. To help prevent this, practice the following medication safety tips year-round:

  • Remove expired, unwanted or unused medications from your home as quickly as possible, preferably through an authorized collection site.
  • Store medication in a cool, dry place. Keep it out of reach and out of sight, and in a locked location. Do not store it in a purse or nightstand, or other locations children can easily get into.
  • Don’t put medication away in front of children or take medication in front of them, as they tend to mimic adults’ behaviors.
  • Remind children that medicine is not candy.
  • Remember that child-resistant medication containers do not necessarily mean child-proof.

If you are unable to attend this annual community event, follow these easy steps to dispose of most medications in your home:

  • Mix medicines (do not crush tablets or capsules) with an inedible product such as dirt or used coffee grounds
  • Place the mixture in a sealed plastic bag
  • Dispose of the bag in your household trash
  • Remove all personal information from the prescription’s label

To participate in National Take Back Day on Saturday, Oct. 22, anonymously drop off unused medications at any of the more than 30 participating locations throughout Orange County.

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How to Make Shots Less Stressful

Vaccines represent significant breakthroughs in medical research and disease prevention. When the Centers for Disease Control’s recommended immunization schedule is followed according to plan, it is shown to be the most effective and safest way to protect your child from potentially fatal diseases, according to Dr. Jasjit Singh, medical director of infection prevention and control at CHOC Children’s. However, the process of going to the pediatrician and receiving shots can be stressful, or even anxiety-producing, for young children.

A patient’s relationship with their pediatrician is important, and once you have found the right primary care doctor for your family, it can set the stage for their feelings toward medical professionals or clinical settings later in life. Studies show that preparing your children for vaccinations should ideally include three components: explaining what will happen, how it will feel, and strategies for coping with any related stress or discomfort. Follow these simple steps on how to make shots less stressful.

  • Be honest. Tell children their vaccines may be uncomfortable or bothersome for a second or two, and have them practice slowly counting to two seconds so they get a sense of how long that really is. Tell them what to expect at their appointment, and explain why the procedure is necessary and how it will help them.
  • Use Neutral Language: Request that the health care providers let your child know what will happen and when, using neutral language such as “we’re ready to start,” advises Marni Nagel, a pediatric psychologist.
  • Encourage them to ask questions. Remind them that they can ask any questions they want to of their doctor or nurse.
  • Time the appointment well. For babies and toddlers, scheduling the appointment around their bottle/feeding time may help. Receiving a bottle or feeding right after the shot may help soothe your baby.
  • For infants, engaging in at least 4 of the 5 S’s has been shown to reduce distress after immunizations, says Nagel. These include swaddling, placing on the side/stomach while holding, making shushing sounds, rocking, and sucking. Sucking can be done through breastfeeding, a bottle, or pacifier. For infants, dipping their pacifier in sugar water has been shown to decrease stress associated with immunizations. You can also talk to your doctor about breastfeeding during and/or after the immunization.
  • Topical anesthetics. Ask your pediatrician if topical numbing agents may be appropriate for your child.
  • Control your reaction. Children are increasingly observant as they get older, and they will take careful note of your reaction. Remain calm and be mindful of your demeanor, and it may help send a message to your child that they need not be stressed either.
  • Distraction techniques. These will vary depending on your child’s age and interests, but could include telling stories and jokes, looking at a picture book or finding a hidden picture like “Where’s Waldo,” or blowing bubbles.
  • Positive Rewards/Treats. Consider going out for ice cream, going on a special outing such as to the park or playground, or another small treat after your appointment to encourage good behavior, or to soothe your child.

Maximizing your Relationship with your Pharmacist

By Patrick Loo and Preetha Abraham, clinical pharmacists at CHOC Children’s

Most people associate the word pharmacist with the person behind the counter at their local retail pharmacy. The profession of pharmacy has grown greatly in the last few decades and now you can find pharmacists in a variety of settings. Let’s take a quick look at how pharmacists help patients in different locations.

Hospital visits can be a stressful time for both adults and children, but families can be comforted knowing that every medication order at CHOC is carefully reviewed by a pharmacist to ensure:

  • appropriate drug for the diagnosis
  • a double-check for allergies
  • correct dose and frequency
  • no adverse interactions with other medications.

Pharmacists may perform a medication history review on new patients, which means that they will go over all your medications with you to make sure that the correct medications and doses are ordered while you are in the hospital. As part of the medical team, pharmacists provide critical drug information to physicians to ensure that medications are used efficiently and safely. If a patient has an adverse drug reaction to a medication, the pharmacist can help determine how to manage the reaction. Hospital pharmacists also monitor patients on intravenous (IV) antibiotics and often recommend switching to an oral antibiotic when in the patient’s best interest. Pharmacists oversee the correct preparation of medication, whether it is to be given orally or through an IV, and make sure it is delivered to the patient in a timely matter.

If you or your child needs to be admitted to the hospital, here are some tips to help with medication safety:

  1. Tell your doctor and pharmacist all the medications you take – this includes prescription, over-the-counter, and herbal supplements. It is helpful to keep a list handy with all the names and doses of your medications so that you always have that information when needed.
  2. Tell your doctor and pharmacist about any allergies you may have had in the past. This includes both medicines and other allergies (peanuts, eggs, latex, etc.).
  3. Have phone numbers handy (physician, specialists, pharmacy, home care agency) in case there are questions regarding medications or recommendations.

Pharmacists who work at your local retail pharmacy are easily accessible and available. Continuing to use the same pharmacy for all your medications allows a relationship to be formed with the pharmacist. They can be a great source of information about medicine, not only including ones that are prescribed to you by your doctor, but also for recommendations for over-the-counter medications. For example, you can speak to them about how to properly take your medication, possible side effects, and what to do if you miss a dose. They will also have a record of all the current medications you are taking in order to help check for drug interactions or duplicates. When starting a new medication, you should always speak to your pharmacist so that you fully understand how this medication will help you and to answer any questions you may have.

Did you know that pharmacists are the main personnel working at the Poison Control Center? While we recommend all medications are stored up and away from children, if your child ever gets into your purse, under your cabinets, etc. and might have ingested something that could be toxic, it is important to know where to call. By contacting the Poison Control Center at 1-800-222-1222, you can get recommendations of whether you need to bring your child to the hospital or if you can continue to monitor your child at home.

Pharmacists are everywhere in our community and a valuable resource. Since 2003, every pharmacist in the U.S. earns a doctorate degree, specifically a Doctor of Pharmacy. Many people think that pharmacists just count pills all day long, but as you can see they have a greater impact on your health care than you can imagine!

 

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