Dr. Spaceman

So... 30 rock is my favorite show. This is a clip of Dr. Spaceman's best moments in medicine!

Post Pregnancy Diet and Exercise Program

So Sarah has been talking to me about going on a diet and exercising with her after Annie comes so we can support each other while she loses the baby weight. I have been trying to decide if I wanted to do the exercise part because school and work limit my time and Annie is only going to stretch my time further but after speaking with my niece I have decided to participate in the exercise part. I have known for sometime now that I have gained some weight since getting married and starting pharmacy school but I always attributed it to my stress levels, my slowing metabolism, and my sedentary student lifestyle. I didn't think about it much because I always told my self that there wasn't much I could do about it at this point in my life, and I didn't think my weight gain was THAT noticeable.

A picture of my sweet little niece (stolen from my sister's blog)

My decision was made when I was sitting on my sisters couch and my 2 year old niece approached me with a question, she said "Do you have a baby in your belly?" I replied in a bit of a surprised tone, "No, just Sarah does." Klaire, my niece, then walked away while still looking at me. I brushed the first question off but, she took a minute or two to think and returned with her second question, "Do you have puppies in your belly?" At that point all debate was over. I now get to start an exercise program along with my wife. Oh, the honesty of little children.

Newer Does NOT Equal Better

We all acknowledge that there are things that were better in the past. There are things that mankind has tried to improve, but failed.

Many pitchers have tried but none have succeeded at improving upon the Nolan Ryan Express. We have had many presidents since the Civil War but have any really been as good as President Lincoln? There are some fantastic actresses currently but are any of them anywhere near as good as Audrey Hepburn? There continue to be thousands of people who try to make a living as artists but do any of their paintings equal that of Van Gogh or any other of the old masters?

On the reverse. There things that have been improved upon greatly.







There is no comparison between the 8 Track and the iPod when it comes to sound quality, convenience, and portability. There is also no question that thousands of improvements have been made between the Model-T and the Aston-Martin Vanquish.

The same principles apply to drugs. Newer is not always better, and better is not always necessary. Nowadays it costs Billions (with a "B") to research and market new drugs. So drug companies have opted to go a cheaper route by not creating as many new drugs and instead they have been tweaking and or mixing the old ones.

Why research a new drug when you can just take an old one and combine it with another old one and then make them brand name again. For example, Caduet is nothing but Lipitor mixed with Norvasc. Norvasc (amlodipine) is generic and very cheap, Lipitor is still brand name only but not for much longer. By mixing the two together they can extend the patent for years without doing any actual work. This is not an isolated even, more examples are: Vytorin = Zocor (has a generic) + Zetia (will soon have a generic), Hyzaar = Cozaar (soon to have a generic) + Hydrochlorothiazide (Super cheap generic), Avandamet = Metformin (very cheat generic) + Avandia (soon to have a generic).

The other route drug companies have been taking is they have been tweaking just enough to get a new patent but not enough to require any actual effort or make any actual difference in therapy. There are hundred of examples of this, I will just list the most frustrating examples. The first is Antara (fenofibrate, a cheap generic), the drug companies tweaked it and made Tricor (fenofibrate) which is brand name only. Tricor is about to go generic so the tweaked it again to make Trilipix (fenofibric acid)! The next example is Celexa, it is now generic citalopram, which is a $4 generic. The drug companies tweaked it and made Lexapro (escitalopram) which is around $100! Even the best insurances are reluctant to pay for Lexapro and if they do the best copay I have seen was $20 which is still five times more than generic Celexa. There are many more examples but this is already turning into an extremely long blog, and I think you get the point.

Just always remember that then newest drug isn't always then best drug. Also you may not always need the best drug. One example is Lipitor vs Zocor, the first is by far the best but also much, much more expensive. Lets say you go to your doctor and you have high cholesterol, but it is only a little high. You don't need a nuclear bomb (Lipitor) to take care of it, the hand grenade (Zocor) will best just fine for you.

My suggestion is to always tell your doctor you want generic whenever you can get it. If you tell your pharmacists they can help you but it will save you a lot of time if you just let your doctor know from the get go.

Sorry I took so long to blog, but Finals and Rotations have been taking up all of my time. Now I am lucky enough to get a summer break of a few weeks.

Brand vs. Generic: Is there a difference?

So I guess the answer to the question is the same as almost every question in medicine... it depends.

For example, I would never touch Marshmallow Mateys but I love Lucky Charms and I am a big Coke fan but I hate the generic colas. Strangely enough I can't stand brand name Mac and Cheese but I love the Western Family Mac and Cheese.

So... it must be the same for things like drugs, right? Once again, the answer is, it depends.

For most medications generic is no different than the brand name drug. The brand and the generic are so similar in most cases that you are not even given a choice as to which you receive the pharmacy just gives you the generic. It has gotten to the point that many brand names have been nearly forgotten of certain drugs.

Now, for the exceptions to the rule. There are drugs that are referred to as narrow therapeutic index drugs. These drugs have huge differences in efficacy, side effects, and toxicity with very small changes in the amount of medication.

For the legal stuff, the FDA tightly regulates drug companies and their products. Most of the time when a new drug comes out it has gone through years of tests and reviews. When a generic comes out it also has to pass many reviews and tests to prove that it is within a 20% window of similarity to the brand name it is copying. So it can achieve drug levels in the blood between 10% above or 10% below the levels achieved by the brand name. For example, lets say you take Paxil 20 mg (a common medication used to treat depression, OCD, or anxiety) and then we draw your blood an hour later find you have 10 mg in your blood. Generic Paroxetine (the generic for Paxil) could have drug blood levels after one hour that could legally range from 9-11 mg. So there could potentially be a difference but it would be incredibly small, far too little for anyone to feel. Something we also have to remeber is that all generic companies are trying their hardest to get as close as possible to exactly the same, so often times they don't use the range the law allows them.

An interesting fact is that many generic companies are owned by the brand name companies so the brand and generic are made in the same factory bu just put into different packages, so they are the same.

An example of one of those narrow theraputic index drugs. Lets say you have epilepsy (you have seizures often enough to require treatment), and you are taking Depakote ER and you transfer your prescription to a new pharmacy and they fill it with generic Valproic Acid. There should be red flags shooting up everywhere! All drugs for epilepsy should never be switch without a doctors supervision. Even though the difference is incredibly small it is enough of a diffrence that many people have seizures despite taking their medication religiously after being switched to generic.

Now it goes both ways if you are well controlled on generic don't let the pharmacy switch you to Brand without talking to your doctor.

What it boils down to is if you are given generic medication right of the bat, don't worry, it is just as effective as brand. If you are on brand and are switched to generic chances are there won't be a difference but don't be shy about asking. Ask the pharmacist if you will be okay, it is his/her job to know, make them earn their money. Also remember that for everything other than drugs brand versus generic does matter, at least to me.

Do Herbals Have a Place in Modern Medicine?

Yes, the answer to my title is yes. Herbals do have a place in modern medicine whether health care professionals like it or not. People love herbal medications because they are all natural. I have never really understood that reasoning. My question to them is, why does all natural = good? I have never had anyone sufficiently answer that question for me, but in this blog I will answer for you why all natural doesn't always equal good, effective or even safe.

I guess my main problem with the attitude that all natural = good is that I can name hundreds of things that are all natural but are definitely not safe to be ingested. For example, lead, Cyanide, Uranium, etc.

Something that many people don't realize is that 99.9% of all medications are derived from something that is "all natural" but have been chemically tweaked to make them safer, more effective, more potent, or patentable. I can also name many all natural poisons that modern medicine has turned into powerful drugs to help keep people alive and well. For example, Rattle Snake Poison (Blood Pressure Medication), Mustard Gas used in WW2 (Cancer Chemotherapy), Fungus Poison (Antibiotics), etc.

There are times where these chemical modifications are impossible and there are the situations where herbal medications are the most effective thing we have possible and thus your doctor or pharmacist will recommend them.

I will not lie to you, herbal medications do have effect in the body. Many of them even have the effect that they claim to have. The problem is that the companies that produce these medications have no incentive to test the effects of their products, to prove that they contain they same amount of different chemicals from batch to batch, or that they have the chemicals at all. For example, the medication Mevacor (Lovastatin) is a cholesterol reducing medication that can be found in Red Yeast Rice, which is an herbal product. There is no difference between the chemical you will find in prescription only mevacor and the herbal product Red Yeast Rice. So why doesn't your physician tell you to buy Red Yeast Rice? The reason is that you can go buy some Red Yeast rice today can send it for chemical analysis can find it contains 15 mg of active ingredient, then buy some more in a month and find it contains 48 mg of active ingredient. Some batches have been tested to find that they contain none at all! Your doctor writes you a prescription for Mevacor because he wants you to get the exact amount you need every month.

Herbal companies also have no responsibility to test for side effects or drug interactions. One of the most popular herbal medications is St. John’s Wart, it is an herbal used to treat depression. Studies have shown that it does have an effect on depression, it really does help. The problem with this one is that St. John’s Wart interacts with almost every drug you can imagine, it interacts with Warfarin (a blood thinner), it interacts with almost Phenytoin (a medication used to treat Seizures), and it interacts with birth control (it makes birth control much less effective). That is just a few of the medications that it interacts with.

The final reason that your doctor or pharmacist won’t recommend most herbals is we don’t want you treating yourself for serious problems. If you have high cholesterol, depression, arthritis, osteoporosis, irritable bowel, or any other disease your doctor wants to see you. Most of the time he will even save you money by writing you a prescription. When it comes to St. John’s Wart you will pay about $15 every month if you take it how the bottle suggests, but generic Prozac, Paxil or Celexa will only cost $10 every 3 months! So even with your doctor’s visit copay you will save money by getting the prescription medication, not to mention you will have the support of your doctor and pharmacist to make sure you are adequately treated and taken care of.

I both do and don’t include vitamins in this, every doctor or pharmacist will recommend a good daily multi vitamin but you do need to tell your doctor or pharmacist if you are taking a multi vitamin because they too can interact with your medications. Like I said there are herbals that we will recommend, like Acidophilus, it is very good to take when you are taking an antibiotic to prevent stomach problems. Vitamin D and Calcium are essential to treating osteoporosis, but we still want to know you are taking them.

Always make sure to ask the doctor or pharmacist before you start taking an herbal medication and if you ask questions about herbals be prepared to hear, “I don’t know,” because once again companies are not required to study herbals so not much is know about them. Even though it is still important that someone knows you are taking it.

Sorry for the extra long blog this time, I try to keep them short. There is just a lot to be said on this topic. If there are any requests on what you would like to know about I am glad to blog about it.

Pregnancy Risk Line

If you haven't yet checked my wife's blog I suggest you do so. She breaks the news so much better than I do but anyway we are having a baby. I have noticed that so are many other people in the family right now, so I have decided to inform everyone on the Pregnancy Risk Line and other healthy pregnancy tips in this blog (eventhoug I don't claim to know much yet).

The Pregnancy Risk Line is an awesome phone number that you can call for questions about pregnancy and medications/chemicals. You can call and ask if you can take an OTC pain medication or if you can take the Ginko that you bought in the herbals section. It is an essential resource that we have here in the state of Utah.

Despite the name you can still call even after you give birth to ask breast feeding or lactation questions as well, so it is not just for pregnancy but for breast feeding mothers and babies as well.

You may wonder why we need a Pregnancy Risk Line because you have a good doctor that you trust. The reason is that your doctor can't be expected to know everything, not even the OB knows everything about drugs in pregnancy. The main reason for that is the FDA's fault not your doctor's. Overall I am very impressed with OB doctors' knowledge when it comes to pregnancy and drugs (especially my wife's, he is amazing). The problem is the FDA doesn't require any research to be reported on how drugs effect unborn babies or breastfeeding babies, and the information they do require is poor at best. I know it sounds unethical to require testing of medications of pregnant mothers but the truth is most companies have to do it to meet the FDA's requirements but the FDA doesn't force them to publish it but instead to translate it into a letter ranking (A,B,C,D,X).

Most of the testing that is performed is done on lab animals. Last I checked my wife was not giving birth to a Rat, Rabbit, or Hamster so I don't care what a drug does to those animals I want to know what they could possibly do to my daughter! I would guess most of you feel the same. So if you have a question about a drug call your doctor, pharmacist or the pregnancy risk line. If you have a good doctor/pharmacist they will refer you to the pregnancy risk line if they are unsure on the answer or if the data they have are lack luster.

The number is 1.800.822.BABY (2229) for anywhere in the state or 801-328-2229 for the Salt Lake Area only. They are very helpful and know their stuff. If the don't have an answer they will find if for you or direct you to where it can be found.

Second to last I will give a few easy tips for pregnancy: NO decongestants (Sudafed, Sudafed PE, etc.), they can raise your's and baby's heart rate. NO pain medications except Tylenol or something your doctor has prescribed, after your baby take his/her first breath their heart enters into the final stage of development and certain pain medications can cause this development to happen while still in the womb and your baby's heart will stop. NO herbal that you haven't discussed with a heath care provider, they are just as likely to cause a bad reaction as any other medication. NO making these decisions on your own, believe it or not the health care professionals that take care of you do care about what happens to you and your baby. Call them and ask questions, they won't be annoyed. I am still surprised how often I call a doctor to ask a question and they don't even need to pull the patients chart to remember who I am talking about, they do remember you and want you to have a sucessful pregnancy.

Last thing. I include my self I what I have said above. I am just a pharmacy student right now but if you are too embarassed to call someone else then call me, I will find you the answer. I promise that it is better than taking the risk of putting something in your body that could harm your child.

Cough Medicine for Kids?

So I am still terrible at posting more often. There is plenty of stuff that I want to post about but the time to do it is hard to find. For example I have 4 tests next week alone.

So what I am going to talk about today is the use of cough medicine in kids. When is it okay to give your kids cough medicine? at 3 months? 6 months? 1 Year? 2 Years? When your pediatrician gives you a specific dose for you child?

Surprisingly none of the above are correct. The FDA has come out with new guidelines that say you should never give a child under the age of 4 any over the counter (OTC) cough medication. Your pediatrician may give you a dose for your child but the evidence still shows that the medication is still not going to be helpful or possibly even safe.

Current research has show that OTC medications for cough don't work for kids under 4, not only that but the chances that they will have a bad reaction are much higher. We have many moms come into the pharmacy and want to give their kids cough medicine, some have asked for recommendations for their very young kids. I personally have had a mother ask me how much NyQuil she could give her 4 month old! What is worse is when a mother asks for a dose for her baby, we explain to her that her child can't safely take the medication and then she wants us to sell it to her anyway.

It is a moderately recent change in guidelines, a couple of years ago it was okay to give OTC cough medication to anyone 2 and over. So it can be hard to remember that you can't give your 3 year old cough medication anymore. Pediatricians know about this change but there is one big difference between Doctors and Pharmacists. Pharmacists' hands are tied by the FDA, Doctors aren't. So when the FDA says that OTC cough medications are unsafe for children under 4 pharmacists are no longer allowed to give dosing to for kids under 4. Whereas Doctors don't have to follow FDA guidelines, that is why they are allowed to prescribe experimental medications and why they can prescribe medications for a disease other that what they have been proven to treat. So your pediatrician may give you a dose for your child but it is most likely because it is easier to give you dosing on a medication that he knows isn't going to work than it is to explain to you that it isn't going to work.

If you want to know what you can do to help your kids when they have a cough here are some suggestions. A humidifier , lots of fluids, rest and less activity, and letting it run its course naturally. If it last more than a few days, if the child has a fever, or even if your just worried take your kid to the doctor and see if he/she wants to prescribe an antibiotic.

Another thing, if you do have to give your kids medications then designate a medicine giver. Most problems that come from cold medications happen because Mom give the kid some medicine and goes to do her hair and then Dad comes down stairs and give kid another dose not knowing that Mom already gave kid some medication.

Really what it boils down to is finding a Doctor and a Pharmacist that you trust and then taking their advice when they give it.

This is me again. (3/5) A few days after I posted the original blog. As I was reading through it again I realized that my main goal of this blog wasn't apparent in my original posting. My whole goal of this blog in general other than occasionally catalogging what is going on in my life is to make sure people understand how important it is that you find a doctor and pharmacist that you can trust, and are competent. Simple things such as OTCs can be fatal in certain people, for example cough syrup in kids, Benadryl in the elderly, Aspirin in childern, Ibuprofen in unborn children, and the list goes on. What is scary is that there are many health care professionals that are unaware of these things. Just yesterday a professor in my Therapeutics class warned us all that we should think about Malpractice Insurance for when we graduate because the day that a pharmacist can be sued for an OTC recommendation isn't far away. The reason it isn't far away is becuase people put too much trust into health care professionals that don't always deserve that trust, I bet most people have had a bad expercience with a doctor, pharmacist, nurse, dentist, or some other health care professional so my goal is to stress the importance of finding the doctor that you know has your best interest in mind and is doing all he/she can to stay current on what is best for you.

One last thing. I do intend to give my future kids cough syrup, but only after I have taken them to the pediatrician, and only after I have found that the pediatrician is worthy of my trust.

Is Baby Aspirin Safe for Babies?

Two blogs in one day. I never though I would see it. Well, I have recently discovered that my life is completely uninteresting so instead of only blogging once every one to two months I will start periodically giviving advice from your friendy student pharmacist. First on the list: Is Baby Aspirin Safe for a baby?
The answer is definitely not. I had a patient come to the pharmacy a few days ago asking for teething tablets so I gave them to her. Afterward she asked me to direct her to the baby aspirin. I didn't think much of it so I directed her to the baby aspirin. As she walked away I started wondering why a woman who couldn't be over 30 would want baby aspirin when it struck me that she was going to give that aspirin to her BABY! I walked up to her and ask who she was buying the medication for and she said that it was for her 8 month old. I explained to her that aspirin is not okay for babies and she had a hard time understanding why baby aspirin isn't okay for babies so that is why I have selected this topic today.

I will tell you right now that there is no drug on the market with a worse name than baby aspirin. That is why they changed the name, depending on the company, they changed it to either heart healthy aspirin or low dose aspirin. They never changed anything about the actual medication, all they did was change the name. Back in 1981, yes that is right 28 years ago. They discovered that children under the age of 12 who are given aspirin have a very high chance of developing a rare but potentially deadly disease called Reye's Syndrome. It very closely mimics a bad viral infection, so many times parents don't get their kids check out until it is too late.

The main use for Baby Aspirin is to prevent blood clots. The lowest effective dose of aspirin when treating pain or fever is 325 mg whereas baby aspirin is only 81 mg. Far too little to help with fever or pain but more than enough to cause serious injury to a child. As I was saying though, if you have had a heart attack, Pulmonary Embolism, Stroke, Deep Vein Thrombosis, any other clotting event, or even if you haven't had problems but are at high risk aspirin is an effective way to prevent any future clotting events.

In addition to that, you should never put yourself on daily aspirin therapy. You should discuss it with your doctor if you think you may be at risk. Some of you may be familiar with a TV show called Oprah. Well on this show Oprah there is a doctor, Dr. Ozz, who comes a doles out free medical advice. Don't take everything he says as gospel. He advised everyone that is over 55 to take not just one but two baby aspirin everyday! While on aspirin therapy your risk of clotting events goes down, but your risk of having a serious bleeding event that can be just as dangerous goes WAY up. It has been estimated that for every one clotting event prevented by aspirin theray there are hundreds if not thousands of bleeding events CAUSED by aspirin therapy that can be just as dangerous. Bleeding events can also cause hospitalization and death so your risk of clotting problems has to be great enough to assume the risk of a bleeding problem, so once again discuss it with YOUR doctor so someone who is familiar with you and your situation is helping you make the decision.

In summation, don't give your kids aspirin at all, and don't take daily aspirin without talking to your physician.

Books on Health Problems that Can Cause Health Problems

So here are my books for this semester. They are gigantic! Check it out. If I stack them all on top of each other they are 9 inches thick, and when I put them on the scale they weighed more that 25 lbs. I don't know for sure but I may have to buy more this semester still. I am trying to get by with the minimum number of books I have to buy. I guess that is what happens when you have to learn thousands of drugs inside and out.