Los Angeles Times Article on Pharmacists

The Los Angeles Times has several articles on pharmacists in today's edition (November 30, 2009). Pharmacists are a vital, if under-used, part of healthcare -- latimes.com

Ethical Responsibility

According to Los Angeles Times three pharmacists refused to fill prescriptions for Anna Nicole Smith before her death of a drug overdose.  The report states that a pharmacist contacted the internist and said that he had no intention of filling a prescription that amounted to "pharmaceutical suicide". 

It is nice to see a report that highlights the ethical responsibility of pharmacists in making the right decisions in refusing to fill unsafe prescriptions. 

Treatment of constipation in adults

If you are constipated and not sure what to do, I have summarized here some general treatment for non severe constipation. First of all, you need to eat a diet rich in fiber (fruits, vegetables, grains), increase physical activity, and drink plenty of fluids throughout the day. The recommended amount of dietary fiber is 20 to 35 g/day. You can also use bulk Forming Laxatives (Psyllium, Methylcellulose, Calcium Polycarbophil). These are natural or synthetic polysaccharides (carbohydrates) that primarily absorb water and increase fecal mass; they may cause abdominal bloating and gas.

If you do not respond to dietary changes, you may require laxatives other than the bulk forming agents.
Stimulant Laxatives (Bisacodyl, Senna) are indicated for acute constipation. Bisacodyl suppositories work very rapidly. They may cause cramping, diarrhea; I would not recommend for long term use. Osmotic laxatives (Lactulose, PEG 3350, Glycerin, Sorbitol) and Saline Osmotic (Magnesium Citrate, Magnesium Hydroxide, Sodium/potassium phosphate) are another option but long term use is not recommended.

Stool Softeners (Docusate Sodium, Docusate Calcium, Docusate Potassium) have marginal efficacy in most cases of constipation; however, stool softeners are used to soften the stool. Therefore, they can be used as adjunct therapy to other laxative, for it is used to prevent straining and exacerbation of hemorrhoids. They should not be taken together with mineral oil.

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Applying to Pharmacy School

Admission to pharmacy school is very competitive. Just to put it into perspective there were over 95,700 applications for 102 pharmacy schools in 2007 according to PharmCas.org. The application to acceptance ratio for my school was 16:1 for the year I got accepted. That means achieving the minimum pre-pharmacy courses and GPA will not get you into pharmacy school. Each pharmacy school has its own admissions process. Though most schools do not explicitly require undergraduate degree, it is very hard to get into without undergraduate degree. Generally, pharmacy schools are looking for students who are able to handle a rigorous course load and who have been able to keep their GPA competitive. So my suggestion is to keep your GPA high and apply early in the cycle! If you are planning to apply to pharmacy school, please email me your questions. And I will look into your case and give you honest and realistic suggestions. Thanks

High Blood Pressure (Dhiig Kar)

Each time your heart beats, it pumps blood into your arteries. Blood pressure is the force of blood as it pumps through your arteries. The more blood your heart pumps and the narrower your arteries are, the higher the blood pressure. Hypertension is the scientific term used to describe high blood pressure. Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as two numbers. For example, 120 over 80 (written as 120/80 mmHg).

• The top number is your systolic pressure, the pressure created when your heart beats. Less than 120 is the normal.
• The bottom number is your diastolic pressure, the pressure inside blood vessels when the heart is at rest. Less than 80 is the normal.

High blood pressure is defined as follows:

• Prehypertension: systolic 120-139 or diastolic 80-89
• Hypertension: systolic over 140 or diastolic over 90

So what are symptoms of high blood pressure?
In most cases, people who have high blood pressure do not know they have it because they have no symptoms; for that reason, it is called the "silent killer”. Some symptoms that may occur include:

• Nonspecific mild headache
• Chest pain
• Nosebleed
• Tiredness
• Vision changes
• Ear noise

So how high blood pressure is treated?
The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. In some cases, making changes in diet and exercise habits can get blood pressure under control. In other cases, you may need medications as determined by your care provider.

So what causes high blood pressure?
Most of the time, the cause is unknown. This is called essential hypertension. High blood pressure that results from a specific condition such as kidney disease is called secondary hypertension.
In general eating too much salt can lead to high blood pressure. Smoking, obesity, and diabetes are all risk factors for high blood pressure.

So what can you do to control your blood pressure or prevent high blood pressure?

• Lose weight if you are overweight
• Exercise regularly
• Eat a diet rich in fruits and vegetables
• Reduce salt intake
• Avoid smoking
• Avoid stress
• Caffeine (coffee) can worsen high blood pressure

Please check your blood pressure routinely! If you have high blood pressure and it is not treated properly or if you don’t make changes in your diet and lifestyle, terrible things can happen to you including:

• Stroke
• Coronary artery disease and heart attack
• Congestive heart failure
• Kidney disorder
• Blindness
• Impotence
• Memory problems

I can’t stress enough the importance of taking your medications as prescribed. Do not stop taking your medication without your care provider’s consent. Suddenly stopping some types of blood pressure medications can cause blood pressure to rise to extremely high levels, possibly resulting in stroke and heart attack. If medication side effects are bothering you, talk with your pharmacist!

Is Pharmacy for You?

I will be discussing pharmacy school requirements and admissions in details in my next postings. But for now watch this video from the University of North Carolina at Chapel Hill Eshelman School of Pharmacy which pharmacy faculty and students produced answering the question, “Is pharmacy for you?”