Rhythm of Life

We can feel rhythm in just about everything we do.  Driving on the freeway we feel the rhythm of the wheels and the road under our seat.  Sitting in a restaurant we feel the rhythm of people coming and going.  Standing on your porch outside late at night with your eyes closed you can feel and hear the rhythm of the night.  Walking on the beach or next to a river you can hear and feel the constant rhythm of the water.  All of these have a regular rhythm, a regular beat that continues to move.

You know when something changes, when the rhythm or the constant beat is interrupted somehow.  It is clear that if you are sitting in the back seat of the car with your eyes closed driving on the freeway; the car comes into a traffic jam and the rhythm of the drive is interrupted.  We do not always notice the rhythm when it is beating and flowing so smoothly; however, invariably we will become acutely aware of it when it became irregular.

Similarly, our heart has a rhythm that beats relatively constant from the moment life begins.  This rhythm provides a smooth circulation to our body which helps sustain life.  Our steady heart rhythm is interrupted when the electrical impulses that coordinate the rhythm is disrupted somehow, causing our heart to beat too slowly, too fast, or irregularly.   When our heart beats out of normal rhythm, we call it arrhythmic.

Quite often, heart arrhythmias are harmless.  Occasionally, people will have an irregular heartbeat that causes a bit of fluttering or temporary racing heartbeat.  On the other hand, arrhythmias have the potential of causing significant and life threating complications.   An irregular heartbeat is one of the conditions that predispose an individual to developing a blood clot which may get stuck in the legs, lungs, heart or brain.  As we know, blood clots may be life threatening. 

Some irregular heart rhythms can be managed by adopting a Heart Healthy Lifestyle, while other situations will definitely require medication management.  Quite often, a combination of the two will provide the best results; however, this is a decision made between you and your physician.

Anti-arrhythmic medications work by slowing the transmission of the chemicals the heart uses for electrical conduction of the heart rhythm.  This process prolongs the conduction time of the contraction in all areas of the heart which significantly decreases the chances for irregular heartbeats.  This category of medication helps maintain a regular and steady heartbeat.

Please be aware, each medication in this category comes with various Black Box Warnings that are important to understand before taking the medication.   One common warning is the following:

In the Cardiac Arrhythmia Suppression Trial it was shown that patients who have had a heart attack within the last 2 years who were treated for a specific type of non-life-threatening arrhythmia did not benefit and may have been harmed by attempts to suppress the arrhythmia.  These patients showed an increased chance of death during treatment.   Please discuss the risks vs. benefits of this category of medications with your physician before beginning therapy.

Medication Specific Counseling SessionsTM  for the following anti-arrhythmic medications has been added at www.AudibleRx.com.   Please register to become a member, and then have full access to all of the available counseling sessions.

  • Amiodarone (Cordarone-TM, Pacerone-TM)
  • Disopyramide CR (Norpace CR-TM)
  • Dronedarone (Multaq-TM)
  • Flecanide (Tambacor-TM)
  • Propafenone (Rythmol-TM)
  • Propafenone (Rythmol SR-TM)

Please remember…These recordings are meant to supplement your knowledge and understanding of your medications and are not a replacement for counseling with your pharmacist or doctor. AudibleRxTM maintains no liability for your medication education, understanding or usage.  This information does not allow you to take a prescription medication that was not prescribed for you. Talk with your pharmacist or doctor if you have questions about your medication.


Copyright AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).

Breathe Easy...Through Your Nose

Before I get lost in the story behind this particular blog, let me tell you, oxymetazoline nasal spray is one of the most incredibly effective products ever developed to clear a stuffy nose.  That said, this particular over-the-counter medication may also be arguably one of the most frustrating products ever developed. 

This medication works incredibly well to clear a stuffy nose; however, if it is used for more than 2-3 days in a row, your body may become dependent on it and you may get a rebound stuffiness that is worse than the original congestion when you try to stop using it.

Three weeks ago I had septoplasty surgery.   For the past 3-4 years I have been dealing with this breathing issue in my nasal passage.  After a few medication therapy trials, my ENT Doctor said he could fix the issue with this simple surgery.  He described to me that he would simply peel back the mucous membrane that covers my nasal septum.  He would then use his scissors and cut out a little of the protruding bone and clean out a little of the septal area.  Next, he would replace the mucous membrane, put in a few stitches and it would be finished.  Sounds painless, right?

The surgery went beautifully.  I was home from the surgery center by 11am, resting in my chair.  Yes, there was a little swelling and I could definitely feel that someone had been cutting on the inside of my nose; however, the incisional pain was really not that bad. 

Later that evening, I began to get a little tickle in the back of my sinus.  I woke the next morning with a fever and my nose was beginning to get a little stuffy.  By the time I made it into my follow-up appointment that afternoon I had a fever of 101.5F and my nose was so plugged up I couldn’t breathe out of it.  Here is the catch; I was told I could not blow my nose for at least a week because of the recent septoplasty surgery.

While I was at my appointment my Doctor asked me if I would like a little blast of oxymetazoline.  He has this special little nasal blaster he uses to squirt the medication back into the sinus.  I asked if he thought it might help my congestion and his reply was, “well, let’s see”.  So, he blasted two squirts of this medication up each nasal passage and within five minutes I was able to inhale through both nostrils like a wind tunnel.

This was both fantastic and scarry at the same time.  I have been a pharmacist for many years, yet rarely do I get to see a medication work so quickly and efficiently.  My nose is telling me, “YAHOO!!”; however, my pharmacist brain is telling me to be careful.  I was hesitant to use a dose the next day because of such great concern for the rebound effect.  Over the next  four days I used two more doses of this medication.  Each time, my sinus passage cleared out almost immediately and allowed for a beautiful nasal inhalation of oxygen.

Again, this medication works very well for SHORT TERM treatment of nasal congestion.  If you use this medication more than twice daily for more than three days, you will have a very difficult time tapering off of the medication without experiencing some extreme rebound congestion.


Copyright AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).

Count, Pour, Lick & Stick...We're Talking Productivity Here

Over the past few years I have read quite a bit about the measuring of pharmacist’s productivity.  Some of the Chain Pharmacies have over 20 metrics that they use to measure all aspects of how long it takes to get a prescription ready for a patient, get paid, get the patient out the door, and on to the next prescription.

I have yet to come across any metrics that are used to measure how well a pharmacist counsels their patient.  A metric that looks at how well the patient understands what they are going to do with their medications and measures their outcome of therapy based upon the results of the counseling interaction they had with their community pharmacist.

Where I work, we have one metric that we are measured with; the number of prescriptions we fill each day.  This is by no means a perfect metric; however, the accountants need a number to gauge our productivity.  On any given day, we usually meet our metric.  I am taking a moment to discuss this because for some reason the question has come up a few times recently, “What is it you do in the pharmacy anyway?” 

The other day I took a few moments to try and document the activities of a normal day in the pharmacy. 

·         24 times I met patients at the pharmacy counseling station to discuss their new medication with them, assuring that it did not interact inappropriately with their current medication profile and that they understood all the appropriate information about their new medications.
·         5 times doctors called to consult about medication regimens, 3 were for antibiotic therapy regimens and 2 were for pain medication regimens.
·         3 times I called doctors to discuss a potential drug interaction on a new medication order. 
·         1 time I called a doctor back to clarify the dosing on a prescription written for injectable blood thinner medication.  The dose was not appropriate for the patients’ weight.
·         3 times I called doctors to clarify prescriptions because the dose that came through on the electronic prescription was different than the dose we had filled last time for the patient.
·         1 time I called a doctor in the Neonatal Intensive Care Unit to clarify the dose that he wanted us to compound for a newborn being discharged from the hospital.
·         I participated in helping discharge 3 patients from the Behavior Health Unit, each of which had at least 5 prescription orders, and one of which had 13 prescription orders.
·         I worked with a Social Worker at the Hospital to help discharge a patient that had no funds.  We helped them receive 48 hours supply of discharge medications to hold them over until they are able to get to the county/state resource available to them to complete their prescription order.
·         I participated in helping fill a Hospice Admission order which includes 9 emergency medications and then counsel the family member on the use of these medications.
·         I worked with my partner in the store helping to implement a new “real time” computer narcotic inventory system.
·         14 times I consulted with patients on over the counter concerns relating to cough, congestion, diarrhea, constipation, itchy eyes, dry mouth and various other situations.
·         Participated in helping to compound 3 different medications for pediatric patients.

I participated as a member of a team of 2 technicians, 1 pharmacist and 1 pharmacist manager.  Together we exceeded our metric of how ever many prescriptions we needed to fill that day to stay positively productive.   More than that, we worked as a team to assure that our patients received the best possible pharmacy care we could give them. 

Community Pharmacists do fill prescriptions; however, they also know who you are, know your medication profiles, and work behind the scene all day looking out for your best pharmaceutical interest.  Until the point comes that we are able to measure the effectiveness of how a pharmacist participates in your pharmaceutical care, we will continue to count how many prescriptions we fill each day.

You may also be interested in reading:
Mail order pharmacy
Modern Day Snake Oil (Dietary Supplements)
Medications from Canada


Copyright AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).

Unfair Playing Field

Yesterday at work, I had one of my nice Medicare D patients come into the store with a stack of papers in her hand.  She looked my way and asked if she could speak to me for a few minutes.  She proceeded to lay out a series of papers discussing her Medicare D options during this year’s enrollment window, which closes in three more days.  Based on the information that she had, she was being told that next year our pharmacy is still in her network and she would still be able to use our pharmacy; however, it would be at an increased out of pocket expense.  She was being directed to one of the local Chain Store Pharmacies who has a preferred contract with this particular insurance company. 

We have been serving this customer for over 15 years.  We know her profile, her doctors, and she has developed a relationship with both of the full time community pharmacists who work here at the store.  She is now being told that if she transfers her prescriptions to this Chain Store pharmacy, she has the potential of saving over $400 per year in co payment costs.  This is an unfair playing field.

Of course, we discussed service.  We talked about how we are available for consultation and any time we are open she is able to call us and get a pharmacist on the phone and discuss whatever medical related question she has.  She totally agreed with me about our service; however, $400/year comes to more than $30/month and she is on a tight budget.  This is a significant savings in cash flow for this particular customer.

Selling our service is a reasonable argument to maintain business when we are going up against a mail order pharmacy.  To many people, it is perfectly reasonable to maintain prescriptions at a community pharmacy and pay a little extra for their refills so they have access to a community pharmacist  who is familiar with their medication profile.  This argument is not so strong when the patient is being told they can use any pharmacy in the network; however, they will receive a substantial discount if they use this particular chain store preferred pharmacy.

In the past, we have had many situations where patients have transferred their prescriptions somewhere else for convenience, then, after 2-3 months they have transferred their prescriptions back to our pharmacy because of the service.  They appreciate the relationship they had developed with us and are willing to drive a little further or work our hours into their schedule to utilize our service.   I don’t know if this will be the same situation for a Medicare D patient on a limited budget. 

I find the whole scenario very frustrating that a Medicare D patient is being told they need to transfer their prescriptions from a pharmacy that they have used for over 15 years in order to save $30+ dollars per month.

Here is what could have been done differently.  When the open enrollment time comes around, look for more than just the best cost.  Look for the best cost at the pharmacy that you want to use.  There are many different Medicare D programs available and they all want to have your business.  Different Medicare D programs are affiliated or aligned with different and specific Chain Store entities.  If you are linked into one of these programs, you will be directed to that pharmacy.  Look for a program that allows you to pick the pharmacy that you want to use.

Follow this link to the Medicare D prescription plan finder tool.  This will help you find the plan that is best for you.


Copyright AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).

Take Charge of Your Medication; 5 Guiding Principles

Today I have been given the wonderful opportunity of speaking about pharmacy with a group at one of our local retirement communities.  While preparing for this opportunity, I pondered quite a few different topics, such as Medicare D drug benefits, mail-order pharmacy, different disease states or possibly even just open ended questions and answers.  Finally, I came upon a topic I like to call Medication Responsibility.

I sat and took some notes about this topic and before long I had a list of items going that was far too long for a 40 minute discussion.  After a bit of thought about my audience, I narrowed this down to five particular different areas.  I realize that the term Medication Responsibility will mean something different for different people; however, these five topics are a good fit for this particular group of individuals living at this retirement community.

#1           Develop a working relationship with a Community Pharmacist.  I have a good story about a gentleman who endured a frustrating visit to the emergency room and another few days of extreme dizziness that may all very well have been avoided had he first called his Community Pharmacist with a question.  I realize that many people fill their prescriptions via a mail-order pharmacy.  When you have a question about your medications, are you able to phone that mail-order pharmacy and reach a pharmacist that you know and trust?  If the answer is yes, fantastic.   If the answer is no, then is the cost savings worth not having a Community Pharmacist available who knows your medication profile.

                Community Pharmacy is much more than just a place to fill your prescriptions.  When a Community Pharmacy is responsible for filling your prescriptions, the Pharmacist is available to you for questions whenever they are open for business.  The Pharmacist has your medication profile in front of them and can evaluate what you are currently taking and compare that with any type of medication or disease related question you may have.  This is a great service and should always be considered as a first option if you are feeling a little out of sorts and wonder if one of your medications may be causing you to feel this way.

#2           Medication Reconciliation.  This is a fancy phrase for having a complete list of your medications with you at all times.  Write up a list that includes all of your current prescription medications, over the counter medications, dietary supplements, and medication allergies.  Take this list with you to each visit you have with any health care provider and have them look at it.  Make certain that the list that they have matches your list.   This is a working list and will need to be updated or validated with each visit to your Doctor or Pharmacy. 

                This Medication Reconciliation process is especially important if you have had a recent visit to the hospital.  Quite often medications change when you have a short visit to the hospital and you need to be sure your list is complete and approved before heading home from your visit.

#3           Take Charge.  This is important and sometimes difficult to address.  Everyone needs to do this; however, in my experience it is quite often overlooked.  Pick someone, either a family member or a caregiver, and have a conversation with them about your medications.  You are picking someone who will agree to handle your medication for you when you are no longer able to handle them yourself.  This is a push to have you be an active participant in creating your plan, so that a plan is not created for you. 

#4           Medication Storage.  I encourage everyone to keep their medications in a safe, dry location such as your bedroom.  It is important to not keep your medications in the bathroom because the moisture may begin to deteriorate the integrity of the tablet or capsule.  More importantly, store your pain medications in a location that is not visible to visitors.  As incredulous as this may sound, it is not uncommon for a visitor to come into someone’s home and take a few pain medication tablets out of their prescription bottle when the owner is not looking.  Store your pain medications in your bedroom, out of visual sight from anyone who may be entering your room.  Storage in a dresser drawer or your closet works well.

#5           Medication Disposal.  How do I get rid of my medications when I don’t need them anymore?  Please, it is a good idea to get rid of any old medications.  Prescriptions that have been changed or eliminated do not need to be kept around the house just in case you might need them at a later date.  It is more likely that there may be a medication mis-adventure if these are kept in the house. 

                Please, do not give your expired medications to anyone else to take, especially if it is a prescription medication.   It is against federal law to share prescription medication.  An individual needs to be evaluated by a healthcare practitioner and prescribed a medication before they may legally take a prescription medication. 

                Do not flush your medications down the toilet.   Check with your local pharmacy or your waste management program to see if there is a medication take-back program available.
                If there is no medication take-back program available, then you may take the medications and put them in a container such as a zip lock bag. Mix in something unpalatable such as kitty litter or coffee grounds then add a little water to the mixture. Now, take the container and put it in a brown paper bag and put it in the garbage.

I realize that many people may have many more ideas of what Medication Responsibility means to them; however, if you are able to master these five topics, you are well on your way.


Copyright AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).


Thyroxine (which we call T4), is a thyroid hormone which is secreted by the thyroid gland.  T4 is then converted to its stronger active metabolite, triiodothyronine (which we call T3).   The thyroid hormones bind to receptors and exert their metabolic effects, which include helping maintain normal growth & development, utilization of stored sugars, protein synthesis and metabolism. 

T3 hormone is approximately 4 times more potent than T4 hormone and the body does its best to maintain an appropriate balance circulating in your blood system at all times.  Maintaining an appropriate thyroid level is important for maintaing normal mental and physical function.  In children, maintaing a normal thyroid level is vital for mental and physical growth. 

Symptoms of low thyroid level may include a slow heartbeat, tiredness, muscle aches, weight gain, dry skin or sensitivity to cold.  If you experience any of these symptoms on a regular basis, please contact your doctor and let them know. 

Thyroid replacement hormone is used to treat an under active thyroid (hypothyroidism). This therapy will provide additional thyroid hormone if the thyroid is only partially working, or it will replace the thyroid hormone if they thyroid is completely shut down.  The thyroid may decrease in its function naturally over time, or it may become damaged through injury, certain medications, radiation therapy or certain types of disease conditions.

To learn about the medications used to treat hypothyroid disorders, pleasesupport AudibleRxTM by becoming a member, and then have full access to all of the Medication Specific Counseling SessionsTM.

  • Levothyroxine (synthetic T4) (Levothroid-TM, Levoxyl-TM, Synthroid-TM, others)
  • Liothyronine (synthetic T3) (Cytomel-TM)
  • Thyroid (natural thyroid from pigs) (Armour Thyroid-TM, Nature Throid-TM, others)


Copyright AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).

XL, CD, LA, ER...Is there really a difference?

An interesting development has happened in the naming of medications over the past 15-20 years.  After a medication has been on the market for a few years, quite often, the manufacturer will have done some more research and developed a longer acting form of the same medication.  We like this.  Medication adherence is a HUGE issue and whenever we are able to offer a patient once daily dosing, rather than 2 or 3 or 4 times per day dosing, we are greatly increasing the chance for medication compliance.

Here is the issue.  There has been absolutely no standardization in the naming of these medications.  Acronyms are batted around like dented ping-pong balls, and they are not interchangeable.  This is difficult to explain without being too confusing; however, I am going to give it a try.

After the name of the medication, you may see any number of acronyms describing that this particular product is a longer acting product.  Some examples may be as follows: 

·         XL (extra-long?)
·         CD (controlled delivery)
·         LA (long acting)
·         ER (extended release)
·         XT (extra time?)
·         SR (sustained release)
·         SA (sustained action)
·         DR (delayed release)
·         EC (enteric coated)
·         TR (time release)
·         HS (bed time dosing)
·         PM (bed time dosing)
·         CC (continuous control?)
·         XR (extra release?)
·         CR (controlled release)

The point is, there are numerous acronyms, and zero standardization.  Each acronym is considered part of the name of the product and is specific for the product it is designated to.  In other words, there is no set definition for any of the above acronyms and how they apply to the medication they are associated with.

To confuse matters more, there are a few medications that have two different forms of acronyms.  For example, one product has an EC which is a twice daily dosing product and an ER which is a once daily dosing.  Another product has an SR version which is twice daily dosing while it also has an XL version which is once daily dosing.

These acronyms pose as special problem for pharmacists when filling prescriptions.  Not only are we evaluating the entire patient profile to make sure the medication is appropriate for the current situation, we also need to assure that the dosing parameters associated with the particular medication are appropriate for the acronym designation.

Please, if you take any medication that has some sort of long acting or extended release acronym associated with it, take a moment to discuss with your pharmacist exactly what this means.

You may also be interested in reading:

Medication Responsibility
My Pills Look Different


Copyright AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).

Who's In Charge Here?

So, the other day in the pharmacy, a patient called me on the phone to ask if her refill was ready to pick up.  She had called in the day before and used our automated refill line to request a refill of her cholesterol medication.  An electronic request had been sent automatically to her prescriber because there were no refills remaining on the prescription.  When I looked at the prescription in the computer I informed her that no, the doctor’s office had not yet called back and her prescription was not yet ready.

After a few moments of back and forth conversation, we identified that this particular medication had been prescribed to her when she was discharged from the hospital last month.  The prescriber was the “hospitalist of the day” and only practices in the hospital.  I looked at her chart and found who her primary physician is and let her know I would send the request off to this doctor. 

She then let me know that because of her insurance she had to recently change HMO’s and now she is with a different medical group.  She has the name of her new primary care physician; however, she has yet to be seen by her new doctor. 

This information changes the game.  I explain that I will print out a request for the refill of the medication.  I will then write a note to the new physician, explaining the situation, and fax the request to the new doctor.  I also discuss with the patient that it would be a great idea for her to call her new doctor’s office and leave a message with the medical assistant explaining the situation.

I have noticed from the patients profile that it has been 32 days since we have filled the prescription.  Before we end the conversation, I ask her if she has any of her medication left.  She says that she took her last dose two days ago and didn’t take any yesterday.  Because this is a maintenance medication and I don’t want her to go without, I ask that she stop by the pharmacy with her empty bottle and I will give her 72 hours’ worth of the medication, to hold her over until the doctor gets back with us.

In this situation, if the doctor does not get back with us within 2 days I will be on the phone calling the office to see what is going on.  We in the pharmacy certainly may not refill the prescription without the physician’s approval; however, it is perfectly reasonable for a pharmacist to provide the patient with three days of maintenance medication while we are waiting, assuming it all appears clinically appropriate and we document all that we have done.

When you call your pharmacy for a refill, please press the button to speak to someone in the pharmacy, rather than using the automated system, if you have recently changed doctors.  Time will be saved if the pharmacy can send a refill request to the correct doctor on the first try. 

This, my friends, is an example of what can be done in a community pharmacy.  Like I have said many times, take the time to develop a relationship with a community pharmacist so that you have someone to go to when you have questions about your medications.  Regularly we get patients who come in who have not yet received their medication from their mail-order pharmacy and they are out of their medication.  We will gladly work with them and do what we can; however, if we have not been filling their prescriptions on a regular schedule, we cannot forward them some until we hear back from the doctor.

You may also be interested in reading:


Copyright AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).

My Heart Beats For You

So, the other day I was at the counter talking with a patient about their new blood pressure medication.  As we were talking, the patient asked me a question that I had not had before, “If this is a calcium channel blocker, will I need to change the amount of calcium I take in my diet?”  I explained that in all of the years of counseling patients, I had never been asked that question. 

No, the amount of calcium you ingest does not necessarily change how a calcium channel blocker medication works.  Calcium channel blockers work by decreasing the influx of calcium ions into vascular smooth muscle during contraction.  This process effectively relaxes this type of muscle. 

Relaxation of vascular smooth muscle allows for an opening up of the blood vessels which decreases blood pressure.  Relaxation of coronary (heart) vascular smooth muscle helps dilate (open up) the blood vessels in the heart and deliver more oxygen to the heart cells.  Oxygenation of the heart helps treat angina (chest pain).   This relaxation also slows down the rate at which the heart beats.   

By doing this, the resistance that the heart needs to pump against is decreased, heart rate is decreased, and the heart does not need to work as hard to pump blood.

To listen to a Medication Specific Counseling SessionTM on any of the following Calcium Channel Blockers, please registerto become a member of AudibleRxTM and then have full access to all of the counseling sessions for a full five years. 

  • Amlodipine (Norvasc-TM)
  • Diltiazem ER (Cardizem CD-TM, Dilacor XR-TM, Taztia XT-TM and others)
  • Felodipine (Plendil-TM)
  • Isradipine (Dynacirc CR-TM)
  • Nifedipine ER (Procardia XL-TM, Adalat CC-TM, and others)
  • Nisoldipine (Sular-TM)
  • Verapamil SR (Calan SR-TM, Isoptin SR-TM, and others)

You may also be interested in reading one of the following blogs about blood pressure, your heart and circulation.


Copyright AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).

I Have A Cold

A colleague that I work with shared a story with me the other day that is definitely worth repeating.  Now and again this gentleman goes out to dinner with a group of friends.  This particular evening, he said that he walked up to one of his acquaintances at the dinner and put out his hand for a welcoming hand shake.  He was then impressed when the gentleman folded his arms, refusing the handshake, and informed my friend that he has a cold. 

My colleague watched, inconspicuously, throughout the night.  This gentleman with a cold was consistent the entire night about not touching anyone or getting too close to anyone.  He did not reach for the bread or butter and did all he could not to touch any communal cutlery.  This gentleman was being as conscientious as he was able to help prevent transmission of his cold to any unsuspecting neighbor.

I am truly impressed when someone goes to great lengths to help protect their neighbor.  My only concern here is did he do enough to prevent the spread of his cold virus?

The only way to get a cold is to get the virus from someone giving it to you directly (i.e. touching you or sneezing/coughing in your direction), or, putting the virus on something that you touch.  Generally, the most common way to catch a cold is from someone who sneezes or coughs in their hand and then touches you with that same hand. 

The gentleman who was doing his best to help prevent transmission of his cold may not have been doing enough.  It is possible for cold virus to live on many surfaces such as door knobs, chairs, table cloths, forks and wine glasses for several hours.

Other individuals may have been infected when they moved the chairs, cleaned the table, walked out the door, used the sink in the bathroom, or flushed the toilet.    Of course, we run into this every single day of our life as we go to work and use phones, computers, cafeterias, restrooms, elevators and all of the other public space our life is made up of.

The following two paragraphs come directly from this web page:

“Hand washing is an essential and highly effective way to prevent the spread of infection. Hands should be wet with water and plain soap, and rubbed together for 15 to 30 seconds. Special attention should be paid to the fingernails, between the fingers, and the wrists. Hands should be rinsed thoroughly, and dried with a single use towel.”

“Alcohol-based hand rubs are a good alternative for disinfecting hands if a sink is not available. Hand rubs should be spread over the entire surface of hands, fingers, and wrists until dry, and may be used several times. These rubs can be used repeatedly without skin irritation or loss of effectiveness. Hand rubs are available as a liquid or wipe in small, portable sizes that are easy to carry in a pocket or handbag. When a sink is available, visibly soiled hands should be washed with soap and water.”

So, please, this cold and flu season, if you have a cold, do all you can to keep from passing it on to someone else.  If you are in a public space and touch anything, wash your hands with soap and water or use an alcohol-based hand cleanser as soon as possible.

Copyright AudibleRx (TM), all rights reserved.


Have you ever logged onto a website looking for some information, and then spent the first 60 seconds looking at the web page just trying to figure out what to read?  Advertisements on the right, left, top and all through the middle.  What the heck!?!?  Where is the information I was looking for when I arrived at this web page?

When someone sells space on their website for someone else to advertise, they are making money from them and are definitely affiliated with them.  Also, when and individual sells product for a company, they are much more likely to recommend their product over their competitors.  That’s how business affiliation works.

As I state on the front page of www.AudibleRx.com

AudibleRxTM is not affiliated with any drug manufacturer and offers no advertising. Every effort is made to keep the recordings provided by AudibleRxTM completely objective and unbiased.

I am a pharmacist who is attempting to fill a need.   I do not sell advertising on my website.  I do not have a drug manufacturer or institution of some kind paying me to put this program together.  I take one category of drugs at a time, research the pharmacy reference materials, script out a counseling session, record it, then post it to the member area of the AudibleRxTM website.    Please follow this link for a complete description of how I put together a Medication Specific Counseling SessionTM.

Prescription counseling is a necessary part of a patient’s health care.  Individuals need to understand why they are taking their medications and how to take their medications if they are to achieve their best possible outcome.   The Medication Specific Counseling SessionsTM offered through AudibleRxTM will help and individual realize what they do and don’t know about their medications so they will be equipped to take educated questions back to their own doctor or pharmacist. 


TERMS OF USE: These recordings are meant to supplement your knowledge and understanding of your medications and are not a replacement for counseling with your pharmacist or doctor. AudibleRx maintains no liability for your medication education, understanding or usage. This information does not allow you to take a prescription medication that was not prescribed for you. AudibleRx has performed extensive review of each topic to assure the information provided is current and relevant; however, AudibleRx maintains no liability for and can not guarantee the accuracy of the information provided in the recording sessions. Talk with your pharmacist or doctor before taking your medication and if you have any questions regarding your medication. All information provided "as-is" and with no express or implied warranties, including warranties directed to accuracy, non-infringement of any proprietary rights or a third part or fitness for a particular purpose.

PERSONAL USE ONLY: AudibleRx is for personal use only and is not to be used for patient educational training programs without first obtaining licensing rights. 

Copyright AudibleRx (TM), all rights reserved. 

Brain...think about it

When something is not quite working right, we need to take the time to perform some diagnostics on it.  We evaluate how it works, see how it has been taken care of, run some tests on it, and then come up with a plan.  The plan may include taking it apart and seeing if any parts can be replaced.  If that is not an option, we look into how we might change the environment so it may function better.  Finally, we consider if there is anything we can put into it to help improve its performance.

When it comes to our brain, we are a little hesitant about opening it up and trying to replace any parts that aren’t quite working so well.  More likely, we will spend some time with a health professional and gain some insight about how we might change our environment, or possibly, take some sort of medication that may help improve its performance.

Over the past few months I have written blogs discussing anxiety, depression, sleep, schizophrenia, attention deficit disorder, seizures, migraine headaches, and Alzheimer’s diseases.  The common thread here is that all of these conditions involve some sort of brain function that needs assistance of some kind.  Listed below are links to each one of these blogs.

Each one of these conditions has a series of medications that may help alleviate some of the symptoms associated with the particular condition.  Furthermore, each medication has a unique mechanism on how it affects the brain, along with a specific set of interactions, adverse effects and warnings. 

As I have said before, a patient who is educated about their medication is more likely to be motivated to follow their own pharmaceutical regimen.   Take the time to become educated about yours or your loved ones medications so you too can expect your best possible outcome from your medication therapy. 

Registerto become a member of AudibleRxTM and have full access to all of the Medication Specific Counseling Sessions.  We will help you understand what you do and don’t know about your medication so you may take educated questions back to your own doctor or pharmacist.





Copyright AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).

Medication Reconciliation

Here is an example to explain the situation we face. 

Say, for instance, an elderly lady, who lives on her own, dials 911 because she has been feeling dizzy for the last 45 minutes, she is scared and not sure what is happening.  The ambulance comes and takes her to the emergency room.  She is dizzy, confused, alone and does not have a list of her medications in her wallet.  Once there, after 2 hours’ worth of tests, she is admitted to the intensive care unit because her heart shows abnormal symptoms. 

She has a primary physician, a cardiologist for her ongoing heart condition, and a rheumatologist for her arthritic condition.  At home she has 7 different medications she takes on a regular basis, 3 or 4 dietary supplements and 2 or 3 medications she takes for pain control.  She also uses 3 or 4 different over the counter treatments for her bowel control. 

She receives the bulk of her prescriptions through a mail-order pharmacy because her insurance company convinced her that she had to go mail order or face steep financial repercussions; however, she does not have any information with her about the mail order pharmacy.   She also receives some of her medications from a local corner drug store that delivers some of her over the counter items to her when she needs them.

So, while she is in the hospital, the Hospitalist will stabilize her on a medication regimen.  She will most likely be visited at least once by her primary care physician, and then be sent home with directions to follow-up with her cardiologist.

When discharged, she will have a list of medications she is to take.  What about all of the medications she already has at home.  Are the medications she is being discharged on the same as the medications she was taking, or are they different?  Maybe they are the same medication; however, just a different dose.  What about all of the dietary supplements and the over the counter bowel preparations? 

Please understand, this is an extreme example.  Most hospitals do have systems put in place to help with medication reconciliation.  Medication reconciliation is "the process of comparing a patients medication orders to all of the medications that the patient has been taking”. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner or level of care.

I have talked about this in the past, and I will definitely discuss it more in the future; who's responsibility is it to make sure my medications are in order?  For a simple solution on how to take charge of your own medication reconciliation, please review my previous blog on:


Copyright  AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).

Herpes (don't worry, you can't catch it from reading this blog)

Antiviral medications are regularly prescribed to treat the severity of and duration of symptoms caused by the herpes simplex virus (HSV) or the herpes zoster virus (chickenpox virus).

The herpes zoster virus is responsible for both chickenpox and shingles. A good description of the herpes zoster virus can be found at this link.

HSV is commonly categorized into two different types (HSV-1 or HSV-2).   Today, it is known that both HSV-1 and HSV-2 can cause either genital or oral herpes; however, it is much more common to see HSV-1 associated with oral herpes and HSV-2 associated with genital herpes.

When the HSV manifests as cold sores around the mouth, face or eye it is called herpes labialis.    It is possible for the HSV to manifest in other areas of the body; however, it is not as common.  An outbreak of HSV in the genital, anal or buttock region is called herpes genitalis.  
National Institute of Health description of the Herpes Simplex Virus

It is important to realize that antiviral medications are only used to decrease the severity and duration of a viral outbreak.  These medications are not a cure for herpes.  These viruses live in our body and are opportunistic.  The moment our immune system is compromised somehow, either through stress, sickness or some other reason, the virus will proliferate and manifest as an outbreak.  These medications will help sores heal faster, keeps new sores from forming and may help reduce how long the pain or itching will last.  Antiviral medications may also help prevent a herpes outbreak from spreading to another part of the body in a patient with a weak immune system.

Please understand that this category of medications does not protect against the spread of genital herpes.  Please refrain from sexual contact during an outbreak.  Be aware, genital herpes can be passed to your partner during sexual activity even when you are not experiencing any symptoms.  Always use an effective barrier method, such as a condom or dental dam, during all sexual activity.  Please discuss this with your doctor or pharmacist form more information.

Three different antiviral medications are available to treat the symptoms related to an outbreak of either the Herpes Simplex Virus or Herpes Zoster Virus.  Medication Specific Counseling SessionsTM for these three medications are available at www.AudibleRx.com.

·         Acyclovir (ZoviraxTM)

·         Famciclovir (FamvirTM)

·         Valacyclovir (ValtrexTM)

If you would like to learn more about any of these three medications, please register to become a member with AudibleRxTM  and then have access to all of the Medication Specific Counseling SessionsTM.


Copyright AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).