"Hey Doc, got something to stop this coughing?"

"So, there was this funeral procession walking out of a church in San Francisco.  One of the six pole bearers stumbled on his shoe laces and the coffin tipped forward.  The coffin slid down the steep church stairs and continued to slide down one of the steep San Francisco streets.  At the bottom of the hill the coffin went sliding through the front door of a pharmacy, slid all the way back to the pharmacy counter and came to a stop as it ran into the pharmacy counter.  At that point, the coffin door flew open and the corpse popped up and said, Hey doc, got something to stop this coffin?"

It seems this time of year we get at least four or five people a day coming into the pharmacy asking what they should take to stop their coughing.  Like I have said before, when someone asks a question in the pharmacy, it is usually not a simple one line answer.  We need to take the time to ask a few questions to help the patient decide what the best course of action should be.

Coughing is a natural process to clear your airways of something.   The cough is the symptom of something else going on.  If you have a fever,  yellow or green sputum, are coughing blood, or are having a difficult time breathing, please see your doctor as soon as possible.

What we are talking about here is an acute cough, something that has started within the last couple days, not a cough that has been pestering you for weeks or months.  A chronic cough can be caused by many different medical or social conditions and may even be caused as an adverse effect of another medication you may be taking. 

In the pharmacy we have two basic options of over the counter medication to treat a cough.  Guaifenesin is used to treat a phlegm and mucus cough, and dextromethorphan is used to treat a dry and hacky cough.

Guaifenesin is an expectorant that is used to help thin the mucus.  Guaifenesin stimulates the respiratory tract to produce more secretions and increase the volume of fluid.  This increase in respiratory fluid thins out the mucus, making it much less sticky and creates a much easier environment to cough out the mucus.  While taking guaifenesin it is imperative to stay hydrated.  Hydration helps keep the mucus thin and loose.  Guaifenesin works best when it is kept in your system on a regular basis for 3-4 days.  Remember; drink plenty of fluids while taking this medication.

Dextromethorphan works in the cough center of your central nervous system to suppress the cough stimulus.  This medication works well if you are having a difficult time sleeping because your dry hacking cough is keeping you up.  To purchase dextromethorphan you need to ask for it at the pharmacy counter.   Dextromethorphan has been shown to give a euphoric dissociative effect when taken at high doses and you need to be 18 years of age to purchase it. 

Before you take any over the counter cough medication, please take the time to read and understand the dosing information on the medication package.  If you have any question as to which over the counter medication you should use, or, if you don't understand the package dosing instructions, please talk with your pharmacist or doctor.  Remember, you can call any pharmacy and ask to speak to the pharmacist.  They will be happy to direct you to the best alternative to help you  with your coughing.


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Gas (and we're not talking high prices)

Someone walks into the pharmacy and says they have gas.  To me, that spurs up a few questions that I need to ask them.  How long has this been going on for?, Are there any other symptoms like burning in the chest or heartburn or loose stools?  Do you have a fever?  Have you already taken anything or what have you tried already to treat this gas? 
There are many different reasons for the cause of gas such as swallowing air when you eat, different disease states, or improper combining of foods.  These are all great topics on their own, however, right at this moment, the person that came In the store is having a bloating feeling such as an air bubble moving through their gastro-intestinal tract and would like a suggestion for some relief.
They have answered all of my questions reasonably well and we have ruled out the need to be sent to the doctor for an urgent visit.  They have convinced me that this is not a chronic, persistent condition that has been left untreated for some time, and we are relatively sure that this patient does not have an acute infection of some kind. 

Most likely, it is about 30-60 minutes after lunch and they have gas pain.  I recommend to them a bottle of 80mg simethicone tablets.  Simethicone is an anti-flatulant medication that works to decrease the surface tension on gas bubbles in the gastro intestinal tract.  The normal dose is chew and swallow 1-1.5 tablets after meals or at bedtime to a maximum of 4 times daily. 
Within 20-30 minutes the gas pain should subside.  If the gas does not subside, or if you need to continue to re-treat the gas, please follow up with your doctor.


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Caution; Neuro-Transmission Happening Nearby

Depression is real.  When your neurotransmitters (the message carrying chemicals in your brain) become low for some reason, your body may receive mixed signals about emotion, behavior, body temperature, and many other functions we take for granted.  This process of decreased and mixed signals about how we feel may sometimes be diagnosed as depression.

These neurotransmitters may be decreased for any number or reasons, however, most commonly it is from a prolonged stressful (emotional or physical) situation.  Our body is made to handle short bouts of intense stress, however, if someone needs to carry an emotional or physically stressful situation for an extended period of time, the neurotransmitters will actually diminish and lead to a decreased ability to send and receive the important messages of daily function.  I say short vs. long in relative terms.  The time frame will be different for each individual.

Other common reasons for a decrease in neurotransmitter message sending ability include aging, not sleeping well, hormonal imbalance, genetics and significantly limiting your food intake for an extended period of time.   Based on all the reasons for neurotransmitter deficiency, it is quite likely that anyone reading this blog will experience some amount of depression at some point in their life.

Many non-medication therapies have shown benefit in increasing neurotransmitter levels including yoga, acupuncture, massage, hypnosis and meditation.  If we have the time and resources, taking our self out of the daily grind for six months and living in a warm cabin in a meadow, meditating for 8 hours a day, would most likely allow our body to recharge and rebalance our neurotransmitters.  Unfortunately, we usually do not have the time to take ourselves out of the daily grind, and quite often we end up at our Doctors office discussing the medical alternatives.

There are quite a few newer antidepressant medications that work to help increase our level of neurotransmitters.  This increase in message sending ability then helps us process thoughts easier and gain a better outlook on life so that we may manage daily living a little easier. 

It is important to realize that psychotherapy goes hand in hand with antidepressant medication treatment.  This is crucial for two reasons; first, your therapist will help you see and understand what it was that triggered the decrease in neurotransmitters and led to the depression, and second, it is a good idea to have a non-biased third party that you can discuss with how the medication is working.  They will help you define where you need to get to and help you know when you are there.

Please visit the Medications Page of AudbleRx to see which anti-depressant medications are currently available with audio counseling sessions.  To listen to a Medications Specific Counseling Session, please register to become a member, then have full access to all of the counseling sessions.

You may also be interested in reading:
Speak up, it's dark in here (schizophrenia)
Hanging on a ledge with sweaty fingers (anxiety)


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

What is AudibleRx?

I thought I might take a moment to tell you where AudibleRx came from.  It is very interesting how "ideas" come to us throughout the day.  I know that over the years I  have had many different ideas that have entered my thought process, and then, a day or two later they are out the other side and I am on with the next.  Interestingly enough, the idea of AudibleRx entered my thought process almost one year ago today...and it came to stay.

I work in a clinic setting pharmacy that is considered an "out-patient" pharmacy for the hospital that I work for.  We are a unique setting.  It is similar to an independent pharmacy, and we run the store as if it were an independent pharmacy, except for the fact that it is owned by the hospital.  Because we are on the hospital campus, quite regularly prescriptions for specialty items will filter down to us from the other stores in town.  We are in a position where we can't just say, "Sorry we don't have that drug, take it to the next pharmacy".   If we don't have it, we need to take the time to help the patient figure out where and how they are going to get it.

Regularly we get patients and their families coming through the pharmacy that have been to a doctor on campus and they just want to ask us a question.  They start off with, "I get my prescriptions in the mail and I have a question about my medication", or, "I normally get my prescriptions filled at ?? chain pharmacy and they are so busy...", and then they proceed to ask their medication question. 

This got me thinking.  Wouldn't it be great if there was a website that patients could go to and click on the name of the medication they wanted to learn more about and listen to a pharmacist tell them all of the important counseling information about that medication.  Information they trust to be accurate, not just a generic internet search.   Information that would help them specifically with their medication and help them formulate specific, educated questions to take back to their own pharmacist or doctor.

In developing this information I felt that it is very important to maintain complete objectivity by never having any advertising on the website pages.  I want to maintain a clean and user-friendly atmosphere on AudibleRx. 

The Medication Counseling membership area has the currently available Medication Counseling Sessions.  These all last about 7-8 minutes and cover all of the information a pharmacist should cover in a normal counseling session at the pharmacy counter.  I follow the American Society of Health System Pharmacists guide on patient education and counseling in each Medication Counseling Session. 

My plan is to continue to blog, discussing a specific Pharmacy Topic which is relevant to a specific category of medications or a current pharmacy related issue. AudibleRx offers many Medication Specific Counseling Sessions (TM) in the membership area and will continue to produce more each month.  If a particular session is not yet available, please send me a note requesting the particular session.

I appreciate the support of everyone who takes the time to read this blog and pass it on to at least one other person who may find it helpful!


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Hormonal Contraception

Every day women receive hormonal contraception medication from pharmacies and clinics and I am not convinced that they all receive appropriate counseling.  One particular college student recommended to me that I address this issue because there are way too many students on campus that have questions about birth control and don't know where to go to get answers.  She stated that they ask each other questions and more often than not come away misinformed. As a pharmacist, it is my responsibility to provide effective patient education and counseling in all situations involving medication treatment.

Patient education and counseling needs to take place in an environment that is conducive to patient involvement and acceptance and one that supports the pharmacists' efforts to establish an honest relationship with the patient.  The pharmacist needs to have the time to assess whether they feel the patient truly understands how they are going to use the medication, and specifically why they are going to take their prescription.  Finally, the patient needs to feel comfortable enough with their pharmacist to ask questions….I mean, really open up and ask specifically what they need to know, without the threat of feeling embarrassed.   I am bringing this up because, as you can see, there are many barriers to effective pharmacist patient consultation.

When a patient picks up a prescription for an antibiotic, pain, high blood pressure, or diabetic medication, the barriers between the patient and pharmacist can be surpassed rather quickly.  However, when a 19 year old girl goes to the pharmacy for a birth control prescription, there are quite a few barriers that need to be overcome to achieve any sort of effective counseling.  First off, the young woman needs to feel that she can actually approach a pharmacy counter and ask to speak with the pharmacist.  She needs to feel she can trust the pharmacist without being judged and she definitely needs to have some sort of reasonably private area to talk so as not to be overheard by the rest of the store.  Lots of issues! 

This is a cultural issue that I work on daily in the pharmacy where I practice.   It is important for us all to be aware that this is a really big issue, and that it regularly goes unaddressed.   I always encourage patients to find a pharmacist they feel comfortable with and develop a counseling relationship with that pharmacist. 

Hormonal contraception is available and used daily.  My goal here is to help educate consumers. After listening to one of the specific counseling sessions you will have a good idea of what you do know about your medication, and a clear understanding of what questions you need to take back to your own health care provider. 

Each hormonal contraceptive specific Medication Counseling Session will discuss the important treatment information regarding that particular medication. This will include how the medication works,  how to use it, what to expect, potential risks, side effects, adverse reactions and interactions, and what do do if you miss a dose.

Please visit the Medication Counseling page of www.AudibleRx.com.  Once there, listen to the two free recordings first:

            #1 First Session, What to Expect.

            #2 What is a Black Box Warning?

After listenting to the above two recordings, navigate to the medication you want to learn more about at the Contraception page.

            1.  Combination pill pack, Progestin/Estrogen, 28 day pack

            2.  Extended Cycle pill pack, Progestin/Estrogen 91 day

            3.  Progestin only 28 day pill pack

            4.  Patch, Progestin/Estrogen

            5.  Vaginal Ring, Progestin/Estrogen

            6.  Injection, medroxyprogesterone,

            7.  Emergency Contraception

Thanks for taking the time to read this blog.  This information needs to be shared!  Please take the time to forward this on to someone who may thank you for this information.


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