What is a Seizure?

Normally, the brain discharges electrical energy in a controlled manner.  A seizure happens when the electrical system of the brain malfunctions and discharges a flood of electrical energy.  This may result in a surge of energy through the brain which may stimulate contractions of the muscles and unconsciousness.

Of course, there is a lot more to it than this, however, this is the basic of what is happening.  It is interesting to note that it is usually not know what specific event causes an individual to have a seizure.  It may include brain trauma, lack of oxygen, brain tumor, genetics, or a host of other situations, however, commonly, the cause is left unknown.

Medications used to treat and prevent seizures basically help restore chemical balance to the brain by inhibiting specific excitatory amino acids and stabilizing the neuronal membranes.  These medications are sometimes difficult to dose with patients because of the potential for significant side effects and increased number of interactions they have with other medications. 

To learn about any of the following seizure medications, please visit www.audiblerx.com and register to become a member.  For a small fee you will have full access to all of the Medication Specific Counseling SessionsTM for a full year.  These sessions include all of the information you would receive in a complete counseling session with your own pharmacist.
·                     Carbamazepine (Tegretol-tm)
·                     Clonazepam (Klonopin-tm)
·                     Diazepam (Valium-tm)
·                     Divalproex (Depakote-tm)
·                     Gabapentin (Neurontin-tm)
·                     Lamotrigine (Lamictal-tm)
·                     Levetiraetam (Keppra-tm)
·                     Phenytoin (Dilantin-tm)
·                     Tiagabine (Gabitril-tm)
·                     Topirmate (Topamax-tm)

For more information on seizures, please visit the Epilepsy Foundation website.


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Prior Authorization Is Not A Four Letter Word (...literally)

Customer: "My doctor ordered the medication, just fill it and I will be on my way."
Pharmacist: "Sir, unfortunately, your prescription insurance does not want to pay for this specific medication, we need to have your doctor contact the insurance company and request a Prior Authorization for your prescription."

Customer: "I don't understand, my doctor already authorized the medication, you have a prescription for it don't you?"...and on it goes...

This is a conversation scenario we have all too often in the pharmacy.  A patient comes in with a prescription for a medication that is not covered by their insurance and we need to take some time to help the patient understand the process that needs to happen.  It helps to have a little understanding of Prior Authorizations, Formularies, Medical Necessity and what you as a patient can do to help the process move forward.

Your insurance company, in its great wisdom, will decide which medications are covered under your prescription plan.  This list of medications is called the Formulary.  The formulary is usually categorized into 3 or 4 different levels, (or tiers).  The first tier is usually the generic medications which are covered at the lowest set copay.  The second tier is usually the brand name medications that the insurance company has contracted with at a higher copay.  The third (or fourth) tier, depending on the insurance company, is usually the medications that are not covered or have some specific limitation on them.  These are the medications we are talking about in this discussion, the medications that require prior authorization.

There are a few different reasons why a medication would require prior authorization.  They all involve documentation from the physician stating the specific medical necessity of the non covered medication.

                1.  Perhaps there are choices already covered by the insurance that are therapeutically equivalent and the insurance would like documentation from the doctor as to the medical necessity of why the formulary alternatives cannot be used.   

                2.  Perhaps the medication is on formulary and is covered; however, the physician wants the patient to take the medication more often than it is usually prescribed.  For example, the usual dose may be once daily; however, the doctor wants the patient to take the medication twice daily.  The insurance needs documentation as to the medical necessity of this dosing regimen.

                3.  Perhaps the medication is on formulary, however, there are age or gender limitations which need to be addressed by the doctor to show that this particular medication is medically necessary for this particular age or gender.

                4.  Perhaps this is a very expensive medication and there are no other therapeutic alternatives, however, the insurance company needs to document the appropriate diagnosis through prior authorization before they will approve the filling of the medication.

These are just the most common examples; however, I know I have come across numerous different situations over the years.  This is a process and there is hope.  There are a few things you can do as a patient to help the situation along.

First, ask your pharmacist if there is a formulary alternative that might be appropriate to switch to.  Quite often this is a simple fix.  Your pharmacist could easily phone your doctor and suggest an alternative that is covered by your insurance.

If there is no formulary alternative available, or, if you have tried the formulary alternatives and they were not effective or you could not tolerate them for some reason, then a prior authorization will be necessary. 
First, your pharmacist will complete the required documentation with the name of the drug, your insurance information, the insurance phone number and a note to your doctor describing that this medication needs prior authorization.  The pharmacy will then fax the note to your doctor.  If the situation is urgent, the pharmacy may call the doctor's office and explain the situation and the urgency.

At this point, we need to wait for the doctor's office to contact the insurance company and do their part.  Once they have submitted the appropriate documentation, then the insurance company will review the request and either approve or deny authorization. 

Here is where you as a patient can help move the process along.  It is appropriate to give the doctor's office a day to get the paperwork filed with the insurance company.   After 24 hours you could then call the doctor's office and pleasantly ask them if they have submitted your prior authorization request to your insurance company.

Once the authorization has been submitted, you may then call your insurance company to make sure they understand the importance of completing this as soon as possible for you.  If you are having trouble with the person you are speaking with, it is perfectly appropriate to ask to speak with someone else. 

After having spoken with pharmacy insurance representatives over the phone for over 25 years, I can tell you that maintaining a pleasant attitude with the representative on the phone really helps move the process along quicker.  Always be sure to write down the representative's name that you spoke with so that if follow-up is necessary, we know who to ask for. 

Once authorized, the insurance company codes your profile in the computer so that the pharmacy may then process the prescription.

It is important to realize that at any point during this process you do have the option of paying cash for the prescription.  The prior authorization is only to get your insurance company to pay their portion.  If you pay cash for your prescription, it may still be prudent to pursue a prior authorization so that you may get reimbursed for your payment.  The important item to note is that if you pay cash, your prior authorization must be retroactive to the date that you purchased your prescription. 

I hope this helps you understand a little of what we go through in the pharmacy trying to get your prescriptions covered by your insurance.  Please feel free to comment if you have any other great tips for working with insurance companies about prior authorizations!


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Old Knee, New Knee

So, here's the deal.  On the 4th of July I ran, well, walked, jogged and ran, a 10K race with my 20 year old daughter.  We had a fantastic time.  It was a really great way to celebrate Independence Day.  I consider myself to be in reasonable condition and train regularly.  Regardless of my condition, the evening after the race, my knee was in pain. 

Let me digress for a moment.  During my teens and twenties I ran all the time.  Running is a fantastic way to stay in shape for skiing, de-stress, and think through all of the social and emotional issue we come across on a daily basis.  This continued until I was about 30, at which point my body headed in a little different direction for a few years. 

Sometime around 40 I started running again.  It felt wonderful.  The issue was, after 2-3 months of running my knee or leg would begin to hurt.  It may of had something to do with the fact that I was 30 pounds over weight and out of shape; however,  I continued on.  Over the next seven to eight years I started and stopped running quite a few times, each time being limited by a sore knee.   I found that exercising on an elliptical machine or bike riding worked really well because they are both non-impact.

About a year ago I visited my doctor and talked through the situation.  He said that I most likely have an over use injury from the wear and tear on my joint.  He advised me to continue on the non-impact exercises and my knee should tolerate it much better.  After much research, I have a sneaking suspicion that my knee may be in the beginnings of osteoarthritis, which happens from the wear and tear on jonts, as apposed to rheumatoid arthritis which is an auto-immune disease.

So, I started myself on a regimen of a non-steroidal anti-inflammatory medication that my doctor had given me on my last visit and also a scheduled dose of acetaminophen.  This combination works well at bringing down the inflammation while also reducing the pain quite well. 

I also started a regimen of topical capsaicin and trolamine.  These are two topical analgesics that work well at decreasing the pain at the joint.  These are both available in a gel, cream or topical solution and come under many different trade names at your local pharmacy.  Ask your pharmacist and they will help you find which product will work best for your situation.

Please follow this link to my blog on medication options for either Bone & Joint Pain or Spine Pain.

Here I am, a full two weeks after the 10K race, and my knee is feeling at least 80% better and healing quickly.  After two weeks at this regimen, if I was not feeling this much better, I would definitely be making an appointment to see my doctor for follow-up. 

At almost 49 years old my knees are not what they use to be; however, if I follow a few simple steps, I know I will be able to extend their life another 40 years.  Losing 10-15% of my body weight can make a tremendous difference in the impact my knees need to absorb.  Each step we take, our knees absorb 1.5X our body weight, and when we jog, that number can be seven to eight times our body weight! 

Also, it is super important to increase the strength of our quadriceps and other load bearing leg muscles so that we may protect our knees.  It is said that the degree of pain is directly proportional to the level of muscle weakness.  So, onward I go with my squats, lunges and wall sits. 

Please feel free to comment and share your "joint pain" story.


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Community Pharmacy (aka, Your Local Vending Machine?)

Now and again I like to take a moment and discuss Community Pharmacy and your Community Pharmacist.  Pharmacy is so much more than just a vending machine where you go to get your prescriptions that your doctor ordered for you. 

Your community pharmacy is there to work with you and to help you with your complete pharmaceutical regimen.  I have said this before and I will say it again, if you do not feel comfortable approaching your pharmacist with questions, or do not feel comfortable in the pharmacy you are currently using, go to another pharmacy.   Your pharmacist is a resource for you just as your dentist and doctor are there for you. 

I am fortunate that I have had the opportunity to practice at the same community pharmacy for over 15 years now.  It is true that pharmacists do develop some special relationships with their customers.  Don't get me wrong, not everything is always peaches and cream; however, most of the time I am given the opportunity to help make a difference in someone's day.

Examples from yesterday in the pharmacy.

                1.  I started off the day with a young lady who was very frustrated with our pharmacy because her doctor had not yet called back with her refill request.   She said she did not want to be bothered with coming into the pharmacy any more; she does not have the time.  She wanted to give me her credit card number and just have me mail it to her on a monthly basis without her ever calling us.  I explained that we are a community pharmacy and not a mail order pharmacy.  This situation goes into the category of, "you can't please all the people all the time".

                2.  I was processing a prescription for a gentleman and saw that his insurance had changed.   Because he is one of our regular customers I was able to get a call off to him, contact his insurance company, and complete the insurance transaction before he arrived at the store to pick up his prescription.

                3.  One of our regular customers came in with a change in her diabetic medication.   During our pharmacy consultation we discovered that the new prescription did not match what she discussed with the doctor.  The doctor is upstairs in the clinic so I was able to get a quick call off to the doctor, clarify the discussion and change the order accordingly.

                 4.  Toward the end of the day an elderly patient of ours came in and wanted something for her head cold.  I was able to check her chart to see which medications she was on and then consult her with regards to what the best course of therapy would be to avoid any complications with her current medication regimen.

These are just four examples of a day in a community pharmacy.  These situations happen one after another, all day long, while we are filling prescriptions.    It feels like we may have 4 or 5 of these situations going on simultaneously at any time during the day.  Your community pharmacy and your community pharmacist are great resources.  If you do not feel comfortable with your current pharmacy and pharmacist, find another one!

You may also be interested in these recent blogs:

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Steroids (not the PUMP-YOU-UP type)

I was talking with someone about corticosteroids this last weekend and they said, "Heck No, I would never take prednisone or any other sone type medication.  I've seen what they do to people.  They get all bloated and fat and wide eyed anxious!"  Good point!  I am always for taking as few medications as possible, and working on getting off any that are not completely necessary.  That said, at the correct dose and with appropriate monitoring, corticosteroids definitely have a place for treating acute and chronic inflammatory and immune system conditions.

Corticosteroids are medications very similar to cortisol, which is naturally produced by the body.  Cortisol has many functions such as helping the body use sugar and fat for energy metabolism, while also assisting the body manage stress.  Basically, any physical or mental stress will cause the body to increase production of cortisol to help you manage the situation. 

The human body, amazing as it is, recognizes when it has a high level of corticosteroid in it and stops its own production.  If you took an increased dose of corticosteroid for an extended period of time, usually one month or greater, your body diminishes its ability to begin production of its own cortisol.  This effect is different for each individual and is dependent upon the dose and duration of therapy.  Your doctor will usually diminish the corticosteroid dose gradually in order to allow for the body to begin its own production of cortisol again. 

When someone takes a corticosteroid for an acute situation such as a severe allergic response or inflammatory condition, the dose is usually given for 7-14 days.  The body will temporarily decrease its own production of cortisol, however, as the dose decreases, the body will again begin production of its own cortisol and take over when the dosing cycle is complete.

If someone has taken a corticosteroid in an increased dose for an extended period of time, such as may happen when treating an immune system disorder or cancer, it may take up to 12 months for the body to fully regain its ability to produce normal levels of cortisol after the corticosteroid has been stopped.  Again, this is fully dependent on the dose of the medication and the duration of therapy. 

I am taking the time to explain this because this is a big deal.  This medication works incredibly well at treating certain disease states and conditions, however, it helps to understand how this medication affects your entire system.   If you need to use this medication for a chronic condition, please discuss the effects with your doctor or pharmacist so you understand what to expect.

To learn more about corticosteroid medications such as prednisone, dexamethasone, methylprednisolone or hydrocortisone, please visitAudibleRx.com and register to become a member.  You will then have access to the corticosteroid Medication Specific Counseling SessionsTM as well as all of the other counseling sessions. 


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Who Cares?


The BLACK BOX WARNING is a warning system used by the Food and Drug Administration to alert prescribers, pharmacists and patents that this particular medication has potentially dangerous side effects.

This is the highest level of warning the FDA can give to a medication. When a medication receives this type of warning it means that studies have suggested that this particular medication has potentially severe or even lethal side effects.

A Black Box Warning might be added to a product by the FDA after it has been used for a series of years and through routine use it was discovered that the particular medication had serious side effects that were previously unknown. The FDA may also require this warning on a new medication that has potentially significant benefits while also potentially serious side effects.

The term "black box" is referring to the thick black line that borders the warning information in the medication package literature.

If you receive a medication from your pharmacy that has a Black Box Warning you will also receive a Medication Guide that discusses the warning and what it means. Ask your pharmacist to explain the warning information and any risk vs. benefits associated with this medication if the information is not explained clearly, please ask them to repeat the information to you so you may understand it.

After discussing this with your pharmacist, don't hesitate to call your doctor and discuss the risk vs. benefit with them also

It is important that you understand why you are taking your medications, while also being aware of the warnings associated with it.   AudibleRxtm covers each Black Box Warning associated with a specific medication during each of the MedicationSpecific Counseling SessionsTM.  To learn about the warning associated with any particular medication, please register to become a member at AudibleRxtm.


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GERD; It's Not Just My Grammas Name

Have you ever had that horribly uncomfortable burning sensation that starts in the chest and typically works its way up your throat?  The pain usually gets worse when you bend over or lie down and is most likely worse just after eating.  Most likely, this is Gastro Esophageal Reflux Disease, sometimes called heartburn.

It is not uncommon for people to experience some level of heartburn now and again.  If this is something that you deal with on any sort of regular basis, than you may be in the early phase of GERD.  GERD is a condition where the stomach contents will leak backwards up into the esophagus (or throat).

It is possible that the pain you experience may actually be symptoms of a serious heart condition.  Please let your doctor know immediately if you are having symptoms such as dizziness, flushing and sweating coupled with chest pain that spreads through your neck shoulders and arms.

Quite often, a little reading about lifestyle changes and dietary considerations will be all it takes to help relieve your heartburn symptoms.   If you are interested in learning more about the causes of GERD and what life style changes to look for, follow this link to the U.S. National Library of Medicine. 


If you still have symptoms of heartburn now and again, please talk with your pharmacist.  Your pharmacist will have some good ideas on how you can treat the intermittent symptoms of heartburn you may be experiencing.  If you have tried the over the counter remedies, talked with your pharmacist, and are still having regular symptoms of heart burn, please call your doctor. 

If you would like to learn more about the prescription medications used to treat GERD, please visit www.AudibleRx.com, navigate to the medication you would like to learn more about, and click on the medication.

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