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.





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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:


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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

·         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.


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In An Ideal World

AudibleRXTM provides Medication Specific Counseling SessionsTM in audio format; we know that, I have beaten that into this blog over and over during the last 12 months.  If you have been following AudibleRxTM for any amount of time than you most likely have read what a counseling session includes.  If you haven’t, please take a moment and read it now so you can join in this conversation.

Medication Specific Counseling SessionTM full description.

Why would anyone ever want to or need to use AudibleRXTM to learn about their medications?  Well, in an ideal world you would not. The theory is that you would take your prescription to the pharmacy, or it would most likely be electronically sent to the pharmacy, and when you went to pick up the prescription you would have time to cover all of the important aspects of the medication with the pharmacist. 

In theory, this would be your regular pharmacist and they would take the time to discuss with you what the medication does, describe the Black Box Warnings, how it works, allergies, food and drug interactions, cautions and precautions, and a handful of other important information about the particular medication.  Since this was your pharmacy and your pharmacist, they already know your personal history and are able to evaluate the medication against any of your other medications, drug allergies and disease states.

You would know exactly which questions to ask and have them answered before you left the consulting area.  As you were walking out of the pharmacy you would feel confident that you know exactly why you are taking the medication, what it is for and how to assure that you get the best possible outcome of therapy from taking this particular medication.

I have talked to quite a few people about their medications and I am not convinced that this process happens on a regular basis.  When I am consulting someone about their medications, my goal is to:

·         Help them understand all the important aspects about the medication so they will be motivated to follow their own pharmaceutical regimen.

·         Help the patient gain their best possible outcome with their current therapy.

·         Help the patient avoid any medication miss-adventures.

AudibleRxTM helps patients, family members, and care givers understand a medication.   After each 6-8 minute audio session, the individual will have a clear understanding of what they do know and what they don’t know about a particular medication.  They will be prepared to formulate educated questions to take back to their own pharmacist or doctor. 

Please visit the registration page of AudibleRxTM  and register to become a member.  For $14.95 you will have full access to all of the Medication Specific Counseling Sessions  Have a parent or a relative who may benefit from this service, send them a subscription.  Know a care giver or family member who manages medications for a love one, they may benefit from a subscription to AudibleRxTM.

Please use the comment area to share any pharmacy counseling stories or medication miss-adventures.


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Two Names

The other day I had one of my regular patients call me on the phone wanting to know if I carried the generic version of a particular medication yet.  I explained to this patient that this medication is not yet available as a generic; it is only available as trade name.  He said, “So, you don’t carry it yet?”  

So, I re-adjusted the phone headset on my ear and began explaining again that this particular medication has not yet come off patent; therefore, it is only available as a trade name product.  He then said, “So, if I understand you correctly, it is only available as a generic in the hospital setting.  Last week when I was in the hospital they were giving me the generic version of this medication, and they called it by its generic name.”

I adjusted my footing two steps to the left and began again.  In the most polite tone I could deliver, I explained that each medication has two names, a generic name and a trade name.  I discussed that the nurse who was handing him his medication was calling it by its generic name.  This was correct because that is one of its names; however, it also has a trade name.  The patient then asked me, “Well, how do I know if she was giving me the generic or the trade name, they both look the same?”

This was getting near the end point for this gentleman.  I needed to close the deal with an explanation or I was going to lose him with my clear inability to answer his simple question. 

Again, I adjusted my footing, re-positioned my headset and began my answer.  I went back to the tried and true explanation that there are two names for every medication.  I explained that in the hospital, quite often, the medical and nursing staff talk about medications using their generic name.   Even though a medication may not yet be available through a generic company, they still refer to it using its generic name. 

“OHHH”, he said, interrupting me.  “I get it; it hasn’t come off patent yet.”  That’s it I explained.  After a medication comes off patent, many different companies are able to produce generic versions of the medication, with FDA approval of course.  While the company still holds the patent for a product, they are the only ones who may legally manufacture the medication.  Even though the medication is still covered by a patent and is only available under its trade name, many medical professionals will refer to it using its generic name.

You may also be interested in reading the following blogs:
Generics, The Untold Story
My Pills Look Different
The Danger With Dietary Supplements

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Communication, Blood Pressure and Beta-Blockers

When I was a pharmacy student at the University of the Pacific in Stockton, CA, I spent one year working as an intern pharmacist in a local pharmacy.  After I had been there for a short while, the pharmacist that I was working with decided I was ready to counsel patients about their prescriptions.  Shortly thereafter, there I was, discussing a medication with a patient.  This was a blood pressure medication.  This was before OBRA 90 had come about so we did not have the official mandate to counsel; however, regularly we still talked with patients about their medications.

I went on to explain that this was a “beta-blocker” and describe the receptors that it affected and discussed the half-life of the medication.  When I was done I asked if they had any questions, they said no, and off they went.  The pharmacist that I worked with had been listening in.  He said, “Steve, do you think anyone really cares that this is a beta-blocker and do you think they really need to know about the beta receptors that it is blocking?”  His point was that I needed to stick to the specifics; make sure the patient knew how they were going to take their medication, why they were taking it, and what to expect.  That was a point well taken, and one that I have incorporated into each and every counseling session ever since.

Well, here I am, almost 30 years later, ready to talk about beta-blockers again.  These medications work to block the body’s natural chemicals that affect your blood vessels and your heart.  Beta-blockers may decrease blood pressure by relaxing your blood vessels, slow down your heart rate and decrease the strain on your heart.  In general, beta-blockers are used to treat hypertension (high blood pressure), angina (chest pain) and to improve survival after a heart attack.

Currently I have Medication Specific Counseling SessionsTM for the following beta-blockers posted on AudibleRxTM. 

  • Atenolol (Tenormin-TM)
  • Carvedilol (Coreg-TM)
  • Carvedilol (Coreg CR-TM)
  • Metoprolol (Lopressor-TM)
  • Metoprolol XR (Toprol XR-TM)
  • Nadolol (Corgard-TM)
  • Nebivolol (Bystolic-TM)
  • Propranolol (Inderal-TM)
  • Propranolol LA (Inderal LA-TM)

If you take any ACE inhibitors or ARB's for your blood pressure, please remember to read my blog on the Renin Angiotensin Aldosterone System.

Copyright 2012 AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).

Made In The U.S.A.

These days there are quite a few people who do not want to purchase anything unless it is made in the United States of America.  This is their way of showing support for this fantastic country of ours.  Support your local business, help support jobs for our fellow countrymen, and do what we can to stimulate our own economy.

While this process may sound all well and good, it would be a dauntingly difficult mode of life to undertake.  Just take a look around as you drive down the road; every other car you see is from a different country; and what about the cars that are made in the U.S.A., how would a person verify that all of the parts and instrumentation and raw material are actually made in the U.S.A.?

Does anyone every talk on a mobile phone or work on a computer?  My guess is that the entire device, or at least some of its components, were manufactured in a foreign country.  I would even assume that the foreign country that manufactured the electronic device received the raw materials from other foreign countries. 

Then there is clothing.  When a label states that a product of clothing was made in the U.S.A., does that mean that the raw materials were also fabricated in the U.S.A.?  I don’t know the answer to this.   I do know that on quick inspection of my closet, some of my clothes have the “made in U.S.A.” tag on them; however, most of them have the “made somewhere else” tag.

Now, let’s talk about prescription medications.   What is a pharmacist to do when a patient walks into the store and states that they don’t want any medication that wasn’t made in the U.S.A.?  My first inclination is to take some time out for a little education with the patient.  It is important to understand the process of how medications are allowed or not allowed to come into our country.  A few months back I wrote an article that discusses the “Chain of Custody” process which is put in place to protect the consumer.  If you haven’t read it, please follow this link.

Many pharmaceutical companies that are located in the U.S.A. actually contract out the manufacturing process of their medications to foreign pharmaceutical manufacturing companies.  When a patient asks me what country a medication came from, I can pick up the bottle and it will usually state “manufactured for XYZ Company” and then give the U.S.A. address of XYZ Company.  The next line will state the name of the manufacturing plant and the country of origin of the medication.  It is common place for medications to be manufactured in Europe, Asia or the Middle-East for a U.S.A. based pharmaceutical company. 

As described in my “Chain of Custody” article, there are strict practice guidelines regarding manufacturing, storage and shipping that need to be followed and documented the entire process.  If a medication is being manufactured for use in another country, the U.S.A. “Chain of Custody” guidelines do not apply.  Each country has their own regulations regarding the importation of pharmaceuticals.

I work within a system whereby I am signed up with a purchasing group in order to maintain competitive pricing.  When I log on to my wholesaler to order a generic medication, I do not know the country of origin of the medication.  I may have anywhere from one to four choices of a specific generic medication to order.   I don’t know the point of origin of any specific medication until I order it in and read the packaging on the container.  I am limited on which manufacturers I can order because my purchasing group has contracted with specific manufacturers.  I will pay an increasingly expensive price if I purchase outside of my agreed upon contract list.

If a patient wants to make certain that the medication that they are taking is made in the U.S.A. then they need to be proactive and do the leg work before getting to the pharmacy.  They need to do some research on the internet, find out which companies make their generic medication, and then call these companies to find out the point of origin of the specific medication.  The patient may then check with their local pharmacy to see if they might already stock, or be willing to order the specific manufacturer they are looking for.

This is a predicament and I do not have an exact answer.  I would appreciate any comments on this situation.

Generic Medications
Chain of Custody

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Hormones Anyone?

Hormone Replacement Therapy and Hormonal Contraception are not simple topics to talk about.  Quite a bit of thought, education, emotion and guiding principles are involved in each individual’s decision regarding treatment choice. 

At AudibleRxTM my goal is to educate and motivate you to participate in making your own decision.  I want to help you define what you do and don’t know about your current and future medication therapy.

After reading the AudibleRxTM blog and listening to the appropriate Medication Specific Counseling SessionsTM you will be better prepared to discuss your hormonal treatment options with your health care provider.

AudibleRxTM has provided a series of hormone related information blogs:

                Hormone Replacement Therapy alternatives and warnings.
                Hormonal Contraception treatment options and barriers to effective counseling.

                Hormonal Contraception and how it works.

To learn the specifics on any of the medications discussed in these blogs, please visit and LISTEN to the counseling session you are interested in.

If you haven't done so yet, please visit our Facebook page and give us a LIKE.  You may also be interested in following our Pinterest page to see what Pharmacy Topics looks like in pictures.

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$13 Billion Dollar Migraine

As we know, migraine headaches can be quite debilitating.  One study shows that the cost of missed work days and impaired performance from migraine headaches in the United States totals about $13 Billion dollars for one year.  Really?!?!, $13 billion dollars?  That is a humongous number.

One big issue here is the consistency of preventative migraine treatment.  It is estimated that only 50% of regular migraine sufferers utilize some sort of preventative migraine medication treatment.  Taking a preventative medication on a regular basis may actually decrease the frequency of migraine headaches by 50%.

There are quite a few factors that come in to consideration when deciding if you are a candidate for preventative migraine treatment.  If you can say yes to any of the following situations, you should make an appointment with your doctor to discuss the option of preventative therapy.

·         Two or more migraines per month.

·         Migraine pain disability lasting three or more days per month.

·         Inadequate acute migraine treatment regimen.

·         Use of acute migraine medication two or more times per week.

·         Other uncommon migraine condition.

 Three medications currently have FDA approved indications for migraine prophylaxis treatment:

·         Divalproex (Depakote-TM)

·         Propranolol (Inderal-TM)

·         Topiramate (Topamax-TM)

Many other medications are also used for preventative migraine therapy.  A complete article describing the 2012 guidelines for prevention of episodic migraine headaches written by the American Headache Society can be seen here.

Tolearn about any of the medications used for preventative migraine treatment,please register to become a member of AudibleRxTM.  For $14.95 your will have full access to allof the Medication Specific Counseling Sessions.  

You may also be interested in reading the following:
Acute Migraine Treatment

Copyright 2012 AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).