Tag Archives: Pharmaceutical drug

Straight, No Chaser: Do Medications Work Differently in Older People?

General Health and Wellness, , , , , , , , , ,

geriatrics_clip_image

The elderly are living longer and more productively. Part of being able to do so is by maintaining an understanding of how your actions  affect you. One common action of many of the elderly is taking medications. You should be aware that medications have changing effects with aging, and there are many different reasons for that fact.
First of all, changes in our physiology due to aging make the effects of drugs less predictable and consistent than in younger people. A slower metabolism, increases in body fat and alterations in the function of the kidney and liver (major mechanisms for drug elimination) have important ramifications for what ingested substances will do. Thus, the elderly require more stringent monitoring of drug levels and effects, and you may find that your physician needs to adjust medication doses. This same consideration explains why side effects are more common among the elderly.
Be reminded the presence of other diseases brings additional effects and challenges. Just as with one’s own relatively diminished function, disease imposes the same type of changes onto the body. This can speed the presence of side effects and toxicity as well as adjust the effective dose of a medication.

medmngt

Have you ever seen the individual with a small ‘army’ of medications? Think about it. The more medications one takes, the more likely drug interactions will ensue and changes in effectiveness in any single medication may occur. This effect incrementally increases with each additional drug one takes. Similarly, the more medications one is taking, the most likely one is to make a mistake in taking the correct medication at the right time. Now consider your independently living parents or grandparents. The elderly often are more prone to make these types of errors.
What can you do about this? Get organized, and get help! Those daily medication containers are good solutions to incorrectly dosing medications. If you’re especially organized, a log is great—not necessarily for you, but for the physician that will be trying to figure out why you’re dizzy or have an altered mental status if and when that occurs.
Talk with each doctor you see or a pharmacist about what to expect from the combination of medications you take; it can make your lives a lot less complicated.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Treatment of Erectile Dysfunction

Genital/Urinary, Medical Treatment, , , , , , , , , , , , , ,

Penis-Pump-For-Penis-Enlargement-font-b-Erectile-b-font-font-b-Dysfunction-b
Well, here’s what many of you’ve been awaiting.  Assuming the preventative efforts I mentioned didn’t work for you, there are several different treatment approaches. If there’s an underlying medical cause, then treatment of that cause is not only a good way to relieve erectile dysfunction (ED), but it’s a good way to get healthy and avoid other complications from the primary disease. Today, I’ll review different treatment strategies your primary care physician or urologist may discuss or recommend to you for treatment.
The medications
A first consideration is to be wary of (any) medications via mail order. The same level of testing, scrutiny and quality control just doesn’t exist to the same degree as do medications obtained through a pharmacy. Reports abound of people receiving expired or weak formulations of the pills, as well as fake or hazardous substitutes of the pills they thought they were receiving. Engage at your own risk.
Now, regarding those medications you know all too well by name and brand (e.g. Levitra, Cialis and Viagra), there’s no special ‘magic’ to them. They all are variations of the same theme, physiologically relaxing muscles in the penis, resulting in increased blood flow to it.  Unfortunately, that’s not the entire story with these medications.  ED medications all lower blood pressure throughout the body, and that increased blood to the penis is coming at the expense of decreased blood flow elsewhere (This is called a ‘steal syndrome’.).  If you’re otherwise unhealthy, and your redirecting blood that was needed in the heart or brain, you could end up with a heart attack or stroke while taking these meds.  Therefore, this leads to two very important cautions regarding ED meds.  You shouldn’t start them without discussing with a physician first (to determine “…if you’re healthy enough to have sex”, as the commercials say), and secondly, don’t keep the fact that you’re taking them a secret (to your significant other, and especially to any physician you come across if you’re sick).  These medications could be the cause of whatever medical issue has you in an emergency room. They could also be contributors to life-threatening adverse effects if you’re being treated for something else with a medication that interacts with the ED med you’re taking but didn’t bother to mention to the emergency physician.  This is why ED medications generally aren’t given to men also on medications for high blood pressure, an enlarged prostate, blood thinners or certain other heart diseases (e.g. angina).
There are actually even more intricate medications used to treat ED.  Taking testosterone injections is an increasing means of addressing low hormone levels.  Additional injections directly into the penis or inserting a suppository into the penis itself are additional, effective treatment methods.  You’d be given these options by your urologist if necessary.
The counseling
If your ED is due  to anxiety, stress or other psychologically generated reasons, psychotherapy (possibly with your partner) may be of incredible assistance.  If you pursue this option, you and your partner must be prepared to be patient and to work through a variety of issues and possible approaches.
Surgery and additional methods

  • If you’ve ever seen an Austin Powers movie, you’re familiar with (well at least the jokes about) penis pumps.  These are real things, and involve placing a hollow tube over the penis and creating a vacuum to pull blood to the penis via a pump.  A tension ring is placed about the base of the penis to maintain the erection during intercourse.
  • Actual vascular surgery to repair damaged arteries may be indicated in certain cases.
  • Penile implants are an additional option.  Inflatable rods are placed into the sides of the penis.  These rods are simply inflated when needed.

Penile-Prosthesis-300x168
If you think some of this is a bit much, it may or may not be, depending on if you’re the one suffering.  As I usually conclude, prevention would have been a much better course of action.  Hopefully if that’s not the case, you’ve understood the information provided well enough to have an informed conversation with your physician.  Good luck, and I welcome your comments and/or questions.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Do Medications Work Differently in Older People?

General Health and Wellness, , , , , , , , , , ,

geriatrics_clip_image

The elderly are living longer and more productively. Part of being able to do so is by maintaining an understanding of how your actions  affect you. One common action of many of the elderly is taking medications. You should be aware that medications have changing effects with aging, and there are many different reasons for that fact.
First of all, changes in our physiology due to aging make the effects of drugs less predictable and consistent than in younger people. A slower metabolism, increases in body fat and alterations in the function of the kidney and liver (major mechanisms for drug elimination) have important ramifications for what ingested substances will do. Thus, the elderly require more stringent monitoring of drug levels and effects, and you may find that your physician needs to adjust medication doses. This same consideration explains why side effects are more common among the elderly.
Be reminded the presence of other diseases brings additional effects and challenges. Just as with one’s own relatively diminished function, disease imposes the same type of changes onto the body. This can speed the presence of side effects and toxicity as well as adjust the effective dose of a medication.

medmngt

Have you ever seen the individual with a small ‘army’ of medications? Think about it. The more medications one takes, the more likely drug interactions will ensue and changes in effectiveness in any single medication may occur. This effect incrementally increases with each additional drug one takes. Similarly, the more medications one is taking, the most likely one is to make a mistake in taking the correct medication at the right time. Now consider your independently living parents or grandparents. The elderly often are more prone to make these types of errors.
What can you do about this? Get organized, and get help! Those daily medication containers are good solutions to incorrectly dosing medications. If you’re especially organized, a log is great—not necessarily for you, but for the physician that will be trying to figure out why you’re dizzy or have an altered mental status if and when that occurs.
Talk with each doctor you see or a pharmacist about what to expect from the combination of medications you take; it can make your lives a lot less complicated.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Treatment of Erectile Dysfunction

General Health and Wellness, , , , , , , , , ,

Smiling_BobPenis-Pump-For-Penis-Enlargement-font-b-Erectile-b-font-font-b-Dysfunction-b
Well, here’s what many of you’ve been awaiting.  Assuming the preventative efforts I mentioned didn’t work for you, there are several different treatment approaches. If there’s an underlying medical cause, then treatment of that cause is not only a good way to relieve erectile dysfunction (ED), but it’s a good way to get healthy and avoid other complications from the primary disease. Today, I’ll review different treatment strategies your primary care physician or urologist may discuss or recommend to you for treatment.
The medications
A first consideration is to be wary of (any) medications via mail order. The same level of testing, scrutiny and quality control just doesn’t exist to the same degree as do medications obtained through a pharmacy. Reports abound of people receiving expired or weak formulations of the pills, as well as fake or hazardous substitutes of the pills they thought they were receiving. Engage at your own risk.
Now, regarding those medications you know all too well by name and brand (e.g. Levitra, Cialis and Viagra), there’s no special ‘magic’ to them. They all are variations of the same theme, physiologically relaxing muscles in the penis, resulting in increased blood flow to it.  Unfortunately, that’s not the entire story with these medications.  ED medications all lower blood pressure throughout the body, and that increased blood to the penis is coming at the expense of decreased blood flow elsewhere (This is called a ‘steal syndrome’.).  If you’re otherwise unhealthy, and your redirecting blood that was needed in the heart or brain, you could end up with a heart attack or stroke while taking these meds.  Therefore, this leads to two very important cautions regarding ED meds.  You shouldn’t start them without discussing with a physician first (to determine “…if you’re healthy enough to have sex”, as the commercials say), and secondly, don’t keep the fact that you’re taking them a secret (to your significant other, and especially to any physician you come across if you’re sick).  These medications could be the cause of whatever medical issue has you in an emergency room. They could also be contributors to life-threatening adverse effects if you’re being treated for something else with a medication that interacts with the ED med you’re taking but didn’t bother to mention to the emergency physician.  This is why ED medications generally aren’t given to men also on medications for high blood pressure, an enlarged prostate, blood thinners or certain other heart diseases (e.g. angina).
There are actually even more intricate medications used to treat ED.  Taking testosterone injections is an increasing means of addressing low hormone levels.  Additional injections directly into the penis or inserting a suppository into the penis itself are additional, effective treatment methods.  You’d be given these options by your urologist if necessary.
The counseling
If your ED is due  to anxiety, stress or other psychologically generated reasons, psychotherapy (possibly with your partner) may be of incredible assistance.  If you pursue this option, you and your partner must be prepared to be patient and to work through a variety of issues and possible approaches.
Surgery and additional methods

  • If you’ve ever seen an Austin Powers movie, you’re familiar with (well at least the jokes about) penis pumps.  These are real things, and involve placing a hollow tube over the penis and creating a vacuum to pull blood to the penis via a pump.  A tension ring is placed about the base of the penis to maintain the erection during intercourse.
  • Actual vascular surgery to repair damaged arteries may be indicated in certain cases.
  • Penile implants are an additional option.  Inflatable rods are placed into the sides of the penis.  These rods are simply inflated when needed.

Penile-Prosthesis-300x168
If you think some of this is a bit much, it may or may not be, depending on if you’re the one suffering.  As I usually conclude, prevention would have been a much better course of action.  Hopefully if that’s not the case, you’ve understood the information provided well enough to have an informed conversation with your physician.  Good luck, and I welcome your comments and/or questions.
Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: When Good Drugs Do Bad—Drug Interactions

Toxicology/Drugs, , , , , , , , , , , , ,

three-feet-green-iguana-walking-on-the-beach-of-costa-rica

“Be sure to let your doctor know if you grow a third foot.”
Ok, well maybe that is about the only side effect you haven’t heard at the end of one of those commercials that seem to spend half of its time describing the side effects. If you pay attention to a pharmaceutical commercial, though, you’ll appreciate that even though medicines do a world of good, sometimes they cause significant problems. Those problems can become sped up or magnified by the effects of taking several drugs at a time. Alternatively, combinations of medications may make one or more of the drugs less effective. Regarding the medicines you’re taking, you should be clear if drug interactions can be minor and insignificant or serious and  life-threatening. Let’s review the various types of drug interactions.
drug-interactions
Drug/drug interactions: Two or more different drugs taken together may interact and cause an unwanted effect or change how the drug acts in the body. Here are some common examples:

  • An individual who already takes a sedative (e.g., sleeping pill) to help combat insomnia develops an exacerbation of their seasonal allergies. To treat the allergies, they decide to take an over-the-counter (OTC) antihistamine (like diphenhydramine, branded as Benadryl). Diphenhydramine also may cause drowsiness, so the combination of the medications may pose a danger to the person, especially if s/he is operating heavy machinery, such as driving a car.
  • Caffeine (which is a drug) in everyday foods—such as coffee and chocolate—also can interact with certain other drugs. In fact, caffeine is known to interact with over 80 different drugs, including about a dozen with which it produces serious effects. These include commonly used medications like aspirin, ciprofloxacin (branded as Cipro), guafenesin (the generic name for your favorite cough medicines) and diazepam (branded as Valium).
  • Nicotine (another drug) in tobacco products can interact with other medications, especially nicotine-replacement products. So if you’re taking medicine to help with your smoking cessation efforts, and you’re still smoking, you’re making the problem worse!

Drug/food interactions: If you’re a fan of grapefruit or chocolate, then it’s likely that your physician has cautioned you on drug/food interactions. These occur when certain foods or beverages interfere with the metabolism of certain medications. In the example of grapefruit, it’s known to interfere with metabolism of medications used to lower cholesterol levels (called statins). This can lead to adverse drug effects and actual liver damage. Other examples are to be found in the many foods (e.g., red wine, aged cheese) that affect the antidepressant class of drugs known as MAO inhibitors.
Drug/condition interactions: You see these all the time. Many different medication instructions warn you not to take them if you have certain medical conditions, as the medications may make the medical condition worse. Prominent examples include over-the-counter cold, cough and flu remedies that advise you not to take if you have heart disease or high blood pressure. Also if you have kidney or liver disease, any medicine that gets metabolized via one of those routes may have difficulty and delays in getting metabolized and excreted, leading to longer than desired activity of the given drug.
Drug/alcohol interactions: This is actually a subcategory of the drug/drug interaction because alcohol is a drug. It deserves special mention because drinking alcohol while taking certain medications can cause adverse effects related to the additive effects of alcohol and various drugs. Any medication involving the central nervous system or one’s mental state would likely be worsened by alcohol.
The best way to guard against these concerns is to discuss any new medications with your physician or pharmacist prior to taking them. Be smart about medicines you’re putting in your body and don’t be cavalier about them; the wrong combinations can turn a medicine into a toxin.
One final note: don’t be lulled into complacency by herbal preparations as some form of replacement. Herbals are still medicines and work via the same active ingredient as the pharmaceutical drug they’re replacing. As such, they are subject to cause the same types of problems listed above. Even more concerning is that as a class, comparatively less research has been done on herbals. Therefore, the full extent of side effects and drug interactions is not defined. Not knowing the full extend of an herbal medicine’s side effect profile isn’t the same as saying the herbal doesn’t have side effects, and you shouldn’t interpret things that way.
Feel free to contact your SMA expert consultant for any questions you may have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Treatment of Arthritis

Geriatrics/Elderly Care, Medical Treatment, Orthopedics/Bones, Musculoskeletal System, , , , , , , , , ,

arthritisrx

The thing about treating arthritis is you’d better do it. If you’re not lucky enough to have a form that readily responds to treatment or if you didn’t get early treatment, your arthritis will progress and create an incrementally worse situation for you. Given that we’re discussing arthritis, we’re talking loss of mobility somewhere, maybe in your legs or hands, and pain.
The goal of treatment is to reduce pain, improve function, and prevent further joint damage. The underlying cause often cannot be cured.
Treatment considerations for arthritis fall into three general categories: lifestyle changes, medication and surgery. Let’s review each.
Lifestyle
The best time to enact lifestyle changes is before you’re struggling to return to normalcy. Exercise is a lifelong habit that will improve the quality and extend the quantity of your life. For starters, exercise maintains and improves muscle tone. It also strengths your bones and cartilage. This will reduce pain, fatigue and stiffness over the long term.
Exercise should include a tolerable level of aerobic activity, flexibility exercises to sustain your range of motion and strength training to maintain and improve your muscle tone. Physical therapy is another component; massage, heat and ice application, splints and other treatments are important in maintaining blood flow, mobility and positioning as stiffness and deformity increase over time.
Medication
Using medication for arthritis is a very delicate act. Many if not most arthritics are aging and may have other medical issues. Medications in these settings have risks for side effects and drug interactions, including kidney, liver and heart damage, stroke, ulcers and bleeding. Any medications should be coordinated with your physician. Typical over-the-counter (OTC) medical regimens begin with acetaminophen, then move to NSAIDs (non-steroidal anti-inflammatory agents such as ibuprofen, aspirin or naproxen).
When OTCs don’t work, your doctor may prescribe medicines, including steroids and other medications called biologics, immunosuppressants and DMARDs (disease-modifying anti-rheumatic drugs). These drugs all are effective in certain patients but can have serious side effects.
Surgery
Surgery is an option if and when other therapies haven’t worked and if the patient is healthy enough to have it. There are two primary options. Arthroplasty rebuilds the joint, and joint replacement starts from scratch.
Let’s start back where I’ll always hope you start: prevention. Here are some lifestyle change tips for holding off the onset of arthritis or slowing down its advance.

  • If you are overweight, do what you can to slim down. Weight loss significantly reduces joint pain in the legs and feet.
  • Eat a healthy diet full of fruits and vegetables. Among other things, a rich supply of vitamin E yields benefits you’ll need. Also eat foods rich in omega-3 fatty acids (e.g., salmon, mackerel, herring, flaxseed, canola oil, soybeans and soybean oil, pumpkin seeds, and walnuts).
  • Sleeping eight to 10 hours a night and taking naps during the day can help you both prevent and recover from flare-ups more quickly.
  • Avoid staying in one position for too long.
  • Try stress-reducing activities, such as meditation, yoga or tai chi.
  • Avoid positions or movements that place extra stress on your sore joints.
  • Change your home to make activities easier (e.g., grab bars in the shower, the tub, and near the toilet).
  • Consider capsaicin cream over your painful joints. Typically expect improvement after three to seven days if it’s going to help.

If and when you develop arthritis, it’s going to be a tough time. Get ahead of the challenge and take care of yourself in advance. Feel free to ask questions or leave comments.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: How to Prevent Getting the Flu Without Receiving the Flu Vaccine

General Health and Wellness, Infectious Disease, Health Prevention, , , , , , , , , ,

influenza-virusfluchildsneeze_in_arm

Many people choose not to get the influenza vaccine (the “flu shot”) for various reasons. One of those reasons is due to an allergy to eggs. If you have an egg allergy, your options to combat influenza are different and don’t contain vaccination.
The best way to avoid the flu is prevention. Consider adopting these healthy habits before you ever get exposed:

  • Wash your hands frequently with warm soapy water. You know when they’re dirty. Most certainly wash your hands before you use them to eat or put anything else in your mouth.
  • If you can’t wash your hands, use an alcohol-based hand sanitizer.
  • If your hands are dirty and neither soap nor sanitizer is available, still rinse and dry your hands with warm water if you can.
  • Use disinfectant to clean surfaces.
  • Avoid unnecessarily touching your eyes, nose, or mouth.
  • Politely limit close contact with people who are ill, coughing and sneezing.
  • When coughing or sneezing use the bend of your elbow or a facial tissue to help cover your nose and mouth. Learn to avoid coughing or sneezing into your hands.
  • When you become sick, stay home. It’s the proper thing to do to avoid spreading your infection to others.

Vitamin C, echinacea and zinc have long been touted to prevent colds and influenza. There are no studies confirming or refuting this claim. Despite assurances that these and other herbal medicines are safe alternatives because they’re “natural”, the active ingredients in them are the same as found in certain prescription medicines. Thus they too may interact with other medications and worsen certain medical conditions. Given this, you should discuss your use of supplements with your physician or pharmacist prior to use.
Another level of defense for you involves use of certain antiviral prescription medications. If you are exposed to someone (e.g. a family member) with influenza, and especially if you begin having flu-like symptoms, immediately contact your physician to discuss taking medicines to prevent catching the flu. Such medications include Tamiflu® (generic name: oseltamivir), Relenza® (generic name: zanamivir), Flumadine® (generic name: rimantadine) and Symmetrel® (generic name: amantadine). If you make the request more than 24-48 hours after the onset of symptoms, you likely won’t be given the medication, since it isn’t likely to be effective outside of this timeframe.
Feel free to contact your SMA expert consultant if you have any questions on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
 

Straight, No Chaser: Do You Take Antidepressants? Learn About the "Black Box" Warning Label.

Medical Treatment, Mental Health, , , , , , ,

antidepressantblackbox

It’s important to note that most recent group of antidepressants known as SSRIs are a marked leap forward in safety from their predecessors. Even still, they retain undesired effects, particularly in adolescents and young adults. The U.S. Food and Drug Administration (FDA) conducted a comprehensive review of controlled clinical research trials of antidepressants that involved nearly 4,400 children and adolescents. The review revealed that 4% of those taking antidepressants thought about or attempted suicide, compared to 2% of those receiving placebos (a simulated but medically inactive treatment).
In 2005, this information prompted the FDA  to adopt its most serious level of warning on all prescription antidepressant drugs, known as a “black box” warning. This warning means to alert the public about the potential increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. Specifically, makers of all antidepressant medications must post the warning regarding users up through age 24.
What does this mean for you? Regardless of your age, during the initial treatment period (e.g., the first month), you should have a family member closely follow you and look for any abnormalities or changes in behavior. In particular, worsening depression, suicidal thoughts or action, insomnia, increased agitation or withdrawal should be noted and considered a prompt to receive immediate medical attention.
In the event you’re wondering why such drugs would still be available to the public, it’s basically the risk/benefit ratio. These considerations aren’t taken lightly. It’s a testament to positive benefits of these medications that they remain popular and continually used for children and young adults (in particular) with depression and anxiety. Just be sure to have a detailed conversation with your physician or psychiatrist prior to use. These are not medications that you should just receive a prescription for and walk out of the office.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Do medications work differently in older people?

Geriatrics/Elderly Care, , , , , , , , , ,

geriatrics_clip_image

The elderly are living longer and more productively. Part of being able to do so is by maintaining an understanding of how your actions  affect you. One common action of many of the elderly is taking medications. You should be aware that medications have changing effects with aging, and there are many different reasons for that fact.
First of all, changes in our physiology due to aging make the effects of drugs less predictable and consistent than in younger people. A slower metabolism, increases in body fat and alterations in the function of the kidney and liver (major mechanisms for drug elimination) have important ramifications for what ingested substances will do. Thus, the elderly require more stringent monitoring of drug levels and effects, and you may find that your physician needs to adjust medication doses. This same consideration explains why side effects are more common among the elderly.
Be reminded the presence of other diseases brings additional effects and challenges. Just as with one’s own relatively diminished function, disease imposes the same type of changes onto the body. This can speed the presence of side effects and toxicity as well as adjust the effective dose of a medication.
Have you ever seen the individual with a small ‘army’ of medications? Think about it. The more medications one takes, the more likely drug interactions will ensue and changes in effectiveness in any single medication may occur. This effect incrementally increases with each additional drug one takes. Similarly, the more medications one is taking, the most likely one is to make a mistake in taking the correct medication at the right time. Now consider your independently living parents or grandparents. The elderly often are more prone to make these types of errors.
What can you do about this? Get organized, and get help! Those daily medication containers are good solutions to incorrectly dosing medications. If you’re especially organized, a log is great—not necessarily for you, but for the physician that will be trying to figure out why you’re dizzy or have an altered mental status if and when that occurs.
Talk with each doctor you see or a pharmacist about what to expect from the combination of medications you take; it can make your lives a lot less complicated.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

"Why would my doctor tell me not to take cough medicine for my cold or flu?"

General Health and Wellness, Infectious Disease, Medical Treatment, , , , , , , , , ,

coughmed

The first thing to appreciate about cough and cold preparations is they only provide relief of symptoms.  The body itself is providing the actual healing of what is usually a viral infection. The cough associated with a cold, flu or bronchitis will go away on its own (sooner rather than later, assuming you’re not smoking while sick; smoking further inflames your airways, thus stimulating coughing).
The nuisance symptoms of a cough often are most disturbing at night while you’re trying to sleep. Cough suppressants (antitussives) are medications that reduce your cough reflex. Additionally, you will often see the word ‘expectorant’ associated with cough medications; this component helps to hydrate and thus thin the mucus, making it easier for the body to expel.
So… some physicians prefer to allow the body to work these issues out on its own.  It is common to be told to only take cough medications at night to help you sleep, unless you need to take them to also get through your day.
Also, be reminded that all medications have side effects; you may recall that drug allergies or adverse drug reactions (which were covered here) may be additional reasons that your physician may not want you to take cough and cold preparations. If you have any questions in real time, you may always contact your physician or your SterlingMedicalAdvice.com consultant.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

From the Health Library of SterlingMedicalAdvice.com: "Can I use antibiotics if I forgot to refrigerate them?"

General Health and Wellness, Medical Treatment, , , , , , ,

antibiotics_050106

I left my son’s liquid antibiotic sitting on the kitchen counter all day instead of putting it back in the refrigerator. Is the medicine still OK?
Depending on the medication, including liquid antibiotics, it may no longer be effective due to improper storage. Certain medications will break down and lose their potency if not stored in the refrigerator. If you are unsure if the medication is still effective, consult your doctor or pharmacist.
Always be sure to read all the labels on the medication container for directions for use and storage.
 
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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How can I get help if I have trouble swallowing pills?

General Health and Wellness, Head/Eyes/Ears/Nose/Throat, Medical Treatment, , , , , , ,

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Difficulty swallowing pills is a common problem. Be sure to discuss your problem with your doctor when s/he is prescribing a medication for you. While the medication may not be available in a chewable form, it may come in an alternate form such as liquid, powder, sublingual (placed under the tongue to dissolve), orally dissolving (when placed on the tongue), suppository (inserted in the rectum or, for females, in the vagina), nasal spray, injectable liquid, cream, ointment, or patch. These options can allow you to avoid swallowing pills altogether. Your physician also may be able to treat the cause of the swallowing difficulty.
A word of caution: Do not crush pills or empty capsules to make them easier to swallow without first checking with your doctor or pharmacist. Depending on the medication, this may alter the effect of the drug and/or may cause serious, possibly fatal, side effects. Unless your doctor or pharmacist has approved doing so, avoid crushing your medications to make swallowing easier.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: What Would You Do If Your Tongue Suddenly Swelled? Learn About Angioedema

Head/Eyes/Ears/Nose/Throat, Health Prevention, , , , , , , , , , ,

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Here at Straight, No Chaser, we want you to know how to prevent disease and injury because that’s a lot easier than the alternative. However, if and when the time comes, you should also have a few tools in your arsenal to stave off a life-threatening situation. One of the more scary examples of needing help is acute swelling of your tongue, sometimes so much so that your airway appears as if it will be blocked.
The most common cause of acute tongue, lip or throat swelling is called angioedema. This is an allergic reaction and occurs in two varieties.

  • A life-threatening allergic reaction (anaphylaxis) sometimes occurs shortly after an exposure to substance such as medicine, bee or other insect stings or food. It can throw your entire body into a state of shock, including involvement of multiple parts of the body. This can include massive tongue swelling, wheezing, low blood pressure resulting in blackouts and, of course, the rash typified by hives (urticaria).
  • Sometimes lip, tongue and/or throat swelling may be the only symptoms.  This is more typical of a delayed reaction to certain medications, such as types of blood pressure medications (ACE inhibitors and calcium channel blockers), estrogen and the class of pain medication called NSAIDs (non-steroidal anti-inflammatory drugs, such as ibuprofen)

With any luck, you would already know you’re at risk for this condition, and your physician may have prompted you to wear a medical alert bracelet or necklace. In these cases, your physician may have also given you medicines and instruction on how to take them in the event you feel as if your tongue is swelling and/or your throat is closing. These medicines would include epinephrine for injection, steroids and antihistamines such as Benadryl. As you dial 911 (my recommendation) or make your way to the nearest hospital, taking any or all of these medications could be life-saving. By the way, those are the among the same medicines you’ll be treated with upon arrival to the emergency room. In severe cases, you may need to be intubated (i.e. have a breathing tube placed) to maintain some opening of the airway.
If the swelling is (or assumed to be) due to any form of medication, symptoms will improve a few days after stopping it. If the swelling in this instance becomes severe enough, treatment may resemble that of the life-threatening variety.
There are few things better than cheating death. If you’re at risk, carry that injectable epinephrine (e.g. an Epi-pen). If you’re affected, take some Benadryl and/or steroids if you’ve been taught what dose to take, and most importantly, don’t wait to see if things improve. Get evaluated, get treated and get better!
I welcome your questions and comments.
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Straight, No Chaser: What Should NOT Be in Your Medicine Cabinet

Public Health, Toxicology/Drugs, Health Prevention, , , , , , ,

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Ever notice that people run straight to the medicine cabinet to do harm to themselves or others? I want you to know the harder the effort is to obtain items to hurt oneself, the less likely one is to follow through on the notion. On another related note, here’s a quick not-so-fun-but-interesting fact. One of the differences between America and say, certain European countries is the oversized influence of corporations in the States. Why am I talking about that on a medical blog? Read on. If you can’t tell where I’m going with this, you’ll get it pretty quickly.

Here’s my top five items I want you to take out your medicine cabinets and lock up.

1. Any jumbo sized container of any medication. Think about two of the most common over the counter (OTC) medications used for suicide attempts: acetaminophen (Tylenol) and salicylate (aspirin). One thing they have in common is you can buy what amounts to a tub-full of it at your local superstore in the United States. They should call these things ‘suicide quantities’, because often those in the midst of a suicide attempt will grab and swallow whatever is convenient. Many different medications will hurt you if you take enough; Tylenol and aspirin certainly fit that bill. Observing that (and additional considerations after the deaths due to the lacing of Tylenol with cyanide back in 1983), the Brits decided to not only pass a law limiting quantities, but certain medications that are high-frequency and high-risk for suicide use are now mandatorily dispensed in those annoying containers that you have to pop through the plastic container. Needless to say, observed suicide rates by medication rates plummeted as a result. Wonder why that hasn’t been implemented in the good ol’ USA?

2. Have teens in your house? Lock up the Robitussin and NyQuil. Dextromethorphan is the active ingredient in over 100 OTC cold and cough preparations. Teens use these to get high, folks. To make matters worse, they are addictive, and if taken with alcohol or other drugs, they can kill you. Then there’s ‘purple drank’ (yes, that’s how it’s spelled), in which these cough syrups containing codeine and promethazine (Benadryl) are mixed with drinks such as Sprite or Mountain Dew.

3. Have any sexual performance medications? This is part of a category of medicines called ‘medicines that can kill someone with just one pill’. That usually refers to kids or the elderly, but remember that those sexual enhancement drugs are medicines that lower your blood pressure. In the wrong person and in the wrong dose, taking such medicine – whether intentionally or accidentally – could be the last thing someone does.

3. Any narcotic. Need I say more? Remember, you do have people rummaging through your cabinets on occasion!

4. Any sharps. That includes sewing pins, needles, etc.

5. Any medication with an expiration date. The medication date actually is more of a ‘freshness’ consideration than a danger warning. However, in the wrong patient, a medicine that has less than the 100% guarantee of its needed strength that the expiration date represents could be fatal. Play it safe and get a new prescription.

There’s a lot more that could be added to this list, but I like keeping things manageable for you.  Please childproof all your cabinets, and use childproof caps on your medications. I welcome your questions or comments.

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Straight, No Chaser: The Treatment of Erectile Dysfunction

Genital/Urinary, Medical Treatment, , , , , , , , , ,

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Well, here’s what many of you’ve been awaiting.  Assuming the preventative efforts I mentioned didn’t work for you, there are several different treatment approaches. If there’s an underlying medical cause, then treatment of that cause is not only a good way to relieve erectile dysfunction (ED), but it’s a good way to get healthy and avoid other complications from the primary disease. Today, I’ll review different treatment strategies your primary care physician or urologist may discuss or recommend to you for treatment.
The medications
A first consideration is to be wary of (any) medications via mail order. The same level of testing, scrutiny and quality control just doesn’t exist to the same degree as do medications obtained through a pharmacy. Reports abound of people receiving expired or weak formulations of the pills, as well as fake or hazardous substitutes of the pills they thought they were receiving. Engage at your own risk.
Now, regarding those medications you know all too well by name and brand (e.g. Levitra, Cialis and Viagra), there’s no special ‘magic’ to them. They all are variations of the same theme, physiologically relaxing muscles in the penis, resulting in increased blood flow to it.  Unfortunately, that’s not the entire story with these medications.  ED medications all lower blood pressure throughout the body, and that increased blood to the penis is coming at the expense of decreased blood flow elsewhere (This is called a ‘steal syndrome’.).  If you’re otherwise unhealthy, and your redirecting blood that was needed in the heart or brain, you could end up with a heart attack or stroke while taking these meds.  Therefore, this leads to two very important cautions regarding ED meds.  You shouldn’t start them without discussing with a physician first (to determine “…if you’re healthy enough to have sex”, as the commercials say), and secondly, don’t keep the fact that you’re taking them a secret (to your significant other, and especially to any physician you come across if you’re sick).  These medications could be the cause of whatever medical issue has you in an emergency room. They could also be contributors to life-threatening adverse effects if you’re being treated for something else with a medication that interacts with the ED med you’re taking but didn’t bother to mention to the emergency physician.  This is why ED medications generally aren’t given to men also on medications for high blood pressure, an enlarged prostate, blood thinners or certain other heart diseases (e.g. angina).
There are actually even more intricate medications used to treat ED.  Taking testosterone injections is an increasing means of addressing low hormone levels.  Additional injections directly into the penis or inserting a suppository into the penis itself are additional, effective treatment methods.  You’d be given these options by your urologist if necessary.
The counseling
If your ED is due  to anxiety, stress or other psychologically generated reasons, psychotherapy (possibly with your partner) may be of incredible assistance.  If you pursue this option, you and your partner must be prepared to be patient and to work through a variety of issues and possible approaches.
Surgery and additional methods

  • If you’ve ever seen an Austin Powers movie, you’re familiar with (well at least the jokes about) penis pumps.  These are real things, and involve placing a hollow tube over the penis and creating a vacuum to pull blood to the penis via a pump.  A tension ring is placed about the base of the penis to maintain the erection during intercourse.
  • Actual vascular surgery to repair damaged arteries may be indicated in certain cases.
  • Penile implants are an additional option.  Inflatable rods are placed into the sides of the penis.  These rods are simply inflated when needed.

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If you think some of this is a bit much, it may or may not be, depending on if you’re the one suffering.  As I usually conclude, prevention would have been a much better course of action.  Hopefully if that’s not the case, you’ve understood the information provided well enough to have an informed conversation with your physician.  Good luck, and I welcome your comments and/or questions.
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