Author: Michelle Fritsch, Pharm.D.

The Naughty List – Medications to AVOID when over age 65

Posted on by Michelle Fritsch, Pharm.D.

Slide1Did you know there is a list of medications to avoid over age 65? A group of physicians and other experts first published this type of list in 1991. Since that time, the list has been updated several times. The most recent update was released this October of 2015. The list is of medications for which there were safer, as effective options. Mark Beers is the physician who took the lead with these lists, so they are often called the ‘Beers List’.

Did you know that kidney function starts to decline – in the healthiest of people – around age 40? The liver also slows down as we age. The efficiency of the heart pumping is more than we need until about age 30, then it starts to slowly decline.

This is not all bad news. The body is designed to function for a very long time, even with the changes that occur with aging.

The more you keep yourself, and your body, healthy, the better you will feel for many years.

Getting back to the naughty list, these body changes slow how medications get out of the body. So often, a single dose will last longer in your 70’s than it did in your 30’s. This means some medications are dosed at a lower dose. Other medications are taken less often. And the Beer’s list medications should not be taken at all.

Beer’s list medications:

  • Anticholinergic medicines are very drying, increase risk of falls, increase confusion and constipation. A common example is diphenhydramine found in Benadryl, Tylenol PM, Aleve PM, and most over-the-counter sleep aids.
  • Certain blood pressure medicines that can make you very dizzy when you stand up – doxazosin, prazosin, terazosin, clonidine, methyldopa, nifedipine
  • Digoxin – if used, should be used a very low dose such as 0.125 mg daily
  • Some depression medicines like amitriptyline, imipramine, notriptyline, paroxetine have a lot of side effects. There are some effective antidepressants that are safe, have fewer anticholinergic (drying and confusion) effects, and less drop in blood pressure.
  • Benzodiazepines include alprazolam, lorazepam, oxazepam, temazepam, triazolam, clonazepam, diazepam. If you are taking one of these for anxiety, please talk with your doctor at your next visit about reducing and gradually coming off of this medication. They greatly increase your risk of falls, difficulty thinking, car crashes, and delirium.
  • Mineral oil. There are much safer remedies for constipation or any other use of mineral oil.
  • Meperidine is one of the most risky pain medications in older adults due to the slower ability of the body to get rid of it. Talk with your doctor about one of the many safer options.
  • Skeletal muscle relaxants include cyclobenzaprine, methocarbamol, orphenadrine, carisoprodol. These have anticholinergic (drying) effects, make you sleepy, and increase your risk of falls and fractures. In addition, they don’t have very good evidence that they are actually helpful.
  • Nonsteroidal pain medicines, especially indomethacin and ketorolac, can cause stomach bleeding and dizziness. Other common nonsteroidals are ibuprofen, Naprosyn, meloxicam, or etodolac.  If you take one of these, talk with your doctor about taking it with an acid blocking medication to help protect your stomach.

There are other medications on the list. Some are specifically hazardous if you have certain other medical conditions.

DO NOT STOP or change the way you take any medicine without first talking with your doctor.

This is a long list. Please discuss this with your doctor if you are taking any of these medications.

Or, please contact us at www.medsmash.com. We are experts in medications for adults over age 60. We can explain the list and any hazards in your medication list to you. Then, we can work with your doctors to make safer changes.

BIBLICAL APPLICATION

Here are two key ‘Nice Lists’. In these times of holiday activities and worldwide turbulence, I hope these bring hope and joy. The Bible says these are to help us glorify our God in Heaven.

THE FRUIT OF THE SPIRIT

Galations 4:22-23a ESV

But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control

THE BEATTITUDES

Matthew 5:3-12 ESV

3 “Blessed are the poor in spirit, for theirs is the kingdom of heaven.

4 “Blessed are those who mourn, for they shall be comforted.

5 “Blessed are the meek, for they shall inherit the earth.

6 “Blessed are those who hunger and thirst for righteousness, for they shall be satisfied.

7 “Blessed are the merciful, for they shall receive mercy.

8 “Blessed are the pure in heart, for they shall see God.

9 “Blessed are the peacemakers, for they shall be called sons[a] of God.

10 “Blessed are those who are persecuted for righteousness’ sake, for theirs is the kingdom of heaven.

11 “Blessed are you when others revile you and persecute you and utter all kinds of evil against you falsely on my account. 12 Rejoice and be glad, for your reward is great in heaven, for so they persecuted the prophets who were before you.

Some of the greatest gifts of the season can be love, tolerance, patience, and peace.

I will be praying for each of these for each of us.

Blessings,

Michelle

Skin – Is It Just for Beauty?

Posted on by Michelle Fritsch, Pharm.D.

SkinHere in this season of thankfulness and celebration, I offer you a part of yourself worthy of thanks and great care.

Did you know…

  • your skin is the largest organ of your body
  • your skin is your primary defense against infection
  • millions of bacteria live on your skin – and it’s a good thing
  • your skin sheds 50,000 cells every minute
  • you get a new layer of skin about every 28 days
  • your skin weighs about 9 pounds (for the average adult)
  • your skin covers about 21 square feet (for the average adult)
  • your skin plays a big role in regulating your body temperature
  • the melanin in your skin is responsible for its color

As our chief protector, our skin deserves some respect, care, and attention.

Burns

In this season of celebration, there is often a lot of cooking. For me anyway, that means an increased likelihood I’ll burn myself. If the same is true for you, here are some facts about treating your burns.

  • First, if a burn is larger than 2 inches, on a very tender area, or caused by a fire, electricity, or chemicals, go get it checked out by your doctor or the emergency room.
  • Cool the burn with cool (not cold) water.
  • For a minor burn, wash it with mild soap and water then cover with aloe vera or petroleum jelly (not butter, egg, cortisone, lotion, or oil).
  • Do NOT break blisters.
  • You can cover with nonstick gauze to help protect the burn.
  • If your doctor has approved you taking over-the-counter pain medicine like acetaminophen (brand Tylenol), ibuprofen (brand Motrin), or naproxen (brand Aleve), this can help control the pain. NOTE, avoid aspirin in children under 2 or people recovering from chickenpox or flu.
  • Do not scratch the burn as it heals (it will be itchy).
  • Consider a tetanus shot if you have not had a booster within the last 10 years.

Dry Skin

This is also the season where we often spend more time indoors with the heat on (if you’re in a more northern climate). This plus the blustery, drier air outside, can make your skin more dry. When your skin gets too dry, it can crack and lose its ability to protect you. Here are some tips to help you keep your skin moist:

  • Limit your bath/shower to 10 minutes and avoid very hot water.
  • Blot your skin dry gently after cleansing.
    • Apply an ointment or cream after cleaning. Note, these will moisturize better than a lotion, and you don’t have to buy the expensive products. I recommend the generic or store brand that’s on sale.
  • Choose ointments and creams without fragrance. Fragrances and other additives can further irritate skin.
  • Wear lip balm.
  • Protect your skin when outside with gloves, scarves, and hats.
  • As good as it feels, sitting in front of the fire or heater can further dry your skin.

Skin Cancer

1:5 Americans will have skin cancer in their lifetime. Be sure to show any changes in moles, spots, or other skin markings to your doctor. Use of sunscreen, even on cloudy days, helps protect your skin from harmful UV rays. The earlier a skin cancer is detected, the easier it is to treat, typically.

So, enjoy the beauty and festivity of this holiday season, and keep your chief protector, your skin, moist and healthy.

For more information about skin protection, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Are you afraid? Do you feel exposed and at risk?

I know several people who are dwelling on the events in the news. It seems there is so much bad news. There is so much killing and strife. Wars are being waged in new, frightening ways. People are living in fear of one another on the basis of superficial labels of race, religion, or skin color rather than the person inside the skin.

Protection from fear and evil is on many minds and being spoken about at many dinner tables.

I often read (and try to memorize) Psalm 121 at times like these. It begins with:

Psalm 121:1-8 ESV

I lift up my eyes to the hills. From where does my help come? My help comes from the Lord, who made heaven and earth. He will not let your foot be moved; he who keeps you will not slumber. Behold, he who keeps Israel will neither slumber nor sleep. The Lord is your keeper; the Lord is your shade on your right hand.

I encourage you to listen to ‘Praise you in this storm’ by Casting Crowns. It incorporates this Psalm into a beautiful message of hope in God. https://www.youtube.com/watch?v=EjZBZv_771o

There is hope at all times, even these times of turmoil. Jesus gives us the spoiler alert about how all things will ultimately resolve in Him.

John 16:33 NIV

“I have told you these things, so that in me you may have peace. In this world you will have trouble. But take heart! I have overcome the world.”

Consider how you can reach out to other hurting people and spread the light and love of Christ.

Blessings,

Michelle

Image source:  MedlinePlus; National Library of Medicine; National Institutes of Health; U.S. Department of Health and Human Services

Happiness, Hope, and Health

Posted on by Michelle Fritsch, Pharm.D.

Slide2What defines your best days?

When do you feel the most happy and free?

In your darkest days, what is your source of hope?

Scientists, philosophers, and every-day people have been asking these questions for centuries.

Interestingly, studies have shown that more money is not linked to happiness. Actually, more money is associated with higher depression and anxiety rates.

Thinking kindly about other people and helping other people is linked to health, living longer, and overall well-being. Rather than focusing on yourself and your own problems, who could benefit from your care?

Studies have repeatedly demonstrated that happier people are healthier people. It is fascinating that happier people don’t necessarily have more stuff, live with more innovations, or have more resources. This is especially true for psychological and emotional health.

Proposed keys to a happier and healthy life:

  • Feelings of enthusiasm, engagement, and hope
  • Feeling optimistic that good things are going to happen
  • Having supportive family and friends
  • Being able to bounce back from bad situations and make healthy choices

Some aspects of health go beyond diagnoses and medications. Perhaps those elements are at our deepest core and the ones that need the most attention.

Hope is integral to happiness. It is also a key aspect of recovery. It is the element that pulls you away from the slippery slope to negativity. Many people with hope usually believe in a higher power with a sense of spirituality.

So, again, ask yourself, what makes you happy? For what are you grateful? What is your source of hope? What changes can you make today to do something helpful for another person?

The answers could be your source of health.

For more information about the literature on this topic and the relationship between happiness, hope, and health, contact us at www.medsmash.com.

BIBLICAL APPLICATION

So what are the answers to the questions? God, your loving, merciful, forgiving, creator is the source of all hope. Have you experienced that grace? Are you confident in that unconditional love?

It is hard to imagine life without this source of hope. What would each day be like not knowing the God of the universe?

If you do not have a daily, personal relationship with God, keep reading.

God can be your source of hope to get beyond anything that has happened in the past, of strength in the present, and of excitement for the promises of the future.

Romans 12:12 ESV

Rejoice in hope, be patient in tribulation, be constant in prayer.

Romans 15:13 NIV

May the God of hope fill you with all joy and peace as you trust in him, so that you may overflow with hope by the power of the Holy Spirit.

Jeremiah 29:11 ESV

For I know the plans I have for you, declares the Lord, plans for welfare and not for evil, to give you a future and a hope.

You are deeply and unconditionally loved. God has big plans for you.

Bad things will still happen. Some days will be harder than others. Most of the future will be unknown. (But we know the ultimate outcome is eternal life in Christ!)

Romans 5:2-5 ESV

Through him we have also obtained access by faith into this grace in which we stand, and we rejoice in hope of the glory of God. More than that, we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope, and hope does not put us to shame, because God’s love has been poured into our hearts through the Holy Spirit who has been given to us.

May this hope and love be your source of happiness and health!

Blessings,

Michelle

Flu Shots – Do I REALLY need one?

Posted on by Michelle Fritsch, Pharm.D.

Most of us grew up Flu vaccine CDCbefore influenza (flu) shots were recommended for nearly everyone. We lived a lot of years just fine without them. Sure, we got sick for about a week sometimes, but we lived through it and got right back on track with our daily lives.

So why make such a big deal now about flu shots?

We are in the last week or so before flu cases start presenting here in the United States. According to the Centers for Disease Control (CDC), “Flu causes millions of illnesses, hundreds of thousands of hospitalizations and thousands of deaths every season.”

In 2013-14 less than half of eligible people in the country obtained a flu vaccine. For those who were vaccinated, there were 7.2 million fewer people sick with the flu, 3.1 million fewer doctor/clinic visits for flu, and over 90,000 fewer hospitalizations. In particular, there were 55% fewer hospitalizations in people over age 65.

This year (2015-16) the strains of flu covered in the vaccine are even better matched to the dangerous strains expected to cause illness this year. So, this year’s effectiveness will be better than 2014-15.

There are some common beliefs about flu vaccines that are NOT TRUE. Two key myths are:

  • The flu vaccine will make me get the flu
  • The flu vaccine causes problems like autism

The TRUTH is:

  • The flu vaccine is not a live form of the flu virus. It is a killed version that will stimulate your immune system to build resistance against the flu.
  • Many studies have been done that consistently show vaccines are not the cause of the rising number of children with autism. (Unfortunately the real cause(s) have not been found).

You have some options when getting your flu vaccine.

  • Regular vaccine in to your upper arm muscle.
  • High dose vaccine in to your upper arm muscle (approved for people at or over age 65).

Note, there is a live attenuated nasal vaccine. This is for people ages 2-49. There are several reasons why people may not be able to take the nasal vaccine, however, so please talk with us at Meds MASH and/or talk with your doctor about whether this option is good for you.

Be sure to let your doctor and whoever gives your vaccine if you are allergic to EGGS. Note, this is not a reason to avoid vaccination. There is a vaccine you can get. You will be watched more closely for a few minutes after your vaccine.

For more information about flu vaccines, please contact us at www.medsmash.com.

BIBLICAL APPLICATION

The flu vaccine can protect us against a week of feeling miserable (and maybe even more dangerous illness).

What protects us from the other miseries of the world?

The Psalms contain many promises about God’s protection for his people.

Psalm 34:7 ESV

The angel of the Lord encamps around those who fear him, and delivers them.

Psalm 17:8 ESV

Keep me as the apple of your eye; hide me in the shadow of your wings,

Psalm 18:2 ESV

The Lord is my rock and my fortress and my deliverer,

    my God, my rock, in whom I take refuge,

    my shield, and the horn of my salvation, my stronghold.

Psalm 46:1 ESV

God is our refuge and strength, a very present help in trouble.

Psalm 125:2 ESV

As the mountains surround Jerusalem, so the Lord surrounds his people, from this time forth and forevermore.

My Refuge and My Fortress Psalm 91  – check out this Psalm

You are not alone! Your deliverer and protector loves you dearly.

Blessings,

Michelle

Photo credit: Public Health Image Library cdc.gov

Hate and Health

Posted on by Michelle Fritsch, Pharm.D.

Slide1

Hate and negativity are bad for your health.

Holding grudges, blame, racism, oppression, and social isolation have all been linked to poorer health.

Having

  • friends to talk to
  • people who care about you
  • a sense of self-worth
  • forgiveness
  • security
  • conflict management skills
  • religion/spirituality

have all been linked with improved health.

Bad things happen to everyone. Some of these bad things are worse than others.

Every relationship has times of negativity. No person is perfect.

Prolonged negativity with no ability to cope has been linked to mental health and physical health decline.

Negativity can lead to heart disease, diabetes, depression, anxiety, fibromyalgia, and more.

The health effects of negativity are even more pronounced in people over age 65. All life phases introduce change. Post-retirement these changes can include social networks, family dynamics, physical mobility decline, vision and hearing issues, limited income, home downsizing, new diagnoses, and recognition of mortality.

When harbored resentments, self-pity, and rejection are included, the negative health impact can be dramatic.

Are you living in negativity?

What could you do to let go of hurts, find sources of happiness, and reclaim your health and contentment?

For more information about the link between negativity and health, contact us at www.medsmash.com.

BIBLICAL APPLICATION

The ‘Golden Rule’ holds the key for happy living. Imagine if everyone treated everyone else with the same kindness, understanding, and forgiveness they want for themselves.

Over 20 world religions have very similar versions of the Golden Rule. This concept of loving, honoring, and being tolerant of each other benefits everyone.

Matthew 7:12 NLT

The Golden Rule

Do to others whatever you would like them to do to you. This is the essence of all that is taught in the law and the prophets.

Not only are we called to treat each other as we like to be treated, we are called to love each other – even those who hurt us. Wow, talk about radical love!

Luke 6:35 NLT

Love your enemies! Do good to them. Lend to them without expecting to be repaid. Then your reward from heaven will be very great, and you will truly be acting as children of the Most High, for he is kind to those who are unthankful and wicked.

Ephesians 4:32 NIV

Be kind and compassionate to one another, forgiving each other, just as in Christ God forgave you.

Luke 6:37 NIV

Do not judge, and you will not be judged. Do not condemn, and you will not be condemned. Forgive, and you will be forgiven.

Then, we are called to go another step forward…

Romans 12:14-21 NLT

Bless those who persecute you. Don’t curse them; pray that God will bless them. Be happy with those who are happy, and weep with those who weep. Live in harmony with each other. Don’t be too proud to enjoy the company of ordinary people. And don’t think you know it all!

Never pay back evil with more evil. Do things in such a way that everyone can see you are honorable. Do all that you can to live in peace with everyone.

Dear friends, never take revenge. Leave that to the righteous anger of God. For the Scriptures say,

“I will take revenge;

    I will pay them back,”

    says the Lord.

Instead,

“If your enemies are hungry, feed them.

    If they are thirsty, give them something to drink.

In doing this, you will heap

    burning coals of shame on their heads.”

Don’t let evil conquer you, but conquer evil by doing good.

So we are called to love, honor, respect, and care for those who hurt us. God knows about each of those hurts. He will take care of the justice. Our role is faith and following God’s plan (which is way different than normal human response).

When we release the hurts and negativity, we are free to live unencumbered in true joy and peace.

Philippians 4:8 ESV

Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things.

May this happiness and joy be yours!

Blessings,

Michelle

Antibiotic Resistance – REALLY, you should take them all

Posted on by Michelle Fritsch, Pharm.D.

meds and bottleWe are coming into infection season. Colds, the flu, bronchitis, sinus infections, ear infections, pneumonia, and more seem to occur more often as the we stay inside in the colder weather.

Should all infections be treated with an antibiotic? NO

If your infection is from a virus then an antibiotic will provide NO HELP.

If your infection is mild, and your immune system is strong, you can often fight the infection without an antibiotic.

If you do require an antibiotic, have you ever been tempted to take it until you feel better then stop and save the rest for next time? DON’T DO IT!

If you take nothing else from this blog, please take your entire course of antibiotics.

Antibiotics can either weaken an infection until your body’s immune system can completely get rid of it or kill the bacteria. Either way, if the antibiotic is stopped once most of the bacteria are weak or killed, then those few bacteria that are not weak or killed can come back. When they do come back, they can also change just enough that the antibiotic will no longer work.

Antibiotic resistance, when bacteria stop responding to a particular antibiotic, is dangerous. It requires more advanced antibiotics which have more side effects and have a broader effect. Then, if resistance develops to those (usually when the full course is not taken), then even more advanced antibiotics are needed.

When this happens too much you can become resistant to many antibiotics. Also, when this happens over time, entire communities can get strains of bacteria that don’t respond to the usual antibiotics.

I share this to beg you to take every last dose of your antibiotics if you need them this year.

To help you avoid infections, please wash your hands frequently. Especially when you are out in public touching door handles, shopping cart handles, restaurant tables and chairs, etc, you are increasing your risk of picking up a virus or bacteria. When your hands dirty, avoid touching your face, mouth, eyes, and nose.

Have a healthy fall and winter!

For more information about antibiotics and treatment for colds and flu,contact us at www.medsmash.com.

BIBLICAL APPLICATION

It is tempting with antibiotics to stop them once you feel better. But, when you do that, you run the risk of an even more difficult-to-treat infection.

The spiritual equivalent is taking partial doses of all God has to offer. Maybe you go to church once a week and occasionally read the Bible.

Your limited doses of spiritual time can give you glimpses of all of the wonder and glory and peace and joy that is yours in Christ, but not the full view.

Galatians 5:22-23 ESV

But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control; against such things there is no law.

John 14:17 ESV

Even the Spirit of truth, whom the world cannot receive, because it neither sees him nor knows him. You know him, for he dwells with you and will be in you.

Romans 14:17 ESV

For the kingdom of God is not a matter of eating and drinking but of righteousness and peace and joy in the Holy Spirit.

Matthew 5:6 ESV

“Blessed are those who hunger and thirst for righteousness, for they shall be satisfied.”

Putting Christ first in your life, taking full doses of all He has to offer you, will lead to joy and peace beyond what you can imagine.

Little doses give glimpses. Full doses can change your life forever!

Blessings,

Michelle

Image credit: Centers for Disease Control Public Health Image Library

Breast Cancer Treatment

Posted on by Michelle Fritsch, Pharm.D.

697px-Pink_ribbon.svgIt is Breast Cancer Awareness Month. We are seeing pink in all directions.

Breast cancer is the most common type of cancer in women (with the possible exception of some skin cancers).

One in eight women will be diagnosed with invasive breast cancer.

Ductal carcinoma in situ is a type of breast cancer that is contained in the duct, so it is not an invasive breast cancer. Another 60,000 women will be diagnosed with this during the year.

The risk of breast cancer increases with age and seems to peak in the 70’s.

All women at all ages should get regular mammograms. These can find the cancer early. Most guidelines recommend every year starting at age 40. This screening should continue for as long as a woman is still loving and living life! You might have heard on the news this week the American Cancer Society has changed its guidelines for annual mammograms. For woman at average risk for breast cancer, these new guidelines are to start at age 45 and go to every other year at age 55. Note, for women at high risk, screening starts earlier and remains yearly.

When a diagnosis is made, find a breast cancer center who can support you through each decision and each phase that follows. You want to be surrounded by a team of caring professionals who are patient and explain everything until you fully understand.

Surgery, radiation, chemotherapy, and medications are often parts of the treatment options. Different combinations of these treatments will be used based on the important specifics of your cancer and your preferences.

When breast cancer is estrogen-responsive, the following medications are often part of the treatment regimen.

Tamoxifen is often used after diagnosis and initial treatment. It can also be used to lower breast cancer risk in high risk women. It is an antiestrogen medication, so it decreases the impact of estrogen that often drives the changes that lead to breast cancer. The typical length of treatment has been five years. There is new data that it should be taken for 10 years in some women with breast cancer. Be sure to discuss this with that great team of providers you have to see how long you should take it. The main side effects are hot flashes and changes in your menses if you are premenopausal. Tamoxifen can also cause fatigue and increase your risk of clotting.

Aromatase inhibitors are another class of medication sometimes used as part of the treatment for breast cancer or to prevent breast cancer in high risk women. There are three medicines currently in this class. They are anastrazole (brand Arimidex), exemestant (brand Aromasin), and letrozole (brand Femara). These medications decrease the available estrogens by stopping the conversion of androgens to estrogens. These medications can increase your cholesterol and decrease your bone density (increase your risk for osteoporosis). They can also cause hot flashes and fatigue.

Some women take one of the above medications. Others take one type for a period of time then switch to the other. Which type of medication and for how long is an important decision made with your healthcare providers. The decision is based on some tests about your specific type of cancer, its responsiveness to estrogen, any other medical conditions you have, and your preferences.

I highly encourage you to discuss the benefits of the medications and any risks, including side effects, with your cancer treatment team. Your pharmacist is another source of detailed information about these and other medicines.

For more information about breast cancer treatment medications, contact us at www.medsmash.com.

If you want to get more involved in the search for a cure, I encourage you to read about the Army of Women organized by Dr. Susan Love. This program has made millions of volunteer women sources of new data in the search for a cure. I have participated in a couple of studies. It takes little time. One study collected only information. The other did a bone scan. No tests or procedures or data will be taken from you without your full consent. You can made a difference!

Biblical Application

Diagnoses such as breast cancer can invoke many feelings. One of those can be a fear of loss. Even before diagnoses are finalized, options are considered, prognoses are made, our minds can take us down paths of fear, anxiety, depression, hopelessness, futility, or impending doom.

God is aware of our needs and our weaknesses. He knows how our mind works when faced with a diagnosis like this.

The Bible is full of verses of hope and assurance. You truly can lean on God in all situations, no matter how frightening they may seem.

Isaiah 41:10 ESV

Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand.

Philippians 4:6-7 ESV

Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus.

Psalm 56:3 ESV

When I am afraid, I put my trust in you.

2 Timothy 1:7 ESV

For God gave us a spirit not of fear but of power and love and self-control.

Deuteronomy 31:6 ESV

Be strong and courageous. Do not fear or be in dread of them, for it is the Lord your God who goes with you. He will not leave you or forsake you.”

Claim and cling to this hope, love, and assurance that is yours in Christ. You are never alone. You are never abandoned. You are eternally loved.

I encourage you to share this hope beyond understanding with anyone you know facing breast cancer. You can be a light in their dark time, especially if they have not experienced the power of your God.

“Again and again, I’ve found Him faithful to respond and the closer I move to Him, the safer I feel and the better I rest.”

Patsy Clairmont

Blessings,

Michelle

Image thanks to MesserWoland – own work created in Inkscape, based on the graphics by Niki K

Medications to avoid when over age 65

Posted on by Michelle Fritsch, Pharm.D.

Slide1

Since 1991 there has been a group of geriatricians and other physicians identifying medicines that might be inappropriate in people over age 65. Dr. Mark Beers originally led this group, so it is called the ‘Beers Criteria’. This list has been updated every few years. The most recent update was this month.

The medications on this list have SAFER and/or MORE EFFECTIVE options available.

Some of the reasons for medications to make the list include:

  • blood pressure lowering medicines that cause more dizziness and falls than other options
  • medicines with anticholinergic (very drying) effects that can have several negative effects including worsening memory
  • anxiety medicines that cause thinking/memory problems and falls
  • depression medicines that cause several problems
  • allergy medicines that cause drowsiness, driving accidents, and falls
  • medicines that are cleared from the body through the kidneys which slow down with age
  • medicines that are cleared from the body through the liver which can slow down with age
  • medicines that are ok at low doses but dangerous at high doses
  • medicines that can cause delirium
  • medicines that can worsen memory
  • medicines that can cause constipation
  • medicines that can make urination with prostate enlargement even more difficult

This year, for the first time, guidelines for safer options to replace these dangerous medicines were written. This is exciting news!

If you are over 65, please talk with your prescribers about these lists of potentially inappropriate medicines and these lists of safe alternatives.

For a personal evaluation of your medicines, please contact www.medsmash.com.

Biblical Application

In your daily walk with God, what are the most effective steps and activities? What does the Bible say you should do regularly?

And, where are the pitfalls? What should you avoid?

Just as the Beers List guides prescribers to select the most beneficial and safest medicines, the Bible guides our spiritual practices. Your heart, your tongue, your thoughts, your study, your time, and your actions are included in this guidance.

Romans 12:2 ESV

Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.

Colossians 3:5-10 ESV

Put to death therefore what is earthly in you: sexual immorality, impurity, passion, evil desire, and covetousness, which is idolatry. On account of these the wrath of God is coming. In these you too once walked, when you were living in them. But now you must put them all away: anger, wrath, malice, slander, and obscene talk from your mouth. Do not lie to one another, seeing that you have put off the old self with its practices and have put on the new self, which is being renewed in knowledge after the image of its creator.

James 1:19-20 ESV

Know this, my beloved brothers: let every person be quick to hear, slow to speak, slow to anger; for the anger of man does not produce the righteousness of God.

Ephesians 4:32 ESV

Be kind to one another, tenderhearted, forgiving one another, as God in Christ forgave you.

James 1:22-27 ESV

But be doers of the word, and not hearers only, deceiving yourselves. For if anyone is a hearer of the word and not a doer, he is like a man who looks intently at his natural face in a mirror. For he looks at himself and goes away and at once forgets what he was like. But the one who looks into the perfect law, the law of liberty, and perseveres, being no hearer who forgets but a doer who acts, he will be blessed in his doing. If anyone thinks he is religious and does not bridle his tongue but deceives his heart, this person’s religion is worthless. Religion that is pure and undefiled before God, the Father, is this: to visit orphans and widows in their affliction, and to keep oneself unstained from the world.

There are certainly many more verses that guide our lives. These can be a start in developing a strategy to avoid inappropriate, dangerous behaviors and replace them with life-giving, holy options.

Blessings,

Michelle

Triggers – Asthma and COPD

Posted on by Michelle Fritsch, Pharm.D.

inhaler imageThere are so many things that can bring on an asthma attack making it hard to breath. Some examples are:

  • Perfume
  • Smoke
  • Dust
  • Weeds
  • Pollen
  • Foods
  • Pets
  • Exercise
  • Cool, damp air

People with asthma can go from feeling fine to struggling for breath in just a few minutes.

The same thing can happen to some people with chronic obstructive pulmonary disease (emphysema or chronic bronchitis). Not all people with COPD have an asthma-like component, but some do.

There are medications that can help PREVENT these sudden attacks.   There are also medications that can reopen the airways to TREAT these attacks.

The medications used most often are given by inhalers. This allows the medication to go to the lungs where it is needed without having such a big impact on the rest of the body. This cuts down on side effects.

If you are prescribed inhalers, it is important to take them regularly and as prescribed, especially the ones taken one to times per day.   They are intended to PREVENT these attacks. They will not be helpful if only taken once in awhile during attacks. They need to be taken every single day.

The ones you take as needed should be taken with careful technique. They won’t work if they aren’t used properly. This is harder than it sounds. Be sure your doctor or your pharmacist has shown you step by step how to use your inhalers. Then, show them how you use them to be sure your technique is correct.

One more thing, be sure to always rinse out your mouth and spit out the water after using a steroid inhaler. These inhalers are very effective at preventing attacks, but they can also make it easy to get an infection in your mouth that is painful. Rinsing your mouth after EACH use cuts way down on the risk of this mouth infection.

Inhalers save lives. But they must be taken at the right times and with the right technique.

For more information, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Not only are there triggers for asthma attacks, we often have triggers that get us off track on our day and in our spiritual walk. These can be things that distract us, things that confuse us, and often things that make us angry.

What are those topics that you feel so strongly about you just have to chime in to conversations about them? Maybe you can ignore some things and let them slide on by. But, what are the things that you just have to participate in the discussion?

What are the things that make you really angry? What are your hot button triggers that send you into a rage?

We all have them. It’s the way we are ‘wired’. Just as there are medications that can prevent the sudden reaction to asthma triggers, there are steps we can take to reduce our reaction to our life triggers.

First, throughout the Bible we are reminded that anger should be contained.

Ephesians 4:26-27

Be angry and do not sin; do not let the sun go down on your anger, and give no opportunity to the devil.

James 1:19-20 ESV

Know this, my beloved brothers: let every person be quick to hear, slow to speak, slow to anger; for the anger of man does not produce the righteousness of God.

Proverbs 29:11 ESV

A fool gives full vent to his spirit, but a wise man quietly holds it back.

Proverbs 19:11 ESV

Good sense makes one slow to anger, and it is his glory to overlook an offense.

Proverbs 15:1 ESV

A soft answer turns away wrath, but a harsh word stirs up anger.

Proverbs 15:18 ESV

A hot-tempered man stirs up strife, but he who is slow to anger quiets contention.

There are at least 60 verses in the Bible dealing with anger management. James sums up the instruction well:

James 4:1-2 NIV

What causes fights and quarrels among you? Don’t they come from your desires that battle within you?  You want something but don’t get it. You kill and covet, but you cannot have what you want. You quarrel and fight. You do not have, because you do not ask God.

Take time to consider and identify your triggers. Again, we all have them. Then, take them to God to help you avoid them or handle them with grace rather than anger.

Blessings,

Michelle

Image credit: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services

Getting Better – It Takes More than a Prescription

Posted on by Michelle Fritsch, Pharm.D.

ID-10093880Do you have a health issue? If so, you just need a prescription, and you’ll be all better, right?

Huey Lewis sang that he ‘wanted a new drug’. His proposed ‘new drug’ had no side effects and made him feel like he felt when falling in love.

Does that describe the prescriptions that you take?

Unfortunately it’s just not that easy.

All medications have side effects. Many medications have very specific instructions to use them in a way that leads to the best possible outcome.

But, we are all busy. Who has time for those pesky details? Does it REALLY matter if you take it with food or first thing in the morning when you brush your teeth? If you take two when you remember them vs one in the morning and one at night, that’s ok, right? Do you really have to breathe in some special way when you use an inhaler? You just squirt it in, right?

To get the most benefit from your medications – and – to minimize your side effects, these details are very important. Let’s explore some of the types of important details.

Timing – If your medication is to be taken more than one time per day that means it doesn’t last a full 24 hours. To keep the medication active in your body, you need to take it more than once. If you take it too close together, you will get more than a full dose while the two doses overlap. This can increase your side effects or even be dangerous because you have too much medication. If you miss a dose, you will have time with little or no medication in your system to treat your condition.

Food – Some medications will bind to medication in the stomach and not be absorbed. So, you will get no medication in your body if you take it with food. Other medications will make you sick to your stomach if you don’t take them with food. Food will decrease or prevent that side effect of feeling nauseous.

Finishing early – Some conditions require that the whole bottle/set of medications be taken. Often we think once we feel better we’ll just stop taking the medication. Sometimes we even keep the extra in case we need them another time. Some medications, like antibiotics, need to be taken until all are gone. You start feeling better when the bacteria is made weak, but it is not gone yet. If you stop the antibiotic when you feel better, the bacteria can get strong again. Often that same antibiotic won’t weaken the bacteria the next time, so you will need to be on an even stronger antibiotic.

Finishing too quickly – Other medications need to be gradually taken away rather than stopped all at once. Your body can’t take back over all at once if you have been taking these medications. Examples are beta blockers for high blood pressure and prednisone for inflammatory reactions. The gradual taper of these medications is essential to avoid severe side effects. (Note, this DOES NOT mean you are addicted.)

Technique – Inhalers, eye drops, ear drops, injections, patches, suppositories, and other medication forms can be difficult to use correctly. If you don’t use them just right, you won’t get the full benefit of the medication. This is a waste of money, and more importantly, won’t help you feel better. For some of these medications, correct use can even be the difference between getting better and calling 911.

So, I highly encourage you to pay attention to these details about your medications. If you see instructions you don’t understand or know their purpose, ask your pharmacist. Pharmacists are there to explain, demonstrate, and help you get the most from your medications.

For more information, contact us at www.medsmash.com

BIBLICAL APPLICATION

What are the quick fixes to Heaven? What is the way to assure entry then get on with the busy-ness of life?

First, God’s every desire for you to live eternally in Heaven is clear in the Bible. The basics of the path to God are below.

John 3:16 ESV

“For God so loved the world, that he gave his only Son, that whoever believes in him should not perish but have eternal life.

John 14:6 ESV

Jesus said to him, “I am the way, and the truth, and the life. No one comes to the Father except through me.

Ephesians 2:8-9 ESV

For by grace you have been saved through faith. And this is not your own doing; it is the gift of God, not a result of works, so that no one may boast.

Once you have had the amazing experience of finding God, and you have welcomed Him in to your life, what next?

Do you then work hard to earn God’s love? No, God loves you no matter what. His grace covers anything you do or do not do.

Do you then go on about your business now that this task is done?

Timing – Filling your life with God is an all-of-the-time, every day, all times of day opportunity. I don’t think any of us take advantage of this fully. Not a single one of us is perfect. But, God’s grace is always there for you!

Food – The Bible, the word of God, is your nourishment. This is not a one-time read that then goes on the shelf. Each time you read it, you will learn new things. God has so much to share with you!

Finishing early – It can be tempting to make this life-altering, life-filling decision to dedicate yourself to God. It can then be easy to move on to other things. God wants to be in close contact with you all of the time, good times and bad, busy times and leisure. I highly encourage you to experience this close daily walk with your God!

Jesus states there are two main rules for life for us.

Mark 12:30-31 ESV

And you shall love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength.’  The second is this: ‘You shall love your neighbor as yourself.’ There is no other commandment greater than these.”

This prescription to walk with God is a daily, sometimes even minute-to-minute, dose that is always available. And the side effects are wonderful!

Blessings,

Michelle

Image courtesy of rakratchada torsap at FreeDigitalPhotos.net