liver

When the simple is complex

When Something so SIMPLE is NOT so simple – Tylenol®

Posted on by Michelle Fritsch, Pharm.D.
When the simple is complex
When simple pain meds aren’t so simple

How often have you reached for simple acetaminophen (brand name Tylenol®) in your life? It is the go-to remedy for so many symptoms. It will reduce a fever, help with a headache, and help with general aches and pains.

Note, acetaminophen is the generic name. The generic version works just the same as the brand Tylenol® version. It is sometimes abbreviated APAP. So, Tylenol® = acetaminophen = APAP.

#1 treatment of osteoarthritis

Do you have arthritis? I know I do. Most of us (about 90%) have osteoarthritis. This is a condition where the cartilage coating our joints has worn away. There is now pain where bone is rubbing against bone. Your main symptoms are usually pain when you use the joint, stiffness, weakness (from your tendency to use it less), and crackling sounds.

I know I can no longer sneak up on my teenagers when I climb the stairs. My gravely sound in my knees is easy to hear.

The American College of Rheumatology, the main group of specialist doctors who treat arthritis, recommends acetaminophen for osteoarthritis.

Safer than NSAIDs (ibuprofen = Motrin®, Advil®; naproxen = Aleve®, Naprosyn®)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain. They treat pain in a way just like acetaminophen, and they also help with inflammation.

There are three big risks associated with these that I want you to know about:

  1. They can be hard on your kidneys. Be sure your doctor and your pharmacist know that you take these, how much you take, and which ones you take. They will monitor your kidney function and likely ask you to stop taking them if your kidneys show signs of injury.
  2. They can be hard on your stomach. Your risk of stomach ulcer goes up when you take these. ALWAYS take them with FOOD. If you develop stomach pain, more indigestion, reflux, or burning, tell you doctor.
  3. They can raise your blood pressure. This in turn can increase the stress on your heart. If you have high blood pressure or a heart condition, talk with your doctor and pharmacist BEFORE choosing to take an NSAID.

Risks of acetaminophen – not so simple

Acetaminophen is safe, but not completely safe. It has some risks. The biggest risk is when we take too much. And taking too much, is VERY EASY to do.

Sometimes people don’t realize that Tylenol® and acetaminophen are the same thing. When in pain, they take both thinking they are different medicines.

Many opioid pain medicines contain acetaminophen (APAP). Here are some examples:

  • Percocet® (oxycodone and APAP)
  • Roxicet® (oxycodone and APAP)
  • Endocet® (oxycodone and APAP)
  • Norco® (hydrocodone and APAP)
  • Vicodin® (hydrocodone and APAP)
  • Lortab® (hydrocodone and APAP)
  • Lorcet® (hydrocodone and APAP)
  • Tylenol #3® (codeine and APAP)
  • Tylenol #4® (codeine and APAP)

Many cough/cold/flu medicines also contain APAP. Some examples are:

  • Contac Cold & Flu
  • Theraflu
  • Alka Selzer plus Cold
  • Vicks Sinex
  • Comtrex

Too much acetaminophen in a day can damage your liver. The most that should be taken in a day is 4,000 mg (8 Extra Strength 500mg tablets). A group of experts is supporting a change so people use 3,000 mg or less. This will decrease the chance of people taking too much if their combination medicines have some ‘hidden’ acetaminophen.

The other important factor is alcohol. It is best to not drink alcohol when taking acetaminophen. Both make the liver work hard. Each can damage the liver when the liver is overworked. It can hurt your kidneys, too. If drinking while taking acetaminophen, please not every day and not beyond 1-2 drinks.

For more information about best use of acetaminophen, contact us at www.medsmash.com/contact, 410-472-5078, or michelle@medsmash.com. We can assess all of your medication regimen to screen for hidden acetaminophen.

BIBLICAL APPLICATION

Oh my, isn’t this also true of our Christian walk? The rules are ‘simple’ – Love the Lord your God and your neighbor as yourself.

Love, love, love!

It is good for you, it is good for others, it’s so simple!

I can give a list of the people I have hurt, offended, taken for granted, or overlooked in the last day or two.   I get distracted, frustrated, caught up in work, or frazzled. There is no excuse. My intention is to spend each day expressing God’s love. And, each day, I fall short of my well-intentioned goal.

Paul describes his own struggle with this in Romans Chapter 7.

Romans 7:14-25 NIV (underline emphasis mine)

We know that the law is spiritual; but I am unspiritual, sold as a slave to sin. I do not understand what I do. For what I want to do I do not do, but what I hate I do. And if I do what I do not want to do, I agree that the law is good. As it is, it is no longer I myself who do it, but it is sin living in me.  For I know that good itself does not dwell in me, that is, in my sinful nature.[c] For I have the desire to do what is good, but I cannot carry it out. For I do not do the good I want to do, but the evil I do not want to do—this I keep on doing. Now if I do what I do not want to do, it is no longer I who do it, but it is sin living in me that does it.

So I find this law at work: Although I want to do good, evil is right there with me. For in my inner being I delight in God’s law;  but I see another law at work in me, waging war against the law of my mind and making me a prisoner of the law of sin at work within me.  What a wretched man I am! Who will rescue me from this body that is subject to death?  Thanks be to God, who delivers me through Jesus Christ our Lord!

So then, I myself in my mind am a slave to God’s law, but in my sinful nature[d] a slave to the law of sin.

Why can’t we follow this simple rule of love?

Living in love means turning away from fear and selfishness*. We are so hardwired to think of ourselves first and foremost. It is a true choice (sometimes a very difficult choice) to put other people first. True love as demonstrated by Jesus is not selfish.

1 Corinthians 13:4-7 NIV

Love is patient, love is kind. It does not envy, it does not boast, it is not proud.  It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs.  Love does not delight in evil but rejoices with the truth.  It always protects, always trusts, always hopes, always perseveres.

Can you imagine our world if we all lived in perfect love, as we were designed to live? Can you imagine each person you see treating you with love and respect? Can you imagine a world without conflict?

It is coming!

Blessings,

Michelle

* This is a reminder of a book I have been recommending that addresses this conflict between fear/selfishness and love. The God-Shaped Brain by Timothy R. Jennings, MD.

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Your amazing liver

Your Amazing Liver – what does it do exactly?

Posted on by Michelle Fritsch, Pharm.D.
Your amazing liver
Your liver breaks down medication and many other functions.

You have a liver. Do you have any idea what it does? I would venture a guess that most people don’t.

The liver sits in the upper right quadrant of your abdomen. When your doctor presses on your abdomen and puts fingers up under your ribs, that is what is being checked. Usually they won’t feel it or maybe just feel the very edge.

The liver has several functions:

  • Clotting factors in your blood are produced
  • Proteins in your blood are produced
  • Triglycerides and cholesterol are made
  • Stores vitamins
  • Removes toxins, such as ammonia, from the blood
  • Processes nutrients from our food
  • Regulates sugar in the blood
  • Metabolizes (breaks down) alcohol and medications

Of course it is the medication part that I am anxious to talk about.

What does the liver do to medication?

There are several types of enzymes in the liver.

These enzymes change the form of medications. They usually break medications down to a less active form. This also allows the medication to be processed and then to leave the body. If this slows down, then the medication stays in active form longer giving the medication a bigger effect and making it last longer.

Different medicines are broken down by different enzymes. Most of these enzymes are cytochrome P450 (CYP450)enzymes. There are several different CYP450 enzymes, each impacting different medications.

Some people have genetic differences that change those enzymes. For instance, a particular enzyme can be less active in some people based on their genes. This will make that medication more active, sometimes even toxic, for that person. It is becoming more common for people to be tested for any genetic changes that can help guide best medication use.

When there is more than one medication that is metabolized by the same enzyme that can change how those medications are broken down. This is where it really gets complicated. Some medications will induce the enzyme, or make it more effective. Others will inhibit the enzyme making it less effective. While others compete for the activity of the enzyme. These actions and interactions impact how well the medicine works and the amount of side effects it will have.

Even tobacco, some food, and herbs can impact the enzymes.

So, when your pharmacist is filling your prescription, there is SO MUCH more they are looking at than just getting the right number of tablets in to the bottle. The potential interactions need to be carefully screened each time any of your medicines are changed.

AND, this screening can only be complete if your pharmacist also knows what herbs, vitamins, over-the-counter, and other substances you take.

Pay attention to the extra instructions on your medicine label. These liver enzymes are often the reason for special instructions such as ‘avoid grapefruit’ or take at particular times of the day (to separate from other medications).

If you would like to know more about the liver and how liver enzymes impact medications, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Just as the liver has a very specific function within the body, each element of the armor of God has a specific function.

Ephesians 6:10-17 NIV

Finally, be strong in the Lord and in his mighty power.  Put on the full armor of God, so that you can take your stand against the devil’s schemes.  For our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms.  Therefore put on the full armor of God, so that when the day of evil comes, you may be able to stand your ground, and after you have done everything, to stand.  Stand firm then, with the belt of truth buckled around your waist, with the breastplate of righteousness in place, and with your feet fitted with the readiness that comes from the gospel of peace.  In addition to all this, take up the shield of faith, with which you can extinguish all the flaming arrows of the evil one.  Take the helmet of salvation and the sword of the Spirit, which is the word of God.

To take advantage of the full protection available to you, put on each piece of armor. Keep each functioning in its most complete and efficient form through prayer and reading the Bible.

If you’ve so much as glanced at the news in the last few weeks, you know that the ‘power of this dark world’ seems to be out in full force. People are hurting people all over the place.

Go out into this hurting world with your truth, righteousness, faith, assurance of salvation, and the Word securely in place.

Now is the time to have some scripture memorized or in your phone where you can reinforce your own understanding or reach out to others in an instant. That sword of the Spirit might be just what someone needs.

I’m praying for the hurt, the evil, the grief, the biases, the fear that separates us from each other and from turning to the love of God. May you be a light in this darkness.

Blessings,

Michelle

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