The Benefits of the Flu Shot Usually Outweighs the Risks

It’s that time of year again, you see everyone pushing their Flu (Influenza) Shots. Your doctor, pharmacy, local grocery store and many others are all having flu shot clinics. There will be about 143 million doses produced this year which would be the most ever. You need to understand the risks and the benefits of the flu shot in order to decide if it is something you should get.

What is influenza (The Flu)?

Influenza is a contagious respiratory infection caused by the influenza virus. It can cause fever, chills, dry cough, sore throat, headache, muscle ache and extreme tiredness. The symptoms are similar to a cold (a different virus) but can be much more severe. Also the flu symptoms usually come on suddenly and with a high fever. It is impossible to diagnose the flu from symptoms alone, but your doctor can identify it with a test. If you get the flu, go to the CDC website for information on how to treat it.

What is the influenza vaccine (the flu shot)?

The Flu Shot is an inactivated (killed – and cannot cause the flu) form of the virus which is injected into the muscle. After the injection is given it takes the body up to 2 weeks to develop immunity to the virus. Because the virus is always changing, the virus itself is different every year. An attempt is made to identify the 3 most likely strains to cause illness and the vaccine is created with these strains. When the vaccine closely matches the virus causing illness it provides good protection during flu season. When the match is not so good there is still some protection available by having taken the shot.

What are the risks of getting the flu?

In the United States, the number of people hospitalized due the flu is approximately 226,000 people. Also, about 36,000 people die due to the flu. Most of these people are elderly. Even if you are not hospitalized, you can become very sick and could have other complications such as bacterial pneumonia, ear infections, sinus infections and dehydration. If you have medical conditions such as asthma, diabetes or heart failure you could have a worsening of these conditions as a complication of the flu.

What are the risks of the flu shot?

The flu shot is inactivated virus so you cannot get the flu from the vaccine.

Some mild side effects form the vaccine are soreness, redness and swelling at the injection site, fever, and aches. These problems are usually mild and last only one to two days.

Some severe problems are also associated with the flu shot but they are considered to be very rare. One of these problems is a life threatening allergic reaction. If this does occur it is usually within a few minutes to a few hours of the shot. This is believed to be most likely due to the egg protein used to make the shot. There is also a very small chance (1 or 2 cases per million vaccinations) of getting Guillain-Barre´ Syndrome but a definite relationship to the flu shot has not been established.

There is also a concern with a preservative use to make some of the vaccines available on the market. The preservative is thimerosal and it has been associated with autism in children and Alzheimer’s in the elderly. The Centers for Disease Control and Prevention (CDC) has stated the evidence does not support a link to thimerosal. (CDC Statement on Autism and Thimerosal) If you are concerned about this issue there are some flu vaccines labeled as “thimerosal free”.

Who should get vaccinated?

According to the CDC you should get vaccinated if:

• you are between 6 months and 18 years old or greater than 50 years old
• you are pregnant
• you have heart, kidney, liver or lung disease, diabetes, asthma, or anemia
• you have HIV/AIDS
• you are having cancer treatment with radiation or drugs
• you are taking drugs that suppress the immune system (including steroids)
• you live in a nursing home or other long term care facility
• you are a health care provider
• you have contact with or care for any of the above people
• you are a police officer, firefighter or provide any other essential community service
• you live in a dorm, jail or other crowded facility
• travel to the southern hemisphere between April and September
• you want to decrease your chance of getting the flu

Who should not get vaccinated?

You should not get the flu shot if:

• you have a severe egg allergy (the flu shot virus is grown in eggs)
• you have a severe allergy to any component of the vaccine

Talk to your doctor before getting the flu shot if:

• you have had a severe reaction to the flu shot in the past
• you have ever had Gulliain-Barre´ Syndrome
• you are moderate to severely ill. You may need to wait until you recover before you get the flu shot.

In conclusion I believe the benefits outweigh the risks for the majority of the population. To determine if it would be a benefit for you to get a flu shot talk to your doctor about your specific situation. For myself, the benefits far outweigh the risks and I get my flu shot every year.

The best resource for more information is the CDC’s Flu site.

Where Do You Hurt? The Drug Doesn’t Know.

Pain may be the number one reason people seek treatment at the doctor’s office or at the local pharmacy. As a pharmacist, I am frequently approached with questions about pain management. I often see people looking for a product to treat pain and reading the front of the package. After a brief discussion I recommend a product and the person responds with “but it doesn’t say it will help with _____ pain”.

Today’s advertising has created many misconceptions about medications and the way they work. Some people believe a medication must say it “treats back pain” or it will not work for back pain. In reality, a medication intended for the treatment of pain will be distributed throughout the body. If you have a headache, backache or sore muscles the drug does not just go to that area of the body. It doesn’t “know” where the pain is located. One medication is often packaged in several different ways. One package will say for headaches while another one will say for menstrual cramps and yet another will say for muscle aches. An unsuspecting consumer could have three different packages of the same medication with different labeling. This could put them at risk of taking too much medication as they try to treat more than one problem. The Mayo Clinic has a great article about pain medication labels

There are essentially three classes of over the counter pain medications (analgesics).

• Acetaminophen (Tylenol®) - This is often the first line therapy for pain. It remains one of the safest pain medications on the market with relatively few side effects. Can be used for pain or fever. Avoid if you have liver problems or drink alcohol. Do not exceed 4000mg in 24 hours. Many other medications contain acetaminophen as one of the ingredients. Read the labels and do not use with these other medications.
• Salicylates – Useful for fever, pain and inflammation. These products tend to be hard on the stomach but the coated ones have less of this side effect. Alcohol in combination increases chances of ulcers. Do not give in children (even teenagers) due to the possibility of developing Reyes Syndrome. These may also increase bleeding and bruising.
  • Aspirin (Bayer®, Bufferin®, Ecotrin®) -

  • Magnesium Salicylate (Doan’s®) – Might be easier on the stomach than aspirin. May cause increased magnesium levels, especially for those with kidney problems.

• NSAIDs (Non-Steroidal AntiInflamatory Drugs) – Useful for fever, pain and inflammation. Can be hard on the stomach but generally less so than salicylates. Do not use with alcohol due to increased chance of ulcers. Do not use more than 10 days without doctor supervision.
  • Ibuprofen (Advil®, Motrin®)
  • Naproxen (Aleve®) - Twice daily dosing is an advantage.

Combination products – These items combine the above ingredients with each other or with other ingredients to possibly improve effectiveness.

• Aspirin and Caffeine (Anacin®) – The caffeine assists the aspirin to work better. Follow all the same precautions as aspirin alone. The addition of caffeine may interfere with sleep if given late in the day.

• Aspirin, Acetaminophen and Caffeine (Excedrin®, Goody’s®)- The caffeine assists the aspirin to work better. Follow all the same precautions as aspirin alone. The addition of caffeine may interfere with sleep if given late in the day.

• Acetaminophen and phenyltoloxamine (Percogesic®) – The phenyltoloxamamine is an antihistamine which is supposed to increase the effects of acetaminophen. This claim has not been evaluated by the FDA and it may cause drowsiness. Do not use if you need to be alert or you are driving.
• Aspirin, Caffeine, Salicylamide (BC ®, Stanback®) – The addition of salicylamide has not been proven to improve effectiveness. In fact it may be responsible for side effect such as ringing in the ears and some blood disorders (low platelet count and low white blood cell count).

As you can see the above list of active ingredients is relatively short. But the typical pharmacy has very large display of items in this category. This is partly as a result of the same product being labeled for migraine headache, tension headache and body aches. There is no need to purchase a separate item for each individual type of pain you may experience. The important things to remember are to follow the package instructions and precautions and know the ingredients of the products you take so you aren’t over dosing on a medication. Also refer to the FDA’s site Use Caution with Pain Relievers.

This article does not endorse any of the above medications and you should check with your doctor for advice when self treating for pain.

The Benefits Home Blood Pressure Monitoring

About High Blood Pressure

According to the JNC-7, high blood pressure affects about 50 million people in the United States. Of these people about 30% are not aware they have high blood pressure. And only 34% of those who have high blood pressure have it under control. They further explain that reducing blood pressure can decrease chances of stroke, heart attacks and heart failure. As a result it is very important to identify and treat high blood pressure. High blood pressure often has no signs or symptoms so the primary way to detect high blood pressure is by having your blood pressure checked when you visit the doctor. This will catch many cases of high blood pressure but not all.

Home Monitoring

Home blood pressure monitoring can catch some cases that will be missed at the doctor’s office and it is a good way for someone to be involved in their own care. By keeping track of your readings and showing them to your doctor, they will have more information about how your blood pressure changes during the day and will be able to make better treatment decisions.

Home monitoring can also detect:

• White Coat Hypertension – Blood pressure is high in the doctors office but normal the rest of the time. This usually does not need treatment.
• Masked Hypertension – Blood pressure is normal in the doctors office but is high the rest of the time. Will probably need treatment but often will not be treated.
• Morning Hypertension – There is a sharp increase in blood pressure in the mornings. Some believe this to be the most dangerous type of high blood pressure with increased chances of heart attacks and stroke.

These three types of high blood pressure usually cannot be detected in the doctors office.

When taking your blood pressure at home it is a good idea to write the information down (date, time, blood pressure, heart rate) on a Blood Pressure Log and bring this log into your doctor’s office during your appointment.

Blood pressure Monitors

• Manual – This type of monitor consists of an inflatable arm cuff, a pressure gauge and a pumping bulb. You use a stethescope to listen to arterial blood sounds as you pump up the pressure in the cuff, then deflate it. It requires some skill and practice to master this technique and is difficult to perform on yourself. One advantage is they are less expensive.
• Digital – This type of monitor is completely automatic and will inflate, deflate, measure blood pressure and heart rate at the touch of a button. Many will also store multiple readings. These are available for the upper arm, wrist and finger although the upper arm style is considered to be the most accurate.

When purchasing a home blood pressure monitor consider the following

• Cuff size – This is essential to getting an accurate reading. Many monitors are available with different sized cuffs. If your arm is large or small, pick a cuff size that is appropriate.
• Display – Make sure it is easy to read and the numbers are clear.
• Accuracy – Bring the monitor with you when you visit the doctor and compare it to the reading from your your doctor. Also you can check if it has been validated by the British Hypertension Society or the Dable Educational Trust.

Tips to get an accurate Blood Pressure Reading

• Avoid alcohol, caffeine and alcohol for 30 minutes prior to testing.
• Use the bathroom before testing.
• Rest quietly for at least 5 minutes before testing.
• Follow all the instructions that came with your monitor.
• Sit in a comfortable position, lags and ankles uncrossed, and back supported.
• Your arm should be supported (on a table or desk) at the level of your heart.
• The cuff should not be over clothing and should be wrapped snug (not tight) on the arm.

Learn more about high blood pressure at the National Heart Lung and Blood Institute

Get a free blood pressure log you can download and print and bring with you to the doctor.

Here are a few Omron brand Blood Pressure Monitors

Errors Associated with Extended Release Medications

Prescription errors continue to be on peoples minds and often make national headlines. Medication errors can happen in hospitals, pharmacies, doctors offices, nursing homes, and your home. In fact, medication errors can occur anywhere drugs are prescribed or dispensed and can occur at any time. As a result, everyone involved in the process has a responsibility to try to prevent errors. Medication errors in general is a very broad subject. Today’s focus will be on a small subset that in my observations has not received significant attention.

Many medications are available in more than one formulation. A good example is Tylenol (Acetaminophen). It is available in tablet, caplet, gelcap, liquid (suspension and solution of different concentrations), meltaway, and extended release tablet. In fact