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Preston Pharmacy News - December 2010


The holidays have arrived and with them come the cold and flu viruses, making this a good time for all of us to review the basics of prevention. December 5-11, 2010 is being recognized as National Handwashing Awareness Week. Handwashing is one of the easiest and most important ways to prevent the spread of illness and infection and while this seems simple, not everyone has caught on just yet, though the numbers are improving. A study conducted in August 2010 showed that 85% of adults were observed washing their hands in public restrooms, up from 77% in 2007. While handwashing in general is up, only 39% of Americans reported that they always wash their hands after coughing or sneezing*1. This issue of Preston Pharmacy News will review the common cold and the basics of handwashing. While you may already be aware of this information, it is a good opportunity to pass the information on to family and friends.

The Common Cold

It is estimated that people in the U.S. experience approximately 1 billion colds each year.2 Adults average two to four colds a year while children will have six to ten colds in a year’s time.2 The cold season generally begins in the fall and may last until March or April. There are over 200 viruses that can cause the common cold though the rhinovirus is the most common.2,3 A cold can be transmitted by touching objects (hands, doorknobs, railings) which have germs on them and then touching your eyes, nose, or mouth or by inhaling germ-containing droplets in the air produced by coughing, sneezing, or talking.2,4 The first symptoms of sore “scratchy” throat begin 1-3 days after infection and is usually followed by nasal congestion, runny nose, sneezing, and sometimes cough. Headache, chills, body aches, and mild fever may also present. 5(p211) Symptoms may last 1-2 weeks but most people recover within one week.2 The common cold is sometimes mistaken with the influenza virus because the symptoms are very similar, though usually the symptoms are more intense with the flu. There is no treatment for the common cold. Because it is a virus, antibiotics will not help, and efforts are geared at symptom management. Non-drug therapies include getting plenty of rest, staying well hydrated, a healthy diet, avoiding second-hand smoke, and humidifiers.5 (p212) Ice chips, sore throat spray and lozenges may be helpful for sore throats. Topical and oral decongestants as well as saline nasal spray can be used for nasal congestion.6 Cough generally does not require treatment but can be bothersome, therefore cough suppressants such as codeine, dextromethorphan, and diphenhydramine have been approved by the FDA to treat this symptom.5(p204)

Handwashing 101

Here is what the Centers for Disease Control (CDC) have to say about hand hygiene: Wash your hands BEFORE and AFTER preparing and eating food, using the toilet, changing diapers, tending to someone who is sick, treating a cut or wound; AFTER blowing your nose, coughing, sneezing, handling an animal or animal waste, handling garbage. People should be reminded to rub hands together and scrub all surfaces for 20 seconds (hum the “Happy Birthday” song twice) and if soap and water are unavailable, rub alcohol based gel over all surfaces until hands are dry.7

Propoxyphene Removed from Market

At the request of the U.S. Food and Drug Administration (FDA), the manufacturer of propoxphene (Darvon, Davocet) will withdraw this product from the U.S. market. The FDA has also requested generic manufacturers of propoxyphene-containing products to withdraw their products as well.8 Propoxyphene is an opioid typically used to treat mild to moderate pain. The FDA has concluded that the risks outweigh the benefits of use. “New data shows that the drug can cause serious toxicity to the heart, even when used at therapeutic doses.”8 Adverse effects consisted of potentially serious or fatal heart rhythm abnormalities.9 Healthcare professionals should stop prescribing and dispensing propoxyphene-containing products and patients should contact their provider to discuss switching to another therapy for pain management.8 It is especially important that patients contact their health professional before stopping propoxyphene if they have been taking it for more than a few weeks because it can cause withdrawal symptoms if stopped abruptly.9 Patients are advised to dispose of unsued propoxyphene following the recommendations outlined in the Federal Drug Disposal Guidelines.8

Colchicine Controversy

The FDA recently ordered companies to stop marketing unapproved single-ingredient oral colchicine, a medication used to prevent gout and treat gout flares. Single-ingredient oral colchicine has been used for years, however, the FDA now requires that all prescription drugs obtain its approval. At the current time Colcrys™ is the only FDA-approved single-ingredient oral colchicine product available in the U.S. It was approved in 2009 and contains important safety data and recommendations on drug interactions and dosing which are not available with unapproved products. Colcrys’ manufacturer has a patient assistance program and copay assistance program to ensure all patients have access to colchicine until the FDA approves a generic product. 10

New Drug Approvals

The DEA has announced policy changes that will now recognize nurses who work in long term care facilities (LTCF) as agents of physicians who prescribe certain medications regulated under the Controlled Substances Act. Once an agency relationship is established, a nurse at a LTCF acting as an agent of the prescribing practitioner may communicate to a pharmacy prescription orders for Schedule C-III, CIV, and CV medications.7

Pradaxa (dabigatran) – oral direct thrombin inhibitor indicated to reduce the risk of stroke and blood clots in patients with non-valvular atrial fibrillation. This medication will be dispensed with a Medication Guide informing patients of the risk of bleeding.11,12

Latuda (lurasidone) – atypical antipsychotic approved for the treatment of patients with schizophrenia. At this time, efficacy for use greater than six weeks has not been established in controlled trials. Expected to be available February 2011.13

Kombiglyze XR (saxagliptan/metformin XR) – once daily combination tablet for adults with Type 2 Diabetes. The combination of saxagliptan and metformin XR increases insulin secretion in a glucose-dependent manner, decreases hepatic glucose production, and improves insulin sensitivity.14

Atelvia (risedronate delayed-release tablets) – once weekly delayed release version of Actonel for the treatment of post-menopausal osteoporosis. Patients are instructed to take Atelvia in the morning immediately after breakfast with at least 4 ounces of water.15

Ofirmev (acetaminophen) – IV formulation of acetaminophen indicated for the management of mild to moderate pain, moderate to severe pain with adjunctive opioid analgesics, and reduction of fever. Available by prescription only; administered only as a 15 minute infusion.16

Teflaro (ceftaroline fosamil) – injectable cephalosporin antibiotic approved for the treatment of adult patients with community-acquired bacterial pneumonia and acute bacterial skin and skin structure infections, including methicillin-resistant Staphylococcus aureus. This medication should not be used in patients with cephalosporin sensitivities.17

Quote of the Month

Each day comes bearing its own gifts. Untie the ribbons” – Ruth Ann Schabacker

References for December 2010 Issue
  1. The American Cleaning Institute. Public handwashing takes a hike. Available at: http://www.cleaninginstitute.org. Accessed October 22, 2010.
  2. National Institute of Allergy and Infectious Diseases. Common cold. Available at: http://www.niaid.nih.gov. Accessed October 20, 2010.
  3. Centers for Disease Control and Prevention. Common cold and runny nose. Available at: http://www.cdc.gov. Accessed October 20, 2010.
  4. Mehta B. What parents need to know about the common cold. Pharmacy Today. 2009;15(9)(suppl):S1-S4.
  5. Tietze KJ. Disorders related to cold and allergy. In: Berardi RR, DeSimone EM, Newton GD, Oszko MA, Popovich NG, Rollins CJ, Shimp LA, Tietze KJ, eds. Handbook of Nonprescription Drugs. 13th ed. Washington, DC: American Pharmacists Association; 2002.
  6. Centers for Disease Control and Prevention. Symptom relief. Available at: http://www.cdc.gov. Accessed October 22, 2010.
  7. Centers for Disease Control and Prevention. Clean hands save lives. Available at: http://www.cdc.gov/. Accessed October 20, 2010.
  8. U.S. Food and Drug Administration. Propoxyphene: Withdrawal – Risk of cardiac toxicity. Available at: http://www.fda.gov. Accessed November 22, 2010.
  9. American Pharmacists Association. Propoxyphene removed from U.S. market. Available at:http://www.pharmacist.com. Accessed November 24, 2010.
  10. American Pharmacists Association. FDA: Stop marketing unapproved colchicines. Available at: http://www.pharmacist.com. Accessed November 24, 2010.
  11. Pradaxa Web Site. Available at: www.pradaxa.com. Accessed October 29, 2010.
  12. U.S. Food and Drug Administration. FDA approves Pradaxa to prevent stroke in people with atrial fibrillation. Available at: http://www.fda.gov. Accessed October 29, 2010.
  13. Latuda Web Site. Available at: www.latuda.com. Accessed October 29, 2010.
  14. Astra Zeneca Web Site. Kombiglyze XR tablets approved in the US for the treatment of type 2 diabetes mellitus in adults. Available at: http://www.astrazeneca.com. Accessed November 24, 2010.
  15. Atelvia [package insert]. Norwich Pharmaceuticals, Inc., Rockaway, NJ; October 2010. http://www.wcrx.com/pdfs/pi/pi_atelvia.pdf. Accessed November 22, 2010.
  16. Ofirmev Web Site. Available at: www.ofirmev.com. Accessed November 24, 2010.
  17. American Pharmacists Association. New cephalosporin antibiotic Teflaro approved. Available at: http://www.pharmacist.com. Accessed November 22, 2010.

Additional Resources:
Federal Drug Disposal Guidelines available at: http://www.whitehousedrugpolicy.gov





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December, 2010