While risk-reducing behavior is the cornerstone of HIV prevention, the healthcare and research community has been constantly searching for better ways to further reduce the risk of contracting the virus.  Unfortunately, the development of vaccines to prevent HIV infection has so far been unsuccessful.  Recent studies have discovered that it is possible for high-risk individuals to reduce the risk of contracting HIV up to 92% by taking a once-daily medication, Truvada^®, along with risk-reducing lifestyle modifications and regular testing.² This process is collectively known as Pre-Exposure Prophylaxis, or PrEP.

PrEP involves many different factors:

1. Commitment to taking a single pill every day. If the medication is not taken daily, it is possible for the patient to contract HIV that is resistant to the medications in Truvada^®.
2. Basic health screening to ensure the medication will be safe and effective. A doctor or pharmacist will need to check the patient’s HIV status and other lab tests (kidney function, list other tests here) every 3 months.
3. Continuing risk-reducing behaviors. Condom use and refraining from needle sharing is also very important.  Taking medication daily helps to further decrease the risk of contracting HIV, but should not be thought of as an alternative to risk reducing behaviors. ³

To increase access to PrEP in our community, Kelley-Ross pharmacists have developed a pharmacy-based PrEP program, One-Step PrEP®.  This program allows patients to receive screening, lab tests, education, and medication at Kelley-Ross Pharmacy in as little as a single visit every three months.  This innovative pharmacy program seeks to build upon the clinical services provided by Kelley-Ross pharmacists, and further increase access to an effective public health service to reduce HIV infections.

For more information about our new One-Step PrEP® program, click here.

Worried about insurance coverage?  While most insurance plans cover PrEP, the Washington State Department of Health has recognized this public health opportunity and established the PrEP Drug Assistance Program (PrEP DAP).  For more information on this, click here.

Written by Adrian Hughes, PharmD Candidate, 2015

1. http://www.doh.wa.gov/Portals/1/Documents/Pubs/150-030-HIVSurveillanceSemiAnnualReport2-2014.pdf
2. http://www.cdc.gov/hiv/prevention/research/prep/study
3. <a href="https://www.aids web collaboration software.gov/hiv-aids-basics/prevention/reduce-your-risk/pre-exposure-prophylaxis/”>https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/pre-exposure-prophylaxis/

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If you are interested in learning more about our Community Pharmacy Residency Program, click here.

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In September 2014, the Centers for Disease Control and Prevention (CDC) published new guidelines recommending that all adults 65 and older receive Pneumococcal Conjugate Vaccine (PCV13, brand name Prevnar-13) in addition to Pneumococcal Polysaccharide Vaccine (PPSV23, brand name Pneumovax).

What is PCV13?

PCV13 is a vaccine that protects against 13 strains of Streptococcus pneumoniae, the bacteria that causes pneumococcal disease.  It is made by conjugating the outer capsule of these strains with a nontoxic protein that stimulates a strong immune response.

How do people get pneumococcal disease?

Streptococcus pneumoniae is spread through coughing or sneezing or through direct contact, such as kissing. Not everyone who carries the bacteria becomes ill, so it’s possible to “catch” pneumococcal disease from someone who appears healthy.

What happens when someone gets pneumococcal disease?

Pneumococcal disease can cause pneumonia, meningitis, or blood infection (bacteremia).  Symptoms of pneumonia can include a high fever, chills, cough, shortness of breath, and chest pain.  Symptoms of meningitis can include a high fever, chills, stiff neck, disorientation, and sensitivity to light.  Among those who contract pneumococcal disease, those age 65 and older and adults with underlying medical conditions are at higher risk of death.  For more information about types and symptoms of pneumococcal disease, please visit CDC: About Pneumococcal Disease.

Why vaccinate adults against pneumococcal disease?

In the US, 90 percent of pneumococcal disease cases are in adults.  Each year, more than 30,000 cases of invasive pneumococcal disease (meningitis and bacteremia) occur in the US.  Additionally, as many as 175,000 people are hospitalized due to pneumococcal pneumonia in the US each year.  The case-fatality rate of pneumococcal pneumonia is 5-7 percent.

Pneumococcal disease has a high association with other complications as well.  Pneumococcal meningitis can cause hearing loss, seizures, blindness, and paralysis.  Concurrent cardiac events are also common among patients hospitalized with pneumococcal pneumonia.

Which adults should get PCV13?

All adults age 65 and older should get PCV13.  In addition, adults age 19 through 64 years with kidney disease, immunocompromising conditions, cancer, a damaged or missing spleen, cochlear implants, or cerebro-spinal fluid (CSF) leaks should receive PCV13.  For more information on adults at risk, please visit Pneumococcal Vaccination: Who Needs It?.

I have received PPSV23.  Why should I get PCV13?

PPSV23 and PCV13 are made in different ways. The conjugated protein in PCV13 can cause a stronger immune response.  They also provide protection from different strains of Streptococcus pneumoniae.

Why is the CDC changing their recommendations now?

This new recommendation is based on a large clinical trial that showed that adding PCV13 on top of PPSV23 in adults 65 and older reduced the rate of community acquired pneumonia by 45.6 percent and invasive pneumonia by 75 percent.  For more information on the recommendation process, please visit CDC GRADE for Pneumococcal Vaccines.

When should I get PCV13?

Adults 65 and older who have not previously received pneumococcal vaccine, or who are unsure, should receive a dose of PCV13 first, then a dose of PPSV23 6-12 months later.  Adults 65 and older who have previously received PPSV23 should also receive PCV13.  In this case, PCV13 should be given at least 1 year after the most recent PPSV23 dose. For those whose first dose of PPSV23 was more than 5 years ago and before the age of 65, a second dose of PPSV23 should be given 6–12 months after PCV13.

Can I get the influenza and pneumococcal vaccines at the same time?

Yes. These vaccines can be given at the same time, but in different arms. In fact, pneumococcal disease can be a complication of influenza, so getting both vaccines is a smart choice. Unlike influenza vaccine, however, pneumococcal vaccination is not given every year.

What are some side effects of PCV13?

Mild side effects such as redness or pain at the injection site may occur. Very rarely, fever, muscle aches, or more severe reactions may develop.

References:

1. Pneumococcal Disease: Facts About Pneumococcal Disease in Adults. http://www.adultvaccination.org/professional-resources/public-health-toolkit/patient-fact-sheet.pdf
2. About Pneumococcal Disease. http://www.cdc.gov/pneumococcal/about/index.html
3. Pneumococcal Disease. http://www.adultvaccination.org/pneumococcal_vaccine_vaccination_adult_immunization.htm
4. Pneumococcal Vaccination: Who Needs It? http://www.cdc.gov/vaccines/vpd-vac/pneumo/vacc-in-short.htm
5. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) for Pneumococcal Vaccines for Adults aged ≥65 years. http://www.cdc.gov/vaccines/acip/recs/grade/pneumo-vac-adult.html
6. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP). http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6337a4.htm#box

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Prescriptions and over-the-counter medicines expire and become unusable after some time. How and where can you get rid of these items? Kelley-Ross Pharmacy is here to help! We’ve put together a list of some key techniques and references for safe disposal of drugs.

Can I just throw medicine in the trash?

Throwing medicine in the trash is not ideal as it poses both a safety and environmental risk. It can be a danger to children, pets, and others coming into contact with it. Medicine doesn’t stop being medicine once it’s in the trash –it’s still chemically active, and can still contaminate. Ideally, medicines should be disposed through a registered take-back program or through an approved drug disposal system (more on that below).

In some situations, the ideal solution may not be available. If that is the case, the best way to dispose of medicines in the trash is to mix the medicine with cat litter or coffee grounds in a separate sealed bag before throwing away. Be aware that even mixing medicine with litter or coffee grounds is often not enough to deter children and pets, and it does not insure against drug theft and abuse either.

What about Medicine Take-Back Programs?

A safer way to dispose of your unwanted medicines is through a take-back program. Several counties in Washington have sites that participate in medicine take-back. Just gather your unwanted medicines in their original containers, remove the labels or mark out your personal information, and find a take-back location near you. Here is a searchable list of locations: Medicine Take-Back Locations

Don’t see a take-back location near you? Some medicine disposal systems using mail-back via USPS may be available for purchase through your pharmacy –just ask. Another online resource provided by the National Community Pharmacists Association (NCPA), DisposeMyMeds.org, also enables a search of take-back locations throughout the country. Click this link for more information about these options: Other Disposal Options

When should I flush my medicine?

The FDA has a list of medicines that it recommends flushing for the safety of a household, which include medicines that have potential to be harmful to others for whom they are not prescribed. Specifically, children and pets may be the ones to come into contact with the medicine, risking accidental injury or even death. Some examples include:

• oxycodone/acetaminophen (Percocet^®)
• hydrocodone/acetaminophen (Vicodin^®)
• fentanyl (Duragesic^®) patches
• diazepam (Diastat^®) gel
• methylphenidate (Daytrana^®) patches
• Several others –this list can be accessed from this link: FDA Recommended Medicines to Flush

There is conflicting information regarding the flushing of medicines and pollution of groundwater. This is an important reason why take-back programs are encouraged. Nevertheless, it is highly important to be mindful of safety concerns when disposing of these medicines. Patches, if thrown in the trash, should be folded in half, with the medicine-containing side inward, before ever discarding. These items should be treated the same as oral medicines in terms of disposal safety –i.e., mix them with an unappealing substance like cat litter and seal in a separate bag.

Kelley-Ross Pharmacy carries a medicine disposal product called DRUGBUSTER^® which is a safe option for disposing of unwanted medicine at home, including pills and patches. It is a specially formulated solution that dissolves and neutralizes the chemical contents of medicine. The entire bottle can then simply be discarded into the trash. This product is available for sale at Kelley-Ross. Read more about it by clicking the link here: DRUGBUSTER®

What are controlled substances and where do I dispose of them?

Controlled substances are medicines like certain pain relievers and stimulants, which have the potential to be abused. Five different classifications or “schedules” are used for grouping these medicines, and the Drug Enforcement Administration (DEA) handles this task. Only law enforcement locations, like police departments and sheriff’s offices, and can accept controlled substances for take-back. Here is a link to a searchable list of locations, and be sure look for the green checkmark with the phrase “Accepts controlled substances”: Law Enforcement Take-Back Locations.

Some examples of controlled substances are:

• Opioids such as oxycodone/acetaminophen (Percocet^®), hydrocodone/ acetaminophen (Vicodin^®), morphine (Kadian^®), fentanyl (Abstral^®)
• Stimulants such as amphetamine (Adderall^®) and methylphenidate (Ritalin^®)
• Benzodiazepines such as alprazolam (Xanax^®), diazepam (Valium^®), lorazepam (Ativan^®)

What about my needles, syringes, and other sharp items?

Proper disposal of sharps is an important part of public health to prevent injuries and disease transmission. Sharps containers are available for purchase at most pharmacies, and are an easy, in-home way to get rid of these potentially dangerous items. Some locations where sharps containers are sold will also offer disposal for a fee –just ask when you make your purchase.

An alternative in King County is to place sharps in a 2-liter P.E.T. plastic soda bottle, tape the container shut tightly, and mark it as “Sharps –Do Not Recycle.” In Seattle, this may then be taken to Seattle’s North or South Recycling and Disposal Station for free disposal. Outside of Seattle in King County, the securely taped and labeled bottle may be placed into the regular garbage (NOT the recycling). For more information on county-specific disposal, here are some links:

• King County Sharps Disposal
• Snohomish County Sharps Disposal
• Kitsap County Sharps Disposal

Are there some additional resources?

The DEA hosts a national annual medicine take-back day. Click here for more location and detailed information on this: DEA Drug Take-Back Program

The FDA website is a useful resource with helpful recommendations for medicine disposal, and a link to this may be found here: FDA Unwanted Medicine Disposal

References:

Seattle & King County Public Health website- Safe and legal disposal of sharps: http://www.kingcounty.gov/healthservices/health/communicable/hiv/resources/disposal.aspx

Snohomish County Public Works –Sharps disposal brochure:

http://snohomishcountywa.gov/DocumentCenter/View/3770

Kitsap County Public Works Website- Sharps disposal:

http://www.kitsapgov.com/sw/recycle.asp?ItemID=70

DRUGBUSTER^® website:

http://www.drug-buster.com/home.html

Washington State Medication take-back locations:

http://www.takebackyourmeds.org/what-you-can-do/locations

Alternative medication disposal options:

http://www.takebackyourmeds.org/what-you-can-do/other-take-back-locations

FDA list of medicines for flushing:

http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#MEDICINES

DEA Drug Take-Back Program website:

http://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html

FDA medicine disposal recommendations:

http://www.fda.gov/forconsumers/consumerupdates/ucm101653.htm

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By law, schedule 2 prescriptions cannot have refills and must be written as a new prescription each time the patient requires a supply of medication. Schedule 2 prescriptions also are not able to be phoned or faxed to the pharmacy. For many patients this will mean more trips to their healthcare provider’s office. And for many offices an increased burden on support staff to manage the additional prescription writing volume. The change also impacts pharmacies as the record keeping requirements are much more stringent for schedule 2 medications.

It is also important to note that our Polyclinic location does not mail schedule 2 medications.

If you are a patient who regularly uses a hydrocodone based product to manage your pain, we suggest you contact your healthcare provider’s office and pharmacy soon in order to understand their controlled substance prescription policies and how you might be impacted by this change.

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While we all know it is important to protect the skin from sunlight and UV-radiation, it is also important to protect the skin from damage that can be done in the cold weather. In preparation of November’s National Healthy Skin Month, take some time to evaluate your skin by starting with something as simple as treating dry skin. The clinical term for dry skin is “xerosis.” It is common for people to experience dry skin in the fall and winter months. Dryness makes the skin susceptible to itching, flaking, cracking, and even bleeding. Strong winds and indoor heating add to this damage. Here are some tips for relieving dry skin:^1,2

1. Avoid using hot water. Hot water strips the natural oils from your skin faster than warm or cool water.
2. Wash your face with a cleanser only in the evenings and rinse with cool water in the mornings. Avoid cleansing too much. Dermatologists recommend a mild, non-drying and non-fragrant soap such as Dove, Oil of Olay or Aveeno Cleansing Bar for Dry Skin.¹
3. Limit shower time to no more than 5 to 10 minutes. More time in the shower can make your skin dry. This may seem counterintuitive, but those who constantly wash their hands throughout the day know that prolonged contact with water dries out the skin.
4. Apply moisturizer immediately after showering while the skin is still damp. This allows the skin to capture the moisture. Applying moisturizer not only helps to keep the skin healthy and soft, but it also soothes the skin to lessen itching and provides a protective barrier against germs.
5. Use ointment and creams over lotions. Ointments or cream containing jojoba oil, olive oil or shea butter work well. Other ingredients include lactic acid, urea, hyaluronic acid, dimethicone, glycerin, lanolin, mineral oil and petrolatum.¹ See below for more detail on these ingredients.
6. When shaving, do so after washing. Apply cream or gel and leave it on for a few minutes. Shave in the direction of hair growth. Blades should be changed every 5 to 7 shaves because dull blades may irritate dry skin.
7. Use a humidifier and a cool damp cloth to keep the skin moist. Keep your environment moist, even in dry weather.
8. Stay away from direct contact with heaters, hair dryers, and fireplaces. Heat can irritate and dry the skin.
9. Use gloves. Protect your hands from the cold weather and wind. Also, protect your hand from water by wearing gloves when cleaning or washing the dishes.
10. Avoid clothes with wool or synthetic fibers that may scratch the skin. Choose clothing made of cotton and natural fibers. When wearing clothes with synthetic fibers, wear a layer of cotton underneath to prevent direct contact with the skin.

When choosing a moisturizer, look for the ingredients that best suite your need. Lactate and urea are keratolytics that help to break down and shed dead skin. It is a good choice for flaky skin and will additionally soften and soothe the skin. Be sure to apply sunscreen when using ammonium lactate because it causes the skin to be sensitive to sunlight.

Glycerin, dimethicone and hyaluronic acid are humectants that help the skin retain water. These products attract water to the skin layer and hold it there.  These ingredients can be found in Cetaphil and CeraVe.

Lanolin, mineral oil and petrolatum are occlusive emollients that allow the skin to hold onto the water absorbed while showering and provide a protective layer. Although these ingredients are good for providing a protective layer, there are some things to consider when using products with these ingredients.  Vanicream contains lanolin, an oily substance secreted by sheep, which has been noted to create allergic response in some patients.³ Products such as Eucerin or Lubriderm contain mineral oil, which can make the skin feel heavy and leave oily residues. Aquaphor contains petrolatum, which is great for capturing moisture, but can slow the skin’s recovery time. If any of these products are too thick or oily, limit the use to bedtime and use a less occlusive agent during the day.

If problems with dry skin persist, contact your physician or dermatologist for further options. These tips can also be useful for treating dry skin due to other causes including exposure to chemicals, aging, eczema, and psoriasis. For more information, visit the American Academy of Dermatology.

References:

1. American Academy of Dermatology. Dry skin: Tips for relieving. American Academy of Dermatology. http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/a—d/dry-skin/tips. Updated 2013. Accessed October 08, 2013.

2. Dry Skin. In DynaMed [database online]. EBSCO Information Services. http://search.ebscohost.com.offcampus.lib.washington.edu/login.aspx?direct=true&site=DynaMed&id=115508. Updated April 29,2013. Accessed October 08, 2013.

3. Loden, Marie. The clinical benefit of moisturizers. European Academy of Dermatology and Venereology. Published November 19, 2005;(6):672-688.

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Did you know that simply knowing your pharmacist’s name can help you be more familiar with your medications? A survey conducted by the American Pharmacists Association showed that consumers who knew their pharmacist’s name were twice as likely to talk with their pharmacist about questions they had about their medications. They were also twice as likely to read prescription labels and more likely to know the active ingredients in their medications – both prescription and non-prescription. Knowing what active ingredients you’re taking is important in avoiding interactions between medications that can be harmful to your health, as well as avoiding accidental overdoses from taking several products with the same active ingredients.

Every year, Americans spend billions of dollars on prescription and non-prescription medications. Wouldn’t you want to ensure this was money well-spent? The most expensive medication is one that doesn’t work – or worse, actually causes you harm. Talking with your pharmacist about your medications is one of the best and easiest ways to increase the likelihood that your medications work properly and decrease unnecessary medication costs.

Pharmacists are medication experts and can help you manage your health in a variety of ways. Medication Therapy Management services, or MTM, provide a one-on-one review of all your medications to screen for interactions between drugs, unnecessary drug duplications and to ensure all of your conditions are adequately treated. Pharmacists can also provide advice on over-the-counter medications, herbal supplements, and vitamins and minerals. They can help you monitor your diabetes, screen for high blood pressure, help with smoking cessation, and much more.

Pharmacists at Kelley-Ross Pharmacy provide many different services to meet the needs of our patients.  A few of these include:

• A robust immunization program that provides seasonal and life-span vaccines
• Our travel clinic provides a comprehensive travel service; reviewing your itinerary, prescribing necessary medications, and providing safe travel advice, all in one convenient location
• A unique narcotic overdose prevention program that provides take-home naloxone to help patients, their families and their friends
• Our PCAB accredited compounding lab is able to provide customized medications to meet the unique needs of our patients and their providers
• The MedSync Cycle Fill program allows patients to synchronize refills of all of their chronic medications to just a single day each month
• Specialized compliance packaging options
• Our Clinical Pharmacy Institute that focuses on delivering medication management expertise and high quality clinical pharmacy services in a variety of settings and locations

Ultimately, your health care is your responsibility, but your pharmacist can help. Find a pharmacist you are comfortable with and try to use the same pharmacy to fill all of your prescriptions, especially if you see multiple doctors for your health care needs. Update your pharmacist regularly if you have changes in your health or the medications you are taking. This allows them to have a complete medication history when checking for problems or possible interactions.

Take some time this month to get to know your pharmacist and see what a difference it makes in your health care.

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Psoriasis is an autoimmune disease that affects the body’s skin cells. It is the most common autoimmune disease and affects approximately 7.5 million Americans. The disease is caused by an error in the body’s immune system which sends out improper signals to skin cells, telling them to speed up replication. For most patients, this results in painful, red, itchy patches and silvery-white plaques that form on the surface of the skin. While other types of psoriasis exist, “plaque psoriasis” is the most common form of the disease.

Many people confuse psoriasis with another common skin condition, eczema. Eczema is a condition of dry, flaky skin that can be made worse by harsh soaps that further dry the skin, or contact with fragrances that cause an allergic reaction. Unlike psoriasis, patients with eczema also commonly suffer from food or seasonal allergies. The two diseases can further be separated based on the timing and location of the rash. The first episode of eczema normally appears before a child turns five. Rashes are limited to the backs of the knees, inside elbow creases, hands, forearms and face. Psoriasis, on the other hand, typically appears in adulthood. The rash occurs on the fronts of the knees, elbows, hairline and lower back.^{1, 2}

During the month of August, the National Psoriasis Foundation works to raise awareness, encourage research and advocate for better care for patients with psoriasis. Recent research suggests that people with psoriasis may be at risk for other serious medical events. Researchers from the University of Pennsylvania found an association between the severity of psoriasis and rates of lung disease, diabetes, heart attack, and other serious diseases increased as well. While no cause and effect relationship was proven, it is suggested that patients with psoriasis seek out treatment before it becomes severe.

While moderate to severe psoriasis is treated with oral or injectable drugs, less severe forms are normally treated with creams or ointments. Current research shows that topical drugs, such as corticosteroids and Vitamin D analogues, can decrease symptoms by reducing inflammation and preventing skin cells from over-proliferating.  Many providers will prescribe treatments for psoriasis that require compounding your prescription.  Kelley-Ross pharmacy is a PCAB accredited compounding pharmacy.  They can work with you and your doctor to create a topical treatment that’s tailored to fit your needs.  Whether your provider determines that a traditional or a compounded medication is right for you, Kelley-Ross Pharmacy is your resource for quality pharmacy services.

References:

1. Weston W, Howe W. Patient information: Atopic dermatitis (eczema) (Beyond the Basics). UpToDate.com. http://www.uptodate.com/contents/atopic-dermatitis-eczema-beyond-the-basics. Updated 2/16/2012. Accessed 8/26/2013.
2. Feldman S. Patient information: Psoriasis (Beyond the Basics). UpToDate.com. http://www.uptodate.com/contents/psoriasis-beyond-the-basics. Updated 8/2/2011. Accessed 8/26/2013.

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