From Geriatric Pharmacy Intern, Amalia Castro, PharmD(c)
Nova Southeastern University School of Pharmacy
A new study shows that cutting back on calories reduces aging, as well as, the incidence of age related diseases such as cardiovascular disease, cancer and preserves the brain in primates. Scientists at the University of Wisconsin-Madison performed the study for a period of 20 years. Study author Ricki J. Colman, PhD, reports that this was the largest and the most highly controlled study showing the benefits of calorie restriction on disease prevention and increased survival. He also believes that the results of this study can be applied to humans due to the close relationship between both primates and humans. The study reveals that only 50% of the monkeys that were allowed to eat freely survived, while 80% of the monkeys eating the same foods, but with a 30% calorie reduction, continue to exist.
Richard Wiendruch, PhD, professor of medicine at the University of Wisconsin-Madison School of Medicine and co-author of the study, states that a calorie restricted diet can lead to a longer life span and improve quality of life in old age, as seen with the primates. The study proved an increase in survival by reporting that the incidence of cardiovascular disease and cancer was twice as much for the monkeys on the unrestricted diet. Wiendruch also reports that surprisingly only 42% of the primates on the unrestricted diet had diabetes or pre-diabetes, while none of the monkeys on the calorie restricted diet showed any signs of this disease. This last finding is astonishing and is worth studying on human subjects.
As far as avoiding brain atrophy, the study revealed that the monkeys that consumed fewer calories where able to preserve regions of their brain responsible for short-term memory and problem solving, which are greatly affected with age. The study also showed that a restricted diet appears to have an effect on brain mass. Nevertheless, more studies need to be conducted on these findings, especially on the effects of a calorie-restricted diet and the lack of brain shrinkage.
More information on this topic can be found on the July issue of Science.
Sunday, July 26, 2009
Wednesday, July 15, 2009
Vitamin Toxicity: How much is too much?
Many of us believe that taking abundant amounts of vitamins cannot harm us. This is true for some vitamins like C and B. When we take too much of those vitamins we just urinate the excess. However, there are 4 vitamins which are stored in fat. The vitamins stored in fat (aka fat-soluble) are A, D, E and K. All of them are components in multivitamins. When these fat-soluble vitamins are taken in excess, there may be serious consequences.
Vitamin D is being used by many in the ageing population to prevent or to treat osteoporosis. We can find vitamin D in milk, orange juice, multivitamins and most calcium tablets. It is also found in prescription medications like Fosamax-D. Our bodies also produce it when we are exposed to sunlight. The recommended daily allowance (RDA) is 1000IU. When a person takes in more than this on a daily basis they are at risk for high blood pressure, nausea, vomiting and lack of appetite.
Vitamin A is found in multivitamins, spinach, carrots, leafy vegetables, pumpkin and pretty much any fruit or vegetable with an orange tint. It is used to preserve our vision, immune and reproductive systems. It is also found in prescription medications used for acne as isotretinoin. The RDA is 5000IU. Overdose causes hair loss, dry skin, nasal irritation, fever, insomnia, fatigue, weight loss, anemia and diarrhea.
Vitamin E is used to boost the immune system, as an antioxidant and to protect the skin. Vitamin E can be obtained from asparagus, avocado, eggs, milk, nuts, spinach, vegetable oil and whole grain foods. The RDA is 30IU. It is also supplied in multivitamins.
Vitamin K helps our bodies clot blood and is used to reverse Warfarin overdose. Sources of vitamin K include green, leafy vegetables, cauliflower, brussel sprouts and cabbage. Just like the others, it is found in multivitamins. The RDA is 75mcg. This vitamin and its amount is important in patients taking Coumadin or warfarin. Overdose can cause our clotting system to go haywire.
The majority of the effects listed were of a milder form. The take home point is to attempt to regulate how much of these vitamins you consume on a daily basis and to recognize the signs and symptoms of overdose.
Vitamin D is being used by many in the ageing population to prevent or to treat osteoporosis. We can find vitamin D in milk, orange juice, multivitamins and most calcium tablets. It is also found in prescription medications like Fosamax-D. Our bodies also produce it when we are exposed to sunlight. The recommended daily allowance (RDA) is 1000IU. When a person takes in more than this on a daily basis they are at risk for high blood pressure, nausea, vomiting and lack of appetite.
Vitamin A is found in multivitamins, spinach, carrots, leafy vegetables, pumpkin and pretty much any fruit or vegetable with an orange tint. It is used to preserve our vision, immune and reproductive systems. It is also found in prescription medications used for acne as isotretinoin. The RDA is 5000IU. Overdose causes hair loss, dry skin, nasal irritation, fever, insomnia, fatigue, weight loss, anemia and diarrhea.
Vitamin E is used to boost the immune system, as an antioxidant and to protect the skin. Vitamin E can be obtained from asparagus, avocado, eggs, milk, nuts, spinach, vegetable oil and whole grain foods. The RDA is 30IU. It is also supplied in multivitamins.
Vitamin K helps our bodies clot blood and is used to reverse Warfarin overdose. Sources of vitamin K include green, leafy vegetables, cauliflower, brussel sprouts and cabbage. Just like the others, it is found in multivitamins. The RDA is 75mcg. This vitamin and its amount is important in patients taking Coumadin or warfarin. Overdose can cause our clotting system to go haywire.
The majority of the effects listed were of a milder form. The take home point is to attempt to regulate how much of these vitamins you consume on a daily basis and to recognize the signs and symptoms of overdose.
Friday, July 10, 2009
Statin use and Alzheimer's Disease
From Geriatric Pharmacy Intern, Amalia Castro, PharmD(c)
Nova Southeastern University College of Pharmacy
According to the Alzheimer’s Association, Alzheimer’s disease is the seventh leading cause of death in the United States and affects more than 5 million Americans. This neurodegenerative disease targets brain cells causing irreversible damage and neuronal cell death, which results in severe memory impairment and radical changes in behavior. The Alzheimer’s Association also states that it is the most common form of dementia, accounting for 50 to 70 percent of dementia cases. Currently, this eventually fatal disease has no cure, and only symptomatic treatment and supportive care are offered to these patients in order to improve their quality of life. Consequently, it comes as no surprise that the struggle to find a way to reverse or eradicate this disease is crucial.
Recent promising studies show that statins, a class of commonly used cholesterol lowering drugs, may help protect brain cells against excitotoxicity, which consists on overstimulation of nerve cells, eventually leading to cell death. Overstimulation is the leading cause of degeneration of nerve cells in Alzheimer’s patients.
Lovastatin was the cholesterol reducing statin used in animal studies done by Amalia Dolga, PhD and her colleagues at the University of Groningen in the Netherlands. Her study showed that besides reducing cholesterol, Lovastatin was able to protect nerve cells against damage caused by overstimulation. By avoiding damage on nerve cells we can extend their memory capacity, avoid their deterioration and cell death caused by Alzheimer’s disease.
On her previous in vitro Lovastatin study, Dolga and colleagues were able to demonstrate this dug’s neuroprotection ability through the activation of the tumor necrosis factor (TNF) 2 signaling pathway. This pathway protects cortical neurons against excitotoxicity that occurs in neurodegenerative diseases such as Alzheimer’s disease. Dolga was able to restate Lovastatin’s protection on cortical neurons, on her current in vivo animal study, and reaffirm that the neuroprotective effect of Lovastatin is dependent on the activation of other factors in the TNF pathway. Her findings strongly suggest that Lovastatin may be a promising guide towards improving neurodegenerative diseases. However, more studies need to be performed in order to be certain of statins’ benefits against Alzheimer’s disease.
More details about this study can be found in the June issue of The Journal of Alzheimer’s Disease.
Nova Southeastern University College of Pharmacy
According to the Alzheimer’s Association, Alzheimer’s disease is the seventh leading cause of death in the United States and affects more than 5 million Americans. This neurodegenerative disease targets brain cells causing irreversible damage and neuronal cell death, which results in severe memory impairment and radical changes in behavior. The Alzheimer’s Association also states that it is the most common form of dementia, accounting for 50 to 70 percent of dementia cases. Currently, this eventually fatal disease has no cure, and only symptomatic treatment and supportive care are offered to these patients in order to improve their quality of life. Consequently, it comes as no surprise that the struggle to find a way to reverse or eradicate this disease is crucial.
Recent promising studies show that statins, a class of commonly used cholesterol lowering drugs, may help protect brain cells against excitotoxicity, which consists on overstimulation of nerve cells, eventually leading to cell death. Overstimulation is the leading cause of degeneration of nerve cells in Alzheimer’s patients.
Lovastatin was the cholesterol reducing statin used in animal studies done by Amalia Dolga, PhD and her colleagues at the University of Groningen in the Netherlands. Her study showed that besides reducing cholesterol, Lovastatin was able to protect nerve cells against damage caused by overstimulation. By avoiding damage on nerve cells we can extend their memory capacity, avoid their deterioration and cell death caused by Alzheimer’s disease.
On her previous in vitro Lovastatin study, Dolga and colleagues were able to demonstrate this dug’s neuroprotection ability through the activation of the tumor necrosis factor (TNF) 2 signaling pathway. This pathway protects cortical neurons against excitotoxicity that occurs in neurodegenerative diseases such as Alzheimer’s disease. Dolga was able to restate Lovastatin’s protection on cortical neurons, on her current in vivo animal study, and reaffirm that the neuroprotective effect of Lovastatin is dependent on the activation of other factors in the TNF pathway. Her findings strongly suggest that Lovastatin may be a promising guide towards improving neurodegenerative diseases. However, more studies need to be performed in order to be certain of statins’ benefits against Alzheimer’s disease.
More details about this study can be found in the June issue of The Journal of Alzheimer’s Disease.
Monday, June 22, 2009
Zicam Products Removed from Store Shelves
From Geriatric Pharmacy Intern Angela M Antuna, PharmD(c) Palm Beach Atlantic University Lloyd L. Gregory School of Pharmacy
Why Zicam nasal products are not safe to use
The FDA has recently issued an alert on Zicam nasal gels and swabs due to the risk of anosmia or loss of smell. Reports have shown that people have experienced loss of smell with just the first application. In addition, the loss of smell may be more than temporary. Some reports say that it may be permanent. Others have also reported loss of taste too. The sense of smell and taste work closely together to give food its distinct taste. In some cases the sense of smell can save lives. For example, it is important to be able to smell smoke in case of a fire.
Zicam products are frequently sold at retail drug stores for early signs of the common cold. These products are homeopathic or natural products given in small amounts. Many natural products are not thoroughly tested by the FDA for safety and efficacy. Zinc gluconate is the chief ingredient found in Zicam. Some believe the intranasal application of zinc gluconate may be killing the receptors responsible for the sense of smell. The company strongly believes in the product and that the loss of smell may be due to the common cold itself. The FDA is now thoroughly investigating if the loss of smell is directly related to its use.
The company has willingly taken these products off the market and is asking consumers to throw away any remaining. However, for a refund you could simply go online to www.zicam.com and fill out the form provided. The company states, “The other 17 Zicam-branded products (including our oral Cold Remedy, cough, sinus, extreme congestion and allergy products) are all safe and effective and will remain on retailer shelves.”
Why Zicam nasal products are not safe to use
The FDA has recently issued an alert on Zicam nasal gels and swabs due to the risk of anosmia or loss of smell. Reports have shown that people have experienced loss of smell with just the first application. In addition, the loss of smell may be more than temporary. Some reports say that it may be permanent. Others have also reported loss of taste too. The sense of smell and taste work closely together to give food its distinct taste. In some cases the sense of smell can save lives. For example, it is important to be able to smell smoke in case of a fire.
Zicam products are frequently sold at retail drug stores for early signs of the common cold. These products are homeopathic or natural products given in small amounts. Many natural products are not thoroughly tested by the FDA for safety and efficacy. Zinc gluconate is the chief ingredient found in Zicam. Some believe the intranasal application of zinc gluconate may be killing the receptors responsible for the sense of smell. The company strongly believes in the product and that the loss of smell may be due to the common cold itself. The FDA is now thoroughly investigating if the loss of smell is directly related to its use.
The company has willingly taken these products off the market and is asking consumers to throw away any remaining. However, for a refund you could simply go online to www.zicam.com and fill out the form provided. The company states, “The other 17 Zicam-branded products (including our oral Cold Remedy, cough, sinus, extreme congestion and allergy products) are all safe and effective and will remain on retailer shelves.”
Friday, June 12, 2009
FDA investigating several drugs for possible safety concerns
From Geriatric Pharmacy Intern, Allyson Torres, PharmD(c)
Nova Southeastern University College of Pharmacy
On Thursday, May 28, 2009 the FDA released its quarterly list of drugs that it is in the early stages of reviewing for potential safety concerns. The list contained about 2 dozen drugs, including the overactive bladder drug Detrol® (Pfizer) which is under review for reports of Steven-Johnson syndrome, a serious skin reaction, the smoking cessation drug Chantix® (Pfizer), which is under review for possible risk of accidental injury, vision impairment and other issues, sleep disorder drugs Nuvigil® and Provigil® (Cephalon) which are under review for serious skin reactions and the weight loss drugs Alli® (GlaxoSmithKline) and Xenical® (Roche Inc) for possible induction of liver toxicity.
Alli and Xenical (orlistat) are thought to actually be of value in TREATING certain liver problems, such as non-alcoholic fatty liver disease, in obese patients. Some research has shown that orlistat reduces fatty infiltration, improves inflammatory activity, improves hepatic fibrosis, lowers amino transferase levels, total cholesterol, triglyceride and LDL levels and reduces insulin resistance. However, other research shows no significant improvement, and recently there have been reports of liver toxicity in patients taking orlistat that are suspected to be related to its usage. As reported in the Journal of Hepatology by Montero et al in 2001, one patient developed sub-acute liver failure while being treated with orlistat as the only drug and had to receive a liver transplant. The FDA is clear that it has not yet determined causation in terms of the drugs under review and the reported adverse effects. It will be interesting to see if further research proves whether orlistat can either cause or help treat liver problems- or both!
Nova Southeastern University College of Pharmacy
On Thursday, May 28, 2009 the FDA released its quarterly list of drugs that it is in the early stages of reviewing for potential safety concerns. The list contained about 2 dozen drugs, including the overactive bladder drug Detrol® (Pfizer) which is under review for reports of Steven-Johnson syndrome, a serious skin reaction, the smoking cessation drug Chantix® (Pfizer), which is under review for possible risk of accidental injury, vision impairment and other issues, sleep disorder drugs Nuvigil® and Provigil® (Cephalon) which are under review for serious skin reactions and the weight loss drugs Alli® (GlaxoSmithKline) and Xenical® (Roche Inc) for possible induction of liver toxicity.
Alli and Xenical (orlistat) are thought to actually be of value in TREATING certain liver problems, such as non-alcoholic fatty liver disease, in obese patients. Some research has shown that orlistat reduces fatty infiltration, improves inflammatory activity, improves hepatic fibrosis, lowers amino transferase levels, total cholesterol, triglyceride and LDL levels and reduces insulin resistance. However, other research shows no significant improvement, and recently there have been reports of liver toxicity in patients taking orlistat that are suspected to be related to its usage. As reported in the Journal of Hepatology by Montero et al in 2001, one patient developed sub-acute liver failure while being treated with orlistat as the only drug and had to receive a liver transplant. The FDA is clear that it has not yet determined causation in terms of the drugs under review and the reported adverse effects. It will be interesting to see if further research proves whether orlistat can either cause or help treat liver problems- or both!
Tuesday, June 2, 2009
Age-related medication use considerations
Medications are used with the intent to improve quality of life. Older adults are at an increased risk for medication-related problems. Drug therapy may cause more harm than good if an improper medication is used or therapy is not monitored. There are many factors that increase the likelihood of a medication-related problem in the older patient.
As we get older, our body metabolizes and eliminates drugs less effectively; this is a result of primarily liver and kidney function decline. If doses aren’t adjusted for these changes it can lead to adverse drug events, complications and even mortality. Medication response is also enhanced in the elderly; they are more sensitive to effects of the drug, both therapeutic effects and side effects. Side effects like dizziness, sedation and fatigue are more commonly experienced and pose danger to the geriatric patient. As a results of all this, there are certain medications that should be avoided or used cautiously with monitoring parameters.
Older patients frequently have multiple chronic illnesses (high blood pressure, diabetes, arthritis, GERD, etc.). Medications that may work to help once condition may adversely affect another. Not only do we need to worry about all the illnesses one may have, we also need to consider what other medications they are taking. Adverse drug advents due to multiple drug interactions are prevalent because most geriatric patients take more than one medication.
It is important that all these aspects are considered when prescribing or beginning treatment in the geriatric patient to prevent medication-related problems.
Brian Wolstenholme, PharmD, CGP, FASCP
www.medisort.net
As we get older, our body metabolizes and eliminates drugs less effectively; this is a result of primarily liver and kidney function decline. If doses aren’t adjusted for these changes it can lead to adverse drug events, complications and even mortality. Medication response is also enhanced in the elderly; they are more sensitive to effects of the drug, both therapeutic effects and side effects. Side effects like dizziness, sedation and fatigue are more commonly experienced and pose danger to the geriatric patient. As a results of all this, there are certain medications that should be avoided or used cautiously with monitoring parameters.
Older patients frequently have multiple chronic illnesses (high blood pressure, diabetes, arthritis, GERD, etc.). Medications that may work to help once condition may adversely affect another. Not only do we need to worry about all the illnesses one may have, we also need to consider what other medications they are taking. Adverse drug advents due to multiple drug interactions are prevalent because most geriatric patients take more than one medication.
It is important that all these aspects are considered when prescribing or beginning treatment in the geriatric patient to prevent medication-related problems.
Brian Wolstenholme, PharmD, CGP, FASCP
www.medisort.net
Thursday, May 28, 2009
Caution advised when using certain class of antibiotics
Nadia Surujbally, PharmD(c)
Fluoroquinolone antibiotics put older adults at risk for developing tendinitis and tendon rupture. Examples of this class of antibiotic include: Levaquin, Cipro, Avelox. Prescribers should use caution when treating with fluoroquinolones due to this serious side effect. Tendons hold your muscles in place joining them to your bones. Pain and swelling around tendons could be a sign of tendon rapture or inflammation. Swelling or bruising around the Achilles tendon (behind your ankle) is the most common area affected. If you hear a popping sound or unable to move the area around your tendon, you should seek medical care.
The Food and Drug Administration has a special boxed warning about this side effect especially in adults over 60. At the first sign of inflammation, prescribers should recommend stopping treatment with this antibiotic. Older adults are at risk for this side effect during treatment and months after completing their regimen. Taking corticosteroids, having kidney problems or Rheumatoid Arthritis can also increase risk of having this side effect. Use of these antibiotics should be reserved for known bacterial infections susceptible to these medications.
Fluoroquinolone antibiotics put older adults at risk for developing tendinitis and tendon rupture. Examples of this class of antibiotic include: Levaquin, Cipro, Avelox. Prescribers should use caution when treating with fluoroquinolones due to this serious side effect. Tendons hold your muscles in place joining them to your bones. Pain and swelling around tendons could be a sign of tendon rapture or inflammation. Swelling or bruising around the Achilles tendon (behind your ankle) is the most common area affected. If you hear a popping sound or unable to move the area around your tendon, you should seek medical care.
The Food and Drug Administration has a special boxed warning about this side effect especially in adults over 60. At the first sign of inflammation, prescribers should recommend stopping treatment with this antibiotic. Older adults are at risk for this side effect during treatment and months after completing their regimen. Taking corticosteroids, having kidney problems or Rheumatoid Arthritis can also increase risk of having this side effect. Use of these antibiotics should be reserved for known bacterial infections susceptible to these medications.
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