Nov 16, 2017

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Did you know a 4-year-old can imitate a wolf howl for over 20 minutes? That playing peek-a-boo with children through the glass in the compounding lab always brightens a pharmacist's day? Or that although I probably can identify that light pink, dark pink stomach capsule of yours at 50 paces (it's omeprazole), I really don't know what your small round white pill with no markings is when you describe it over the telephone. There are surprises to learn every day at the pharmacy. I think it's time to share some of these hidden gems we've learned. I'm going to tell you about four secret pharmacy potions that you have in your house right now, and how to use them. But first, a quick word from our sponsor....cholesterol.

What is cholesterol? Cholesterol is a naturally occurring substance in the body that is essential for life. If you had no cholesterol in you, you would die. Cholesterol helps form bile acids in your digestive system, hormones in your endocrine system and important components of every cell membrane in your body. Your liver can make all the cholesterol your body needs. The cholesterol in the food you eat doesn't go directly into your blood stream. Your liver makes cholesterol for you.

Why does your doctor test your blood for cholesterol if it is essential for life? Why does your doctor care if your blood cholesterol is too high? Your doctor cares about blood cholesterol levels because if they are too high for too long you have higher chance of getting a heart attack or a stroke. Every 7 minutes in Canada, someone dies of cardiovascular disease. That is why we care about blood cholesterol levels. And that is why cholesterol medications are so common.

Statins are the most popular cholesterol medications. HMG-CoA reductase inhibitors, or statins very good LDL lowering medications. They help reduce hardening of the arteries or atherosclerosis. Statins have been shown to reduce death due to heart attacks and stroke. In fact, if we reduce someone's LDL with statins, we can reduce their chances of heart attacks and strokes by 25% to 35% with five years' use. As effective as statins are, like every other medication, they do have potential side effects. The statins may upset your stomach. Less common, but more serious problems can include liver issues. Your doctor will check your liver function with a blood test. Other signs of liver problems include flu like symptoms, yellow eyes or skin, dark urine and belly pain. If you start getting a lot of muscle pain, please contact your doctor. Severe muscle injury from statins is rare, but can damage the kidneys.

The statins do a good job of reducing LDL. But, what does all this LDL, and HDL stuff mean? Your liver makes cholesterol, and it puts it into the blood stream. Cholesterol is a kind of fat or lipid. Since blood is mostly water, cholesterol doesn't mix well with it. The liver has to mix the cholesterol with proteins to get it to stay in the blood. This mixture of cholesterol and protein is called a lipoprotein. If you take a blood sample and spin it really fast in a centrifuge, it separates based on density. Different layers in the sample have different densities. Low Density Lipoprotein or LDL is often called "bad" cholesterol because it transports cholesterol from the liver to places like the lining inside the arteries. Through a complicated series of events, these cholesterol deposits can cause blockages that slow or stop blood flow. If blood flow to the heart muscle is stopped, that is a heart attack. If blood flow to the brain is stopped that is a stroke. High Density Lipoprotein or HDL is called "good" cholesterol because it transports cholesterol away from the cells lining the blood vessels. This can decrease the chance of blockages.

Statin drugs like atorvastatin and rosuvastatin have gotten some bad press lately. Let's try to put the risks in perspective. If 20 patients with heart disease take a statin for 5 years, we will prevent one heart attack or stroke. That's pretty good. Muscle pain from statins is rare and the really bad muscle damage called rhabdomyolysis happens in less than one in 43,000 patients. There are alternatives to statins, but they don't have the decades of good research behind them. Ezetimibe and the PCSK9 inhibitors do lower LDL, but none of them has been shown to reduce the chance of a heart attack or stroke when used alone. And the PCSK9 inhibitors cost over $7000 per year. Finally, don't pick fish oil supplements or red yeast rice instead of statins. There is some evidence that fish oil and red yeast rice might be healthy things to add to your diet. But neither has been shown to reduce the risk of heart attack or stroke.

And we're back. The four magic pharmacy potions are cola, tuna juice, cheese slices, and honey. Have you ever noticed children and pets are very similar except pets are better behaved? We get lots of questions in the store about how to get medications into children and pets. For liquids and children, I recommend giving them the liquid and letting them chase it with a tablespoon or so of cola. That seems to wash bad tastes out of the mouth. If you want to crush a tablet and give it to a child, do it in a tablespoon of honey. The honey seems to keep all the bad tasting powder wrapped up. Similarly for pets. Mix the bad tasting liquid with the juice you drain off from your can of tuna. If giving a tablet, especially to a dog, wrap it in a bit of cheese slice and offer it like a treat. That's all this week from the ever surprising world of community pharmacy!

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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