Probiotics the intestines best friend.

One of the many different products that is sold at my pharmacy on a weekly basis with a wide age range of female customers spanning from young children to adult older women, is Florajen probiotics, which come in three different types. Florajen, better known as acidophilus is a probiotic that is widely used within the pharmacy world today. Different trade names include some of the following:
; Bulgaricum IB^®
 DDS-Acidophilus^®
 Acidophilus Extra Strength
 Intestinex^®
Lactinex^®
Probiata^®
Super Vegi-dophilus^®   

these are only some of the different names for these probiotics, but of these Florajen is the one that I see the most widely dispensed from my pharmacy. So what is acidophilus? The many women of the general public come into the pharmacy hearing their girlfriends and other mothers talk about this product for their children, but they have no idea how it works, they only know to come in and ask for the "good bacteria" having no other knowledge of what this drug can do for them. 

Acidophilus by lex-comp definition is:  A bacterium that creates an environment unfavorable to the overgrowth of potentially pathogenic fungi and bacteria. 

Its two main uses are to aid in cleaning up and protecting the intestinal tract, use for diarrhea, and also for bacterial vaginosis. 

          Bacterial vaginosis, is a vaginal infection that occurs due to an imbalance or change from the normal balance of normal bacteria occurring in the vagina, allowing for different disease-causing bacteria, primarily Gardnerella vaginalis, to overgrow.

Florajen is generally very well tolerated, and can be taken orally, usually with a full glass of milk, juice, or water. It is dispensed as capsules, tablets, and different types of granules that can either be chewed or swallowed whole depending on the composition. 

There are three different products that are currently available by Florajen and those include: Florajen, Florajen 3--which is Florajen's general active ingredients and higher potency composed of three different types of bacteria, and Florajen4kids, which is recommended for normal bacterial growth in children. 

Florajen itself is used for aiding healthy bacterial growth in the intestinal tract along with promoting a health immune system. 

Florajen3 does the same thing but also has an additive effect of helping patients who have bacterial vaginosis as well. 

And then Florajen4kids has a 4 bacterial component makeup that can help children's immune systems and gastrointestinal tracts flourish. 

The majority of these products are supplied as capsules and need to be refrigerated due to stability issues, they come in bottles ranging from 30 to 60 capsules. So why do we recommend this product to many of our female patients and to their children as well? There are quite a few reasons that can be found directly from the products websites, that help to encourage our patients to buy these products. 

Safe and Natural

The micro-organisms in Florajen probiotics are the same “good bacteria” that occur naturally in healthy people. Florajen contains the same strain of Lactobacillus acidophilus used by most yogurt companies in the United States since 1973, yet it is dairy-free.

Highly Potent and Effective

Research has shown that to be effective, probiotic supplements must contain billions of live cells. While many off-the-shelf probiotics fall far short of this standard, each Florajen capsule contains over 20 billion live cells.

Refrigerated for Freshness and Potency

Continuous refrigeration maintains Florajen’s freshness and high potency from the time it is manufactured to the time it is purchased. Look for Florajen in the refrigerated section of your healthfood store or ask your pharmacist.

Guaranteed High Quality

Florajen probiotics are 100% U.S. manufactured in GMP certified facilities. Alll product lot numbers are microbiologically tested for quality and safety according to current FDA and USP procedures and guidelines.

All Florajen products have a money-back guarantee if you are not satisfied with them for any reason.

Affordable

Florajen probiotics provide more live cultures at a lower price than competitive products, making them a better value. Our founder believes that everyone should be able to afford the benefits of high quality probiotics and is priced accordingly.

^{**obtained from} http://www.florajen.com/products.shtml

These products are generally well tolerated, but shouldn't be used in patients who have intestinal disease, GI troubles, or who have intolerance to milk products, but they're regularly not problematic. Overall they can help to keep a normal daily balance of "good bacteria" along with increasing health and stimulating the immune system. So probiotics are good recommendation along with other health supplements like vitamins, to make to your patients.

All out of Prilosec, again?

It happens every week, people coming up to the counter and asking, "Is your store all out of Prilosec? Do I have to have a prescription for it now? Where can I find some? Can you Order an of this in for me?"

Over the last couple of years along with all of the other drug shortages that have been occurring around the world Prilosec OTC is one of the main ones that is brought to my attention at the pharmacy counter weekly.
Procter and Gamble which dispense and manufacture the product have been saying time and time again that these shortages will stop, giving future dates that always get extended. Procter & Gamble and their business partners at AstraZeneca, say they have underestimated demand for the drug and are working to increase production and correct the shortage, but what does that mean for the general public who are trying to save money on expensive prescription medications like Nexium? Well there are many different over the counter products they could use in place of Prilosec, such as the generic Omeprazole which is placed on either side of the empty Prilosec shelves in many stores, and yet people won't trust switching. They say that this is the product they've always been using and the only thing that works for them, when the Omeprazole active ingredients are printed directly on the Prilosec box showing that they are indeed the same drug, and bio-equivalent, not to mention much cheaper.

"America's frequent heartburn problem has been much more frequent than we could have ever predicted," said Kurt Weingand, a spokesman for Procter & Gamble. 
With the majority of Americans in America having problems with acid reflux it's no wonder that the shelves are laying empty at major chain pharmacies and drug stores. 

So what's the hold up on mass producing more prilosec? 
In different featured news articles there is much talk about how Astrazeneca could be pumping out pills right and left, and yet they aren't, and customers of the public are left to wonder, why? It could indeed be due to the fact that the shortage of Prilosec had been good for AstraZeneca because it had increased sales of Nexium, a more expensive prescription heartburn medicine that AstraZeneca markets as well. 
With patients worrying about their usual medications not being on the shelves, they're wasting money to make doctor's appointments, and their doctors are prescribing different medications to tide them over, such as Nexium, which without insurance can be as costly as $5 dollars per pill, and for most Americans who are taking it once daily, that's $150 dollars a month, compared to the $24.99 price of prilosec, and $19.99 box of Omeprazole 28 count box. 

So what are these people to do? As a pharmacy intern and student at our pharmacy I've been watching our pharmacists substitute different products when we're short on prilosec and advising them if they don't want to substitute to ask their doctor or primary care physician what they think that they should be taking to help fight the burn. Although this was an even larger problem back in 2003-2006 it is still occurring quite often today in many community pharmacies around the united states, and causes many people to waste time and money. 


*picture from schmidtlaw.com

"The #1 miracle in a bottle to burn your fat."

My post for this week focuses around a topic that has been brought to my attention quite frequently over the past few weeks at the community pharmacy I work at, and that is the topic of Raspberry Ketones. When I first took a phone call from a customer asking if our store carried Raspberry ketones, I was a bit lost because I had never heard of such a thing, until the patient told me that she had heard about them on Doctor Oz. Doctor Oz stated on one of his episodes that Raspberry Ketones are, "The #1 miracle in a bottle to burn your fat." Having never watched Dr. Oz and only having heard about him recently I wasn't sure whether or not he was trustworthy or even a valid source of information, so I talked with my pharmacist about it, and then looked up raspberry ketones to let other patients know the pro's and con's of taking them.

Once Dr. Oz announced this on his show, vitamin stores everywhere started to increase their inventory on this product, and had a hard time keeping it in stock with everyone wanting to by them.

So what are Raspberry Ketones? They're one of the compounds in raspberries and include anthocyanins, vitamin C and beta carotene, along with being an antioxidant. Their chemical structures are very similar to that of synephrine and capsicum which are two main ingredients in many weight loss drugs, and probably why chemists and doctors correlate this new product to weight loss.

The following article talks about the episode of Dr. Oz and goes on to tell the different studies that he based his information off of.

http://supplement-geek.com/raspberry-ketones-weight-loss-review-side-effects/

Many different websites are leading patients astray saying that raspberry ketones suppress appetite, when there is really no clinical research and studies done to prove this, and yet people are eating it up.
Some other false statements that are in the media are that these can boost your total daily energy, and even decrease the rate of aging, again backed by no research.
Other facts: Raspberry Ketone vitamins contain increased caffeine doses and can be contraindicated in some people.

The information that people should be looking at is this:

"When given to mice in very high doses (up to 2% of body weight), raspberry ketone has been shown to prevent high-fat-diet-induced elevations in body weight^. However, no effects on body weight were observed with doses up to 200 times greater than the estimated intake in humans.The high dose effect is reported to stem from the alteration of lipid metabolism, increasing norepinephrine induced fat breakdown. Although products containing this compound are marketed for weight loss, there is no clinical evidence for this effect in humans."


So when my patients come into the pharmacy asking about these raspberry ketones I'm going to give them the option but let them know that there is no clinical significance that this actually do produce weight loss in humans and that there are many more efficient routes that they can take, not to mention less expensive.

 

Introductory Post/ Modern Health Information Technology

My name's Ashley Thompson and I'm a P2 student this year. I've worked in a community pharmacy for the past 6, going on 7 years and am nearly positive that this is the area of pharmacy practice that I'll be going into after graduation. For my blog I will mostly post about current topics that are going on in the pharmacy world, and how I think that they apply to the community pharmacy setting. 

I thought the following article was appropriate for this weeks discussion on information technology and how it will effect the pharmaceutical field in the future. 

http://www.modernhealthcare.com/article/20120903/INFO/309039976/young-tech-savvy-docs-want-a-real-life-but-dont-call-them-slackers#

This article discusses how many young residents and new doctors are switching from paper charts and files to electronic patient profiles and information. They can more readily access their charts, drug information, and have difficult drug calculation tools at their fingertips.

One of the doctors even said that he couldn't imagine doing his job without his Ipad anymore. With the constant creation of new apps being put out onto the web, the younger generation has unlimited opportunities and helpful tools whenever they need them. These two different doctors in the article stated that they used the smartphones and ipads every day, and yet it didn't mean that they were slacking off or giving less patient care than they would if they still used older methods.

 "These doctors embrace technology and teamwork. They like electronic medical records and smartphone apps. And they like sharing the load with other doctors on the team."

Not only did they say that this was a more efficient way to care for their patients, but it also allowed them to have more free time to do other things outside of the busy life of the hospital, and I would have to agree. 

I believe that this also applies to retail pharmacy because you are frequently being asked drug information questions, and complicated information by your patients, and your job as a pharmacist is to be confident in the information that you're supplying your patient with. By having quick and easy access to different drug information sites such as micromedex and lexicomp, you can rest assured that your patients will not only be getting quality information, but they won't have to extend their stay at the pharmacy to get it. Most customers don't want to be at the pharmacy for long, they're expecting quick service, and if they want information about a drug what quicker way to provide that information than by having your tablet, ipad, or smartphone on you at all times? 

One of the concerns people have with this however, is that people will rely too heavily on the information they can look up, and won't have as extensive knowledge about the practice as pharmacists had in the past, which I disagree with. To be able to get the best use out of these different applications, one has to know what they're looking for, what sites to use for the best results, and the quickest way to go about searching for the answer.Being able to interpret the information you're given and translate it into something the patient will understand is still just as important, whether you're looking up the information in a large reference book, or on an easily accessible website. It's also much easier to show the patient the information that you found to be able to back up your search, and let them see for themselves.

As with our class discussion this week, I believe that either a tablet or a smartphone would be practical for the community setting, however a smartphone would probably be easier to carry with you, seeing as it would fit into your coat pocket. More and more these different forms of technology are entering the pharmacy world and expanding the field of practice. I don't currently own a smartphone or an Ipad, but I know that when I'm on my fourth year rotations I will definitely have one or both of these, and that it will only help me to better communicate with not only my patients, but my team members as well.