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Can these medications thin the blood? My husband is having surgery and I am just checking. Horizant, Requip, Tramadol, Provigil, Ketoprofen. Thank you for any help. Sincerely, Nola

Ketoprofen can "thin the blood" so to speak. The type of surgery really matters in what his level of bleeding risk is and when he should stop taking the medication, but typically NSAIDs such as ketoprofen should be stopped at least 3 days prior to surgery. Make sure to run all of these meds by his surgeon.

Also, it is very important to discuss any herbal products your husband might be taking in addition to these, since many non-prescription products can interact with anesthesia.

Money wise how's life as a pharmacist? D you have a big house or other luxuries?

Before I answer this question, let me first state that this should not be the primary reason that anyone would want to be a pharmacist. It is a very important job, and for the sake of the patients and the pharmacist it would be best if they are actually passionate about medicine and want to be a pharmacists regardless of the money.

Now, in terms of money it is all relative. What is a lot of money to some people isn't much money to others. Most pharmacists, depending on the job type and region, make between $90K-130K per year or so. I have a modest home and live a conservative lifestyle, but do not have to worry about money. I'm not balling like Floyd Mayweather, but I am financially secure.

I am a financially savvy person myself. I can attest that you will find many pharmacists that do live in big homes and drive expensive cars. That is their choice however, and barring any substantial additional income will likely prevent them from accumulating substantial wealth and retiring at a reasonable age.

What would be the physiological reason for a PPI to stop working? I was on Aciphex for three years wtih great success and symptom relief, then weaned myself off fairly successfully, was off for two years, and began to take it again recently (at double the dose as per my gastroenterologist's advice about two weeks ago after I experienced a severe flareup of symptoms). Taking the Aciphex at twice the dose has been like taking nothing. Can't seem to find an answer for this anywhere. Thank you.

Hmm, not really sure about the answer to your specific question on this one. I imagine the most likely explanation is a worsening of your disease process (assuming you are taking it for GERD). Sometimes GERD doesn't respond adequately to PPI treatment. Are symptoms constant, or only worse at times? Did the PPI help at all? Sometimes patients have worse symptoms at night, and a possible solution to that would be to add an H-2 blocker such as Zantac at bedtime, although no strong evidence supports that. Another possible attempt at a solution would be to get changed to a different PPI. No evidence supports any PPI as being more effective than the others, but some people seem to respond better to one PPI than other. If this is the case with you, I wouldn't really have an explanation for why AcipHex worked before but not now.

My boyfriend recently suffered a concussion, which also resulted in a ruptured ear drum. He is in a lot of pain but the doctor only prescribed him ibuprofen (mainly for the swelling). He has some Vicodin. Is it safe for him to take the Vicodin considering his concussion?

Hello,

The big concern would be that he will be at a heightened risk of sedation, confusion, and other neurologic effects due to additive effects of the concussive symptoms and drug side effects. While these do not pose any long term harms, he could be at an increased risk of falls and accidents. It would be wise for him to avoid any situations in which he could hurt himself or others while taking it (such as driving or operating machinery).

I am taking warfarin for the 3rd week now. 3 days ago my INR reading was 7.8 in which i was experiencing hematuria. my question is, does this elevation had a effect to my current ankle problem. i thought the pain i was feeling due to my ankle problem ( not the bone but the tissue around my ankle) was improving but since the elevation of my INR the pain is unbelievable. I can't move my foot without feeling the pain. I was off warfarin for the last 2 days and had resume it. will the pain improve?

I honestly doubt the two were related.

What are your thoughts on Drug Information as a career? Pros? Moreso the cons? What is the future of this specialty? Any other insights including perhaps why you didn't go down this path are appreciated as well.

Sorry for the delayed response.

Technically, most pharmacists will spend some of their professional lives dealing with drug information. Whether you work in the retail, clinic or institutional setting, you are going to have to obtain information and evaluate that information according to the situation.

I will assume that you are talking about a career in which your job description is to obtain and evaluate drug information. The pros would be learning new stuff everyday, and not dealing with all of the cons of working in one of the aforementioned settings. The cons would be a lack of direct patient care, relationship building with other healthcare professionals, and I would imagine a limited opportunity to advance your career. I say this in ignorance though, as I have literally no experience in this setting. I had a 4 week "drug information" experiential experience during my clinical rotations, but it wasn't a true drug information setting.

Drug information centers a few and far between, so getting in one would be very difficult. I never really thought about it as a career, and I don't think it would suit me as I am one that is always looking to move around and try new things.

Aaron

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What are your thoughts on Procrit vs. Aranesp? For example, someone taking a Procrit injection every two weeks if hemoglobin is < 12 g/dL, etc. Is it worthwhile to switch to Aranesp monthly? Thanks.

It would be worthwhile if the less frequent injections are a big advantage for you...depending on the cost of course. It may be more expensive to switch to Aranesp, so that would be a factor as well.

There is a good bit more clinical data and experience with Procrit, but no evidence to suggest that one is "better" or safer than the other. So to me, the only two factors are going to be convenience and cost.

Lastly, depending on the reason you need Procrit, you may want to talk with your healthcare provider about modifying your target hemoglobin. Last year, the FDA issued an advisory recommending more conservative hemoglobin targets for kidney disease patients in light of the risks of Procrit or Aranesp treatment. As a general rule, you probably shouldn't start on it until your hemoglobin is falling below 10, and your goal for treatment should not exceed 10-11.

http://themedicineguy.com/post/6936015666/fda-warning-anemia-drugs

Hope this helps!

-Aaron Emmel, Pharm.D., BCNSP, BCPS

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Nice informational video about statin medications.

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I was on adderral (instant release) for a long time but I stopped when summer came and I didn't have classes because I don't like the effects of being more boring. What other drugs might I try for my ADD? I only heard of one non-stimulant, strattera, and the side effects list for that was terrible.

Hello,

Please note my terms of use prior to interpreting the information below.

Stimulants (like Adderall) are the most effective treatment for ADD/ADHD. If you tolerated it ok, and did not experience any significant side effects, that is still probably the best way to go.

Alternative non-stimulant drugs include Strattera as you mentioned, as well as guanfacine. Neither are as effective as stimulants, but they do have the advantage of not carrying as much abuse potential or sleep disturbance. Guanfacine can be quite sedating though, which may be a drawback. Another option is the antidepressant drug bupropion, although it has problems of its own (such as a risk of seizures) and it doesn't have much data for effectiveness in adults.

Let me know if you would like further clarification.

-Aaron Emmel, Pharm.D., BCNSP, BCPS

RxEconsult interviews Dr. Aaron Emmel about his medication therapy management business, SmarterMeds.

Good morning medicine guy. Quick question. Doc gives me 50 mg of painkillers per day for injuries sustained in military. I am tryig to quit smoking but do not know the safety limits of taking pain pills and the nicotine patch. I cannot find a reliable answer to this question, any thoughts?

Good afternoon to you.

The terms of this blog apply to this post.

Well, I am not sure what kind of pain medications you are referring to. Regardless though, it really doesn't matter as there shouldn't be any drug interaction between nicotine and either narcotic pain medications, acetaminophen, or NSAIDs. The only concern I can think of would be with certain migraine medications (the "triptans" and Migranal), as nicotine may enhance their cardiovascular toxicity.

So the fact that you are on a nicotine patch really wouldn't effect the safety of the pain pills otherwise.

Good luck!

-Aaron

I know this is not really what your used to answering , but I was wondering.. Can starting out getting my Pharmacy Technician Certification help my chances of getting into Pharmacy schools? And if so, can you recommend a good school to attend? (I like your videos!) Thanks - Tkc

Thank you!

I have never been involved in the admissions process, so I couldn't give you a concrete answer. But I imagine, that all other things being equal, the person with the certification will look better since the college knows that person has a true interest in pharmacy. If it doesn't interfere with your schoolwork or delay your application, you may want to consider it.

US News did a ranking of pharmacy colleges several years ago, based on survey data from those in the academic field.

http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-health-schools/pharmacy-rankings

I would apply to as many as possible, in whichever locations you'd be willing to go to. Pharmacy school has become very competitive, so you'll have a better chance of getting in the more you apply.

The school that you go to doesn't make as much of a difference in your education as your own personal attitude towards the process. Just remember that the more you learn and the more proficient you become, the better off your patients will be.

Good luck!

-Aaron

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