Breast Cancer and Medical Drugs Treatment

Introduction

It has become a popular fashion statement to support different charities or organizations by wearing ribbons or the even more popular wrist bands. Perhaps the most notable are the yellow wrist bands started by Lance Armstrong to support his charity. However, if you take a close look you will see that many people are showing their support for breast cancer by wearing pink ribbons and bracelets. Breast cancer has unfortunately become so widespread that nearly everyone knows someone that has suffered from this terrible form of cancer.

What is it?

Each month, a woman's breast goes through changes associated with menstruation that can cause a lump to form. While the majority of these lumps are benign (or non-cancerous), each lump should be examined. Lumps are most commonly formed in breast tissue lobules, (small sacs that produce milk), or the ducts that carry milk to the nipple. However, lumps can also form in other breast tissue.

When a lump is found to be malignant, breast cancer is diagnosed. Breast cancer is divided into two main categories: lobular and ductal carcinomas. Breast cancer is also categorizes as non-invasive or invasive.

Breast cancer typically starts with the formation of a small confined tumor. Some tumors are benign, thus not invading other tissue; other are malignant or cancerous. These malignant tumors have the ability to metastasize, which means they spread to other tissues or regions in the body. The larger a tumor grows, the more likely it is that small pieces or cells will break off and spread to other parts of the body through the bloodstream or lymph system. Different types of breast cancer grow and spread at different rates; some may take years, while others may grow and spread much more quickly.

Four Main Types of Breast Cancer Exist:

Invasive Ductal Carcinoma (IDC): Invasive ductal carcinoma (also known as IDC) is the most common form of invasive breast cancer accounting for 75 percent of all invasive breast cancers. These tumors commonly spread to lymph nodes in the armpits. IDC is typically an aggressive cancer and has an increased risk of death compared to other types of invasive breast cancers. IDC metastasizes commonly to different areas of the body including bone, the liver, lung or brain

Invasive Lobular Carcinoma (ILC): Another type of invasive breast cancer is known as invasive lobular carcinoma (or ILC), which accounts for 5 to 10% of breast tumors. ILC more commonly spreads or metastasizes to unusual sites such as the layers that cover the brain and surfaces that cover organs.

Ductal Carcinomna In Situ (DCIS): A form of breast cancer that is non-invasive is known as ductal carcinoma in situ (DCIS). DCIS is the most common type of non-invasive breast cancer and is diagnosed when cancerous cells line the ducts in the breast. "In situ" means that the cancer cells have not spread beyond the ducts. However DCIS can progress and become invasive, especially if not detected early. Most cases of DCIS cannot be felt as lumps or masses but will show up on mammograms?one reason why regular mammograms are a must.

Lobular Carcinoma In Situ (LCIS): Lobular carcinoma in situ (or LCIS) is another form of non-invasive breast cancer. LCIS is a benign tumor that consists of abnormal cells in the lining of the lobule. "In situ" means that the abnormal cells have not spread beyond the lobules. LCIS is not actually considered cancer?it is generally thought to be a 'pre-cancer." LCIS will typically not show up on a mammogram. The only means of detecting LCIS is by taking sample of the suspected tissue and examining it in a lab. It is currently unclear whether or not LCIS progresses to cancer.

Breast cancers, just like other cancers are also categorized or "staged" based on the following system called the "TNM" rating:

• A "T" refers to the size of the tumor. Tumors are graded on a scale of one to four, with four being the most advanced.
• An "N" refers to how much the cancer has affected the lymph nodes, which exist throughout the body. Lymph node involvement is graded on a scale of zero to three, with three having the most lymph node involvement.
• An "M" rating is used to identify if the cancer has spread, which is referred to as "metastasized." Metastases are assigned a zero if the tumor has not spread or a one if it has.

Once the cancer begins to spread, getting rid of it completely is more difficult, although treatment can often control the disease for years. Improved screening procedures and treatment options mean that at least seven out of 10 women with breast cancer will survive more than five years after initial diagnosis, and half will survive more than 10 years.

Fortunately, breast cancer is very treatable if detected early. Localized tumors can usually be treated successfully before the cancer spreads; and in nine in 10 cases, the woman will live at least another five years. Experts usually consider a five-year survival to be a cure.

What causes it?

Although the exact cause of breast cancer is unknown, we do know the main risk factors that put people at risk. Most current evidence indicates that hypersensitivity of estrogen and/or progesterone-specific receptors within breast tissue are responsible for the majority of breast cancer cases. It is believed that these two hormones may be responsible for proliferation of breast cells and resultant tumor formation. For example, estrogen tells cells to divide; the more the cells divide, the more likely they are going to become abnormal in some way and possible cancerous.

Additionally, the mutations of two abnormal hereditary genes, BRCA1 and BRCA2, have been found to play an important role in the development of breast cancer. It is estimated that about 1 in 200 women carries these genes and are therefore at a substantial greater risk for developing breast cancer.

Who has it?

Among women, breast cancer is the most common cancer and the second leading cause of cancer death, only second to lung cancer. Nearly 200,000 women in the United States will be diagnosed with invasive breast cancer in 2007. It is also estimated that there will be over 40,000 deaths due to breast cancer in 2007. This mortality rate may seem high, but mortality rates have been decreasing every year since 1989. This decline is thought to be due to improvement in cancer treatments and improvement in prevention and early detection techniques.

The incidence of breast cancer begins in early adulthood, with a sharp rise in incidence to the time of menopause. After menopause, the incidence of cancer decreases significantly.

If eight women were to live to be at least 85, one of them would be expected to develop the disease at some point during her life. Two-thirds of women with breast cancer are over 50, and most of the rest are between 39 and 49.

Breast cancer is not a disease that affects only women. One percent of all breast cancers occur in men. According to the American Cancer Society, over 2000 men in the United States will be diagnosed with breast cancer in 2007.

What are the risk factors?

Several risk factors have been identified as having a potential relationship to the development of breast cancer. These include:

• Advanced age
• Personal or family history of breast cancer
• Menstrual periods beginning at an early age (before age 12)
• Abnormal BRCA1 and BRCA2 genes (genetic testing can identify if you carry these genes)
• Late menopause (after age 55)
• Never having children
• Having first child after age 30
• Obesity (especially noted in postmenopausal women)
• Long term use of postmenopausal hormone replacement therapy (greater than 5 years)
• Benign breast disease
• Oral contraceptive use(however recent studies have shown this to not be as significant as once thought)
• Alcohol consumption
• Having received radiation before age 40

Since most of these risk factors are not easily modified, early detection is very important. The American Cancer Society recommends a breast self examination (BSE) monthly for all women older than 20, a Clinical Breast Exam (performed by a healthcare professional) every 3 years (from ages 20-39), and a Mammogram annually for women older than 40.

What are the symptoms?

Symptoms of breast cancer can vary based on the severity of the disease. The most common initial sign of breast cancer is abnormalities on mammograms. These abnormalities can often show long before a woman or her doctor detects any physical changes in the breast.

There are specific factors that should raise suspicion of disease. These include:

• A lump noted on breast self-examination (BSE)
• A thickening or swelling of the breast or nipple
• A discharge from the nipple
• Swelling in the armpit
• More advance stages will show a change in contour, texture, size, or warmth of the breast

How is it treated?

The most important treatment for breast cancer is early detection. Starting around age 20, women should perform monthly self breast examines to check for any new masses or lumps. Contact your doctor immediately if you detect a lump or mass or your breast(s) is painful or abnormally shaped. Also, contact your doctor if you notice any swelling in your armpits, which could also be associated with cancer.

The type of treatment that is chosen for a person with breast cancer is based on several factors, and the individual should work closely with the health care provider to determine the best treatment approach. The decision for treatment is made based on the size and location of the mass in the breast, lab tests performed on the cancer cells, and the stage or extent of the disease. The care given may consist of chemotherapy, radiation therapy, surgery, and hormone therapy or a combination of treatments.

Most individuals with breast cancer will have some type of surgery. Surgery for breast cancer includes either a mastectomy, full removal of the breast, or lumpectomy, which preserves the breast and only removes the lump. Each of these procedures can also be done with or without removal of lymph nodes. Treatment regimens may be used to prevent the spread of breast cancer to the opposite breast and to reduce the incidence of breast cancer.

The U.S. Preventive Services Task Force is urging health professionals to recommend tamoxifen or raloxifene to women at high risk for developing breast cancer to prevent the disease (chemoprevention). This agency is also advising that women at low or average breast cancer risk should not take these medications for chemoprevention due to adverse effects.

Drug classes used to treat Breast Cancer

• Anti-estrogens
• Aromatase Inhibitor
• Monoclonal Antibodies
• Progestins

What is on the horizon?

The FDA recently approved Avastin (also known as bevacizumab) to be used in combination with Taxol (also known as paclitaxel) to treat women with advanced breast cancer who have not started chemotherapy. Studies showed that this combination increased the time that breast cancer did not progress. Avastin is a new class of drugs that block the formation of blood vessels that supply the cancerous tumors, thus eliminating the source of nutrition for the cancer cells.

The American Cancer Society has funded more than 184 research projects relating to breast cancer. A few areas of research include:

• Anti-angiogenesis drugs - These drugs are theorized to block the supply of new blood vessels to breast tumors.
• New molecular targets for anticancer drugs
• Gene therapy - an area of interest to many researchers. The idea here would be to replace the defective genes in cancer cells with normal, healthy genes, thereby correcting the cells' overactive replication problem. The challenge is finding a way to get the healthy genes into the cancer cells.
• The effect of presurgery hypnosis on side effects, recovery, and cost of breast cancer treatment
• How a woman's genetic makeup determines her response to treatment
• Causes of breast cancer - The Sister Study is following 50,000 women ages 35-74 whose sisters (not themselves) have had breast cancer for 10 years to try to identify causes of breast cancer.
• Immunotherapy - vaccines containing specific antigens (particles that generate an immune response) located on the surface of the breast are currently being studied.

There are currently more and more studies that are examining the effects of lifestyle factors and habits that can alter breast cancer risk. Many studies are looking into the effects of exercise, weight gain or loss, and diet on the risk. With the sequencing of the human genome, the advances in breast cancer prevention and treatment related to genes will continue to accelerate.

High Cholesterol and Medical Drug Treatments

Introduction

With cholesterol testing at health fairs and drug stores, and with a breakdown of fat and cholesterol counts on all the packaged food we eat, you are probably well aware of the relationship between high cholesterol and heart disease. Yet, heart disease remains the leading cause of death in the United States; and you may not always eat the healthy, low-cholesterol diet that you should.

Because of the important relationship between high cholesterol and heart disease, all adults over the age of 20 years should have a fasting lipoprotein profile (a complete cholesterol profile--includes measuring total cholesterol, triglycerides, low-density lipoprotein(LDL) and high-density lipoprotein (HDL)) checked at least every 5 years. This should occur more often if a family history of coronary heart disease exists. Most children do not need to have their blood cholesterol level checked.

What is it?

Cholesterol is a soft, waxy, fat-like substance the body needs for cells to grow and regenerate. Cholesterol comes from two sources: your body and the foods you eat. The body makes its own cholesterol in the liver, and it only takes a small amount of cholesterol in the blood to meet your body's needs. However, because cholesterol can be found in foods such as red meats, whole milk dairy foods, and egg yolks, eating too much dietary cholesterol can make your blood cholesterol levels increase. Too much cholesterol circulating in the bloodstream is known as hypercholesterolemia.

Hypercholesterolemia increases the risk of heart disease because it can lead to atherosclerosis, a condition in which fat and cholesterol are deposited on the walls of the arteries. Atherosclerosis can occur in arteries throughout the body, including the coronary arteries (those feeding the heart). In time, narrowing or clogging of the coronary arteries by atherosclerosis can produce the signs and symptoms of heart disease, including angina (chest pain) and heart attacks.

When cholesterol builds up in arteries, it forms plaques which block blood flow and deny oxygen to the heart.

There are a number of types of cholesterol:

1. Low-density lipoproteins (LDLs) are often referred to as "bad cholesterol" because LDL cholesterol carries cholesterol to the body?s tissues, including the arteries. Elevated levels of LDLs can lead to heart disease.
2. High-density lipoproteins (HDLs) are referred to as "good cholesterol" because HDL cholesterol carries cholesterol from the tissues to the liver for removal from the body. Elevated levels of HDLs can prevent heart disease.
3. Triglycerides are a storage form of fat. Elevated levels of triglycerides may also increase the risk of heart disease.

What causes it?

Many factors appear to contribute to the development of high cholesterol:

• Heredity--Your genes partly influence how your body makes and handles cholesterol.
• Your diet--A high intake of saturated fat, dietary cholesterol, and excess calories can cause your cholesterol levels to increase. Being overweight can increase your LDL levels and decrease your HDL levels.
• Age and gender--Cholesterol levels begin to increase in both men and women beginning around 20 years of age. Premenopausal women usually have lower levels of cholesterol when compared with men of the same age. After menopause, a woman's LDL cholesterol level typically goes up, as does her risk for heart disease.
• Other medical conditions--Conditions such as diabetes, liver disease, thyroid disease, or kidney disease can cause elevated cholesterol.
• Lack of physical activity--Increased physical activity lowers LDL and raises HDL levels. Lack of exercise can cause the opposite.

Who has it?

It is estimated that 100 million American adults have total blood cholesterol values of 200 mg/dL and higher--desirable total cholesterol levels are below 200 mg/dL. This desired level may be lower for those who have already had a heart attack or for those at risk for heart disease because they smoke, have hypertension, or have diabetes. There are about 13.2 million Americans with known coronary heart disease and about 8.7 million adults without formally diagnosed coronary heart disease.

Interestingly, about 10% of adolescents age 12 through 19 have total blood cholesterol levels of greater than 200 mg/dL. This may be due to the increasing rates of obesity among children and adolescents. There is compelling evidence that the development of atherosclerosis begins in childhood and progresses slowly into adulthood.

The good news is that medications and healthier lifestyles are making a difference. Today, the number of Americans with a desirable blood cholesterol level (less than 200 mg/dL) has risen to over 51% and the average total cholesterol in this country has fallen from 220 mg/dL in the early 1960s to 203 mg/dL in 2002. But, we still have a long way to go.

What are the risk factors?

A high fat diet, lack of exercise, and a family history of high cholesterol or heart disease will all increase your risk for high cholesterol and heart disease. If you have high cholesterol, the additional risk factors for developing heart disease include the following:

• Increasing age: Being male greater than 45 years old or being female greater than 55 years old (or having premature menopause without estrogen replacement therapy)
• Heredity: A family history of heart disease at a young age(that is, having a father or brother who had a heart attack or died of heart disease before the age of 55 years or having a mother or sister who had a heart attack or died of heart disease before the age of 65 years)
• Currently smoking cigarettes: Smokers' risk of heart attack is more than twice that of nonsmokers. Cigarette smoking is the biggest risk factor for sudden cardiac death: smokers have two to four times the risk of nonsmokers.
• High blood pressure: High blood pressure increases the heart's workload, causing the heart to enlarge and weaken over time.
• Low HDL cholesterol (less than 40 mg/dL): High levels of HDL or "good cholesterol (greater than 60 mg/dL) help to lower risk for heart disease.

Additional Factors that May Increase Risk

• Diabetes: Two-thirds of people with diabetes die of some form of heart or blood vessel disease. If you have diabetes, it's critically important for you to monitor and control any other risk factors you can.
• Obesity/Overweight: People who have excess body fat are more likely to develop heart disease and stroke even if they have no other risk factors. Obesity is unhealthy because excess weight increases the strain on the heart.
• High homocysteine levels: Homocysteine is an amino acid in the blood. Initial studies have found an association with high blood levels of homocysteine and an increased risk for heart disease. Homocysteine levels are strongly influenced by dietary intake of folic acid and B vitamins. Insuring adequate intake of these vitamins may help lower homocysteine levels. Ask your doctor if you should have your homocysteine levels tested. Homocysteine testing is done via a simple blood test.

Metabolic Syndrome, a collection of several health risks and problems, can place you at greater risk of developing heart disease, stroke, and diabetes. It is estimated that 1 in 5 Americans has metabolic syndrome, including 43.5% of people 60 to 70 years of age. Although the cause is unknown, researchers believe that it's related to many factors including diet, family history, and the amount of exercise a person gets. Diagnosis of this syndrome includes 3 or more of the following risk factors:

• A waistline more than 35 inches for men or 30 inches for women measured across the belly.
• Blood pressure of 130/85 mmHg ("130 over 85")or more
• A triglyceride level more than 150 mg/dL
• A fasting blood sugar level more than 110 mg/dL
• A high density lipoprotein level (HDL; also known as the good cholesterol) less than 40 mg/dL for men or less than 50 mg/dL for women

People with established heart disease and metabolic syndrome are considered to be at highest risk for heart problems. This risk is increased even more in people with diabetes. Many of these very high risk patients have a more aggressive LDL (bad cholesterol) goal of less than 70 mg/dL compared to less than 100 mg/dL to 160 mg/dL for healthy individuals.

What are the symptoms?

Before the onset of heart disease, high cholesterol does not usually produce symptoms in and of itself. Without obvious health effects or symptoms, the average person has a hard time making needed diet and exercise improvements. The following are signs or results of high cholesterol:

• Coronary heart disease
• Heart Attack or stroke
• Peripheral arterial disease (narrowing of the blood vessels that deliver oxygen-rich blood to the legs, abdomen, pelvis, arms or neck)
• Inflammation of the pancreas

But any heart patient will tell you, the time to make changes is long before chest pain hits. When "bad" cholesterol blocks arteries in a condition called atherosclerosis, the results can be debilitating and even fatal.

How is it treated?

Treatment of high cholesterol is aimed at lowering the low-density lipoproteins (LDL) or "bad cholesterol," lowering triglyceride levels, and increasing the high-density lipoproteins (HDL) or "good cholesterol." Decreasing total cholesterol by 10% can result in a 30% reduction in coronary heart disease incidence. For every 1% decrease in LDL (bad cholesterol levels), heart disease rates drop 2%. On the other hand, for every 1% decrease in HDL, there is a 2 to 3% increase in the risk of heart disease.

A low fat/low cholesterol diet and exercise are essential in helping to lower cholesterol and to maintain low cholesterol levels. While drug therapy is often needed to lower cholesterol, diet and exercise are additionally recommended to help the drug therapy lower and control cholesterol levels. Patients with established cardiac disease and multiple risk factors (metabolic syndrome, diabetes, or smoking) are sometimes given more intense lifestyle changes.

The decision to start a patient with dietary therapy or drug therapy is usually based on a patient's LDL cholesterol levels, presence of heart disease, and risk factors. Your doctor should calculate your "10-year risk" (also known as a Framingham Risk) for developing heart disease and use that risk estimation to decide if and when to start cholesterol-lowering therapy either through dietary modifications or medications.

Drug Therapy For the initial drug treatment of hypercholesterolemia, HMG-CoA reductase inhibitors (also called "statins") are often used because of their effectiveness and low incidence of side effects. Currently, six statin drugs are available. The choice of which to use will depend on how much cholesterol reduction you need, doctor's preference, and prescription insurance benefits. Studies have shown that certain high risk patients, such as those with diabetes, benefit from cholesterol lowering therapy with statins.

Other drug classes that may be used to treat hypercholesterolemia include bile acid resins, nicotinic acid, fibric acid derivatives, and cholesterol absorption inhibitors. Some of these drugs can be used in combination if a further reduction in cholesterol is needed.

If you specifically have elevated triglyceride levels, a fibric acid derivative or niacin may be most effective for you. Both medications work by decreasing the liver's production of triglycerides. Additionally, fibric acid derivatives (or "fibrates") such as gemfibrozil also increase HDL-C (good cholesterol) production.

Bile acid resins are mainly used in young adults with hypercholesterolemia or in combination with another cholesterol-lowering medication. These drugs interact with several medications including carbamazepine, gemfibrozil, and thyroid medication as well as several blood pressure medicines and antibiotics. These medications should be administered at least 1 to 4 hours before or 4 to 6 hours after these cholesterol lowering agents.

Cholesterol absorption inhibitors are a new class of cholesterol lowering agents and work together with statins to lower cholesterol. This class of drugs works to lower blood cholesterol levels by absorbing excess cholesterol (from foods) in the intestines and thus blocking cholesterol's entry into the bloodstream. In a study published by the Mayo Clinic in May 2005, it was found that the addition of Zetia (a cholesterol absorption inhibitor) to statin therapy may cause a further reduction in a patient?s cholesterol levels. It is thought that this reduction may be the result of the two drugs working together but at different areas of the cholesterol production pathway. In fact, one pharmacy manufacturer combined Zetia with a commonly used statin known as Zocor. This combination product is called Vytorin. However, as with any medications it is recommended that you ask your doctor if this drug or combination of drugs is appropriate for you.

Types of Medical Drug Intake

Not all medical drugs intake are in pill format. There are practically 9 types of medical drug intake which I'd like to share step by step instruction of how to consume them.

How, when, and with what other substances you use your medicine can have a significant impact on your response to many drugs.

Compare your routines with the recommended medication administration methods described below.


EyeDrops

Steps by step instructions

1. Wash your hands thoroughly with soap and water.
2. Gently clean your ear with a damp facecloth and then dry your ear.
3. Warm the drops to near body temperature by holding the container in your hand for a few minutes.
4. If the drops are a cloudy suspension, shake the bottle well for 10 seconds.
5. Check the dropper tip to make sure that it is not chipped or cracked.
6. Draw the medication into the dropper, or hold the dropper-top bottle with the dropper tip down.
7. Tilt the affected ear up or lie on your side.
8. Avoid touching the dropper tip against your ear or anything else. Eardrops and the dropper must be kept clean.
9. Place the correct amount in your ear. Then tug gently on your ear to allow the drops to run in.
10. Keep your ear tilted up for a few minutes or insert a soft cotton plug in your ear, whichever method has been recommended by your pharmacist or doctor.
11. Replace and tighten the cap or dropper right away.
12. Wash your hands to remove any medication.

13. REMEMBER:

1. Follow directions carefully
2. Do not miss doses
3. Store medications out of reach of children

Adapted from the Michigan Pharmacists Association's Patient Education Program.

Additional Tips for Using Ear Drops

1. Follow directions carefully.
2. Do not miss doses.
3. Store medications out of reach of children.
4. Do not touch dropper tip to ear.
5. If more than one type of ear drops is being used, wait at least 2 minutes before instilling the next ear drop.
6. Let the ear drops drain in for at least 2 minutes before moving head from tilted position.

Eye Ointments/Gels

Steps by step instructions

1. Wash your hands thoroughly with soap and water.
2. Avoid touching the tip of the tube against your eye or anything else - the medication and its container must be kept clean.
3. Holding the tube between your thumb and forefinger, place it as near to your eyelid as possible without touching it.
4. Brace the remaining fingers of that hand against your face.
5. Tilt your head forward slightly.
6. With your index finger, pull the lower eyelid down to form a pocket.
7. Squeeze a ribbon of ointment or gel into the pocket made by the lower eyelid.
   
8. Blink your eye gently; then close your eye for 1 to 2 minutes.
9. With a tissue, wipe any excess ointment or gel from the eyelids and lashes. With another clean tissue, wipe the tip of the tube clean.
10. Replace and tighten the cap right away.
11. Wash your hands to remove any medication.

12. REMEMBER:

1. Follow directions carefully
2. Do not miss doses
3. Your eyesight may be cloudy after using the ointment or gel Store medications out of reach of children

Adapted from the Michigan Pharmacists Association's Patient Education Program. Illustration reproduced, with permission, from the Atlas of Primary Eyecare Procedures, Appleton Lange, Norwalk, CT, 1997.

EyeDrops

Steps by step instructions

1. Wash your hands thoroughly with soap and water.
2. Check the dropper tip to make sure that it is not chipped or cracked.
3. Avoid touching the dropper tip against your eye or anything else. Eye drops and droppers must be kept clean.
4. While tilting your head back, pull down the lower lid of your eye with your index finger to form a pocket (see figure).
   
5. Hold the dropper (tip down) with the other hand, as close to the eye as possible without touching it.
6. Brace the remaining fingers of that hand against your face.
7. Gently squeeze the dropper so that the correct number of drops falls into the pocket made by the lower eyelid.
8. Close your eye for 2 to 3 minutes.
9. Place one finger at the corner of the eye near the nose and apply gentle pressure. This will prevent the medication from draining out of the eye. Wipe any excess liquid from your face with a tissue.
10. Replace and tighten the cap right away. Do not wipe or rinse the dropper tip.
11. Wash your hands to remove any medication.

12. REMEMBER:

1. Follow instructions carefully
2. Do not miss doses
3. Use the exact number of drops recommended
4. Store medications out of reach of children
5. If more than one type of eye drop is being used, wait at least 10 minutes before using the next eye drop.
6. If soft contact lenses are used, remove them before administering the medication and wait at least 15 minutes before reinserting them.

Adapted from the Michigan Pharmacists Association's Patient Education Program. Illustration reproduced, with permission, from the Atlas of Primary Eyecare Procedures, Appleton Lange, Norwalk, CT, 1997.

Additional Tips for Using Eye Drops

1. Follow label instructions carefully.
2. Do not miss doses.
3. Use the exact number of drops recommended by your doctor.
4. Store medications out of reach of children.
5. If more than one type of eye drop medication is being used, wait at least 10 minutes before instilling the next eye drop medication.
6. If you wear soft contact lenses, remove them before administering the medication and wait at least 15 minutes after instilling eye drops before reinserting the lenses.

Inhalers

Steps by step instructions

Using an inhaler seems simple, but most patients do not use it the right way. When you use your inhaler the wrong way, less medicine gets to your lungs.

For the next 2 weeks, read these steps aloud as you do them or ask someone to read them to you. Ask your doctor, pharmacist or nurse to check how well you are using your inhaler.

Use your inhaler in one of the three ways pictured below (A or B are the best, but C can be used if you have trouble with A and B)

Steps for Using Your Inhaler

Getting Ready

• Take off the cap and shake the inhaler
• Breath out all the way
• Hold you inhaler the way your doctor said (A, B, or C below).

Breathe in slowly

• As you start breathing in slowly through your mouth, press down on the inhaler one time (If you use a holding chamber, first press down on the inhaler. Within 5 seconds, begin to breathe in slowly.
• Keep breathing in slowly, as deeply as you can.

Hold your breath

• Hold your breath as you count to 10 slowly, if you can.
• Wait about 1 minute between puffs.

A. Hold inhaler 1 to 2 inches in front of your mouth
(about the width of two fingers)

B. Use a spacer/ holding chamber.
These come in many shapes and can be useful to any patient.

C. Put the inhaler in your mouth.
Do not use for steroids.

Clean Your Inhaler as Needed

Look at the hole where the medicine sprays out from your inhaler. If you see "powder" in or around the hole, clean the inhaler. Remove the metal canister from the L-shaped plastic mouthpiece. Rinse only the mouthpiece and cap in warm water. Let them dry overnight. In the morning, put the canister back inside. Put the cap on.

Additional Tips for Using Inhalers

1. There are three types of medication that can be delivered with a metered dose inhaler:
   • Bronchodilators- medications that relax the muscles around the bronchial tubes and make breathing easier. These are used for immediate relief of symptoms.

   • Corticosteroids- medications that decrease inflammation and swelling in the airways. They do not provide relief immediately but may help reduce the frequency and severity of acute attacks, if taken on a regular basis.

   • Cromolyn- medication that reduces inflammation and reactions in the airways. It does not provide relief immediately but may help reduce the frequency and severity of acute attacks, if taken on a regular basis.

2. Rinse mouth with water or mouth wash after using corticosteroid medication to prevent hoarseness and fungal infections in the mouth and throat.
3. If you are taking more than one inhaled medication, it is important to take them in the correct order. Bronchodilating medications are usually taken first to open the airways and allow other types of medications to be more effectively inhaled into the lungs. Corticosteroids and cromolyn are inhaled after bronchodilating drugs.
4. Avoid the use of over-the-counter inhalers. Most of these contain epinephrine, which is effective for only a short time and may cause rebound bronchospasm (making it more difficult to breathe).
5. Take only the recommended number of puffs prescribed by your provider; over-use or incorrect use can be dangerous.
6. Notify your doctor if any of the following occur:
   • You do not get relief from your metered dose inhaler
   • You have increasing shortness of breath despite use of inhalers
   • You are experiencing weakness, increased heart rate, shakiness, insomnia, nervousness, headaches, nausea or vomiting

Insulin - Injecting

Steps by step instructions

1. Select a site for insulin injection. Insulin may be injected into the fatty layer of tissue of the upper arm, the thighs, or the abdomen.
2. Clean the injection site with an alcohol pad and allow it to dry.
3. Pick up your prepared syringe and uncap it to expose the needle.
4. Pinch a fold of skin and quickly push the needle straight into the skin. Be sure that the needle is all the way in.
5. Quickly push the plunger all the way down to inject the entire insulin dose. Once the dose is injected, release the pinched skin and pull the needle straight out. Press on the injection site with an alcohol pad but do not rub the injection site.
6. Dispose of the syringe and needle properly after injection.

Additional Tips for Injecting Insulin

1. It is less painful and less damaging to the body's tissues if the insulin dose is brought to room temperature just prior to injecting.
2. Rotate your injection sites – give each insulin shot in a different spot.
3. Keep a record of your insulin injections in a log book – write down the time and the dose of each insulin injection. Show your log book to your doctor at each appointment.
4. Always check with your doctor or pharmacist if you have questions.

Insulin - Mixing

Steps by step instructions

1. Gather all necessary supplies: insulin vials, syringe, and alcohol pads.
2. Wash hands thoroughly with soap and water.
3. Check the insulin vials to be sure they are the correct insulin and strength. Also, check with your personal healthcare provider to make sure it is okay for you to mix your insulins in the same syringe. Some insulins such as Levemir, should not be mixed.
4. Clear insulin such as Regular, Novolog, Lispro, Lantus, and Apidra do not need to be agitated. All other types of insulin are cloudy and need to be agitated before a dose of insulin is drawn.
5. To agitate insulin, roll the insulin vial between the palms of your hands. Do not shake the insulin vial.
6. Inspect the insulin for any abnormalities in color, particulate matter, consistency, and thickness. If any abnormalities are seen, do not inject the insulin; throw it away and obtain a new vial.
7. If the vial is new, pop the colored cap off.
8. Clean the rubber stopper with an alcohol pad before each use.
9. Verify that you know the correct dose of each insulin to be mixed in the syringe.
10. You will be combing two types of insulin; clear which is short-acting, and cloudy which is longer-acting to make your total dosage.
11. Pick up the syringe and remove the needle and plunger caps. Pull back on the syringe plunger to draw air into the syringe. Draw in an amount of air equal to your dose of cloudy insulin. To measure the amount correctly, pull back on the plunger to the point where the top of the black rubber portion of the plunger meets the measurement line on the syringe.
12. Inject that air into the cloudy insulin vial. This is done to avoid creating a vacuum within the vial when you withdraw your insulin dose and will make it easier to withdraw the dose. DO NOT WITHDRAW THE INSULIN YET. Withdraw the empty syringe from the vial.
13. Repeat this process with the clear insulin. Pull back on the syringe plunger to draw air into the syringe. Draw in an amount of air equal to your dose of clear insulin. Inject that air into the clear insulin vial.
14. Invert the clear insulin vial and syringe and slowly withdraw the appropriate number of clear insulin units first. Remove any air bubbles in the syringe by gently tapping the syringe with your finger and carefully pushing any large air bubbles back into the vial.
15. Double check that you withdrew the proper dose of clear insulin and that no large air bubbles are present; then withdraw the syringe form the vial.
16. Insert the syringe needle into the rubber stopper of the cloudy insulin vial. Invert the vial and syringe and slowly and carefully withdraw the appropriate number of units of the cloudy insulin. Be sure to do this with accuracy since the insulin cannot be pushed back into the vial if too much is withdrawn or large air bubbles exist. Withdraw the syringe from the vial.
17. Double check that you withdrew the appropriate dose. Carefully cover the needle with its cap or lay the syringe down so that the needle does not touch anything. The dose of insulin is now ready to be injected.

Additional Tips for Mixing Insulin Doses

1. Always check your insulin vials to insure that you have the right type of insulin, that it is normal in appearance, and that it is not expired (expiration date is typically printed directly on the vial).
2. Know your correct insulin doses (of your short-acting and longer-acting insulin) before you get ready to draw them into the syringe.
3. Never change insulin brands, types, or concentrations (U-100 versus U-500) without first talking with your doctor.
4. Keep extra vials of insulin in your refrigerator. Make sure you don't run out!
5. Never let your insulins freeze.
6. Keep the vials of insulin that you are currently using in the refrigerator when possible. However, most insulins can be stored at room temperature for up to 30 days.
7. If insulin is not kept in the refrigerator, store it away from heat and light (below 860F).
8. Do not shake your insulin hard and do not let it get tossed around. Longer-acting insulins (typically cloudy in appearance) should be rolled between the palms of the hands to agitate. If insulin is handled roughly, it may be more likely to clump.
9. If you need to travel, protect insulin from getting too hot or cold. Do not leave it in a parked car, especially if it is very warm or very cold outside.
10. When drawing insulins into the syringe remember: CLEAR BEFORE CLOUDY.

Insulin - Preparing

Steps by step instructions

1. Gather all necessary supplies: the insulin vial, syringe and alcohol pads.
2. Wash hands thoroughly with soap and water.
3. Check the insulin vial to be sure it is the correct insulin and strength.
4. Clear insulin such as Regular, Novolog, Lispro and Lantus do not need to be agitated. All other types of insulin are cloudy and need to be agitated before a dose of insulin is drawn.
5. To agitate insulin, roll the insulin vial between the palms of your hands. Do not shake the insulin vial.
6. Inspect the insulin for any abnormalities in color, particulate matter, consistency, and thickness. If any abnormalities are seen, do not inject the insulin; throw it away and obtain a new vial.
7. If the vial is new, pop the colored cap off.
8. Clean the rubber stopper with an alcohol pad before each use.
9. Remove the needle and plunger caps and pull back on the syringe plunger to draw air into the syringe. Draw in an amount of air equal to your dose of insulin. To measure the amount correctly, pull back on the plunger to the point where the top of the black rubber portion of the plunger meets the measurement line on the syringe.
10. Insert the needle straight into the rubber stopper of the insulin vial and push the air into the vial. This is done to avoid creating a vacuum within the vial when you withdraw your insulin dose and will make it easier to withdraw the dose.
11. Invert the vial and syringe and slowly withdraw the appropriate number of insulin units from the vial.
12. Remove any air bubbles in the syringe by gently tapping the syringe with your finger and carefully pushing any large air bubbles back into the insulin vial.
13. Double check that you withdrew the proper dose from the insulin vial and that no large air bubbles are present; then withdraw the syringe form the vial.
14. Carefully cover the needle with its cap or lay the syringe down so that the needle does not touch anything. The dose of insulin is now ready to be injected.

Additional Tips for Preparing Insulin Doses

1. Always check your insulin vials to insure that you have the right type of insulin, that it is normal in appearance, and that it is not expired (expiration date is typically printed directly on the vial).
2. Know your correct insulin dose before you get ready to draw it into the syringe.
3. Never change insulin brands, types, or concentrations (U-100 versus U-500) without first talking with your doctor.
4. Keep extra vials of insulin in your refrigerator. Make sure you don't run out!
5. Never let your insulin freeze.
6. Keep the vial of insulin that you are currently using in the refrigerator when possible. However, most insulins can be stored at room temperature for up to 30 days.
7. If insulin is not kept in the refrigerator, store it away from heat and light (below 860F).
8. Do not shake your insulin hard and do not let it get tossed around. If insulin is handled roughly, it may be more likely to clump.
9. If you need to travel, protect insulin from getting too hot or cold. Do not leave it in a parked car, especially if it is very warm or very cold outside.

Nosedrops

Steps by step instructions

1. Blow your nose gently.
2. Wash your hands thoroughly with soap and water.
3. Check the dropper tip to make sure that it is not chipped or cracked.
4. Avoid touching the dropper tip against your nose or anything else - nose drops and the dropper must be kept clean.
5. Tilt your head as far back as possible, or lie down on your back on a flat surface (such as a bed) and hang your head over the edge.
   
6. Place the drops into your nose.
7. Bend your head forward, toward your knees and move it left and right.
8. Remain in this position for a few minutes.
9. Clean the dropper tip with warm water. Cap the bottle right away.
10. Wash your hands to remove any medication.

REMEMBER:

1. Follow directions carefully
2. Do not miss doses
3. Use nose drops only as long as directed
4. Store medications out of reach of children

Adapted from the Michigan Pharmacists Association's Patient Education Program.

Rectal Suppositories

Steps by step instructions

1. Wash your hands thoroughly with soap and water.
2. If the suppository is soft, hold it under cool water to harden it before removing the wrapper.
3. Remove the wrapper, if present.
4. If you were told to use half of the suppository, cut it lengthwise with a clean, single-edge razor blade.
5. Put on a finger cot or disposable glove, if desired (available at a pharmacy).
6. Lubricate the suppository tip with a water-soluble lubricant such as K-Y Jelly, not petroleum jelly (Vaseline). If you do not have this lubricant, moisten your rectal area with cool tap water.
7. Lie on your side with your lower leg straightened out and your upper leg bent forward toward your stomach.
8. Lift upper buttock to expose the rectal area.
9. Insert the suppository; pointed end first, with your finger until it passes the muscular sphincter of the rectum, about 1/2 to 1 inch in infants and 1 inch in adults. If not inserted past this sphincter, the suppository may pop out. (See below)
10. Hold buttocks together for a few seconds.
11. Remain lying down for about 15 minutes to avoid having the suppository come out.
12. Discard used materials and wash your hands thoroughly.

REMEMBER:

1. Follow directions carefully
2. Store suppositories in a cool place and avoid melting
3. Refrigerate them if so labeled
4. Do not miss doses
5. Store medications out of reach of children

Adapted from the Michigan Pharmacists Association's Patient Education Program

7 Steps To Medical Safety

Unfortunately, medical errors are more common than we think. These medical errors can occur in hospitals, pharmacies or even in your own home. However, being medical informed consumer can help you to prevent these medical errors.

Follow the seven steps to medical safety to help ensure you own safety.

Step 1 - Be Informed

• When it comes to your medicine, the more you know about the medicine, the safer you are.

Step 2 - Communicate

• You could avoid harmful medical drug interactions simply by telling your doctor or pharmacist about all the medications you take, including over-the-counter products, vitamins and herbal supplements.

Step 3 - Check Your Medicine

• Would you know if you got the wrong medication by mistake? Ensure all your medical drug is labeled correctly.

Step 4 - Use Your Medicine Correctly

• Sure, it's easy to take a pill, but ensure medical drugs are not shared among your love ones without consulting the doctor or pharmacist first.

Step 5 - Be Aware

• Studies show that more than one in five elderly Americans use a medication that may be wrong for them. Hence it's best again to get the doctors or pharmacist prescriptions first before taking in any medication.

Step 6 - Keep Good Records

• Take an active role in your healthcare. Make a personal emergency contact and medication card so important information such as the type of medical drug you're taking in is easy to find in an emergency. You could also use your card to keep track of your medications and allergies.

Step 7 - Ask Questions

• Don't be afraid to contact your doctor or pharmacist if you have questions, if a medication doesn't seem to be working or if you have problems with the medication or treatment decision. Your doctor or pharmacist are there to help ensure your safety.
  

Drug Medication Safety Tips

Many consumers might find drug medication safety tips is more of a common sense. But sometimes it's best to read more on drug medication safety message as some medication drugs might have different content.

These are usually printed alongside with the drug medication packaging which I find many consumers neglects it. By neglecting the following message might cause major incidents occurring that could even cost a life.

Hence, I'd like to share 5 general basic safety tips to share for all drug medications which is listed below:-

1. Most medication should be stored in a dry place away from heat and humidity.
2. Use a pillbox or pill organizer to manage your medication.
3. Always keep medications out of reach of children.
4. Check the expiration date each time you take a drug. Discard and replace any medications that are out of date.
5. Storing multiple medications in the same vial can lead to confusion.

Please ensure that you as a consumer start reading all the drug medications warnings before something that could effect your health or even costing a life of your love ones.

A popular quote that you want to remember is "Prevention is better than cure..."