A pharmacist's look at the supermarket and beyond

Month: March 2016

Dust to Dust

I am allergic to amoxicillin. Reconstituting hundreds of amoxicillin suspensions through my early years as a community pharmacist is how I feel that I sensitized myself. That was back in the days of Trimox, Wymox, and Amoxil. I remember the great deals we used to get buying these products directly from the manufacturer, with prices way below AWP, and getting six months to pay. Some companies would even give free gifts, from teddy bears to TVs!
Back to that pesky allergy. I had some dental work done and the dentist ordered some amoxicillin for me and shortly after the first dose, I developed a bight red, very itchy rash over most of my body. I had no prior problems with any of the penicillin family of antibiotics, taken years earlier. We found an alternative and time and Benadryl cleared up the rash. I thought back to mixing all those pediatric suspensions when the water was added and a little pink cloud of powder rose out of the bottle like smoke from a chimney. Occasionally, I could even taste or smell it, so I know it was getting into my body. A certified technician is now my preferred method of reconstituting any of the penicillins. Either that or I hold my breath!
Much more recently, I have had the “opportunity” to do much more product dispensing (counting and pouring) than usual and another concern became apparent. No, not the lack of technician staffing. I addressed that 2 or 3 blog posts ago.
Moving from the pharmacist work station to the dispensing counter, I often inherited an incredibly dusty counting tray and spatula. I think this is a pretty common situation in most retail pharmacies and perhaps in other types of practice sites as well. How much of this drug-laden dust are we passing on to the next patient?
I’ve always been pretty meticulous about using a clean tray, wiping it down frequently with a paper towel damp with alcohol. Obviously, others are not so rigorous. The tray in the picture may be an extreme example of a dusty tray, but it is something I find from time to time at a variety of practice sites. counting trayAre we increasing the incidence of drug allergies within our patient population by not frequently cleaning the apparatus we use to move the “pills from the big bottle to the little bottle,” as Jerry Seinfeld has described community pharmacy practice? I think it is entirely possible. Exposure to these minute amounts of drug may not only lead to new allergies that could potentially cause harm or confound future treatment plans, there may be other biological consequences to this low level exposure. Just look at the changes to our animals friends that are caused by drug contamination of the environment.
In our busy workdays, we rarely have the time to contemplate issues such as this, which may seem inconsequential, but are actually overlooked problems with easy solutions.

With A Grain of Salt

I asked recent student pharmacist, Kimberly A. Pham to take a look at dietary sodium. She began by providing a little background:
“The average American consumes 3,400 milligrams of sodium per day, however the American Heart Association recommends less than 2,400 milligrams per day for blood pressure lowering. People with high blood pressure, kidney disease, or heart failure may benefit from reducing their sodium intake to less than 1,500 milligrams per day. A low sodium diet can reduce blood pressure by 2 to 3 mmHg, which may contribute to as much as 10 mmHg over time. Having a low sodium diet may also increase weight loss and the effect of antihypertensive medication. It may also reduce the risk of heart disease, kidney stones, and osteoporosis.”
So, here is what the recommended daily amount of salt looks like: daily salt
Kimberly also discussed the hidden salt in our modern American diets, saying, “Eighty percent of sodium intake in the Western diet is through processed food.” Yet another reason to shop primarily in the perimeter of the market, choosing fresh fruits, vegetables, meats, seafood, and whole grain baked goods.
Of course, we must not avoid salt altogether, it is essential for life. Salt has been traded as a commodity as part of the earliest economies. Words like salary and salad, as well as phrases such as “the salt of the earth,” “not worth his salt,” and “rubbing salt in a wound” all show how salt is an important part of our culture. However it is well documented that TOO MUCH salt is detrimental to our health. To that end, New York City implemented a requirement that restaurants indicate menu items that contain more than 2,300 milligrams of sodium with a salt shaker symbol nyc saltto alert consumers that they could get their entire daily dose of sodium from that one food choice. Many call this more Nanny-style government from Mayor Bloomberg and the NYC Board of Health, while others think it will improve health and lower health care costs as consumers are encouraged to make better choices. I’ll let you decide if this is really a role for government. Is the government creating an environment that limits our freedoms or acting in its role as safeguard of public health?