By holladay | January 18, 2018 | 0 Comments
There has been extensive evidence to support using proton pump inhibitors (PPIs) for short term use only. Unfortunately, in the long term care setting, most patients take PPIs due to being discharged on one from the hospital. Part of the job of the pharmacist consultant is to keep patients safe and this includes requesting that PPIs like Prilosec and Protonix are used for the shortest duration possible when appropriate.
The evidence supporting adverse events such as increased risk of infections from Clostridium difficile, increased events of osteoporosis, electrolyte imbalances and B12 deficiency has brought this class of medication to be on the BEERS list, or the list of medications that are potentially inappropriate for use in the elderly. Recently a new adverse event was identified.
Recent investigations have suggested an association between PPI use and an increased risk of dementia. While the increase was seen in all types of dementia, Alzheimer’s disease was specifically identified. Several studies have been conducted to try and find the cause.
Gomm et al, provided evidence of a link between PPI use and dementia.1 The study looked at over 70,000 participants over 75 years of age and who were free of dementia. The participants were followed for 7 years and were divided into 2 groups; those who took PPIs and those who did not.
After adjusting for other risk factors, the PPI users were found to be 44% more likely to be diagnosed with dementia. While an absolute causation has not been established, best practice would be to minimize the use of the PPI class of medications in the elderly.
1. Gomm W, Klaus von H, Friederike T et al. Association of proton pump inhibitors with risk of dementia: a pharmacoepidemiological claims analysis. JAMA Neurol 2016;73:410-6.
Christy Ledger, PharmD, MS, BCGP, is a consultant pharmacist with Holladay Healthcare Pharmacy. 

How to Help Save Lives with Med Reminder Apps

By holladay | August 26, 2016 | 0 Comments

Medication non-adherence can be a life-threatening prospect for some long term care facility residents. Nearly 125,000 deaths annually are attributed to failed medication adherence. It can also be a costly problem within your facility. When residents who are on strict or complex medication regimens get off schedule or take the wrong dosage, the result is typically repeated hospitalizations. As they return to your facility, additional time and attention is also required from your staff to properly monitor those residents. Most people don’t intentionally skip a dose or get their pills mixed up, but, sometimes, they just get confused or forget. The good news is that there are many med reminder apps available for those residents who regularly use a smartphone or mobile device.

 So, how do you choose one?

Last year, the University of Arkansas conducted a study of 461 medication adherence apps and presented their findings at the American Pharmacist Association annual meeting. This shows us two things. First, a mobile app is now a viable alternative to pill cases and sorters that really only help organize medications. Second, the number of medication tracking apps is incredible. Here are the three top performers. Each application was rated on a scale of 1-5 stars (5 being the best) across five categories: Adherence Attributes, Medication Management, Connectivity, General Features, and Health Literacy.


Overall Rating:  5 stars

To make managing meds easier, Medisafe enlists the help of visuals. The app actually shows an image of every pill once each medication is entered, creating what the app creators refer to as a “virtual pillbox.” Medisafe received an overall rating of five stars with slightly lower marks in the Medication Management and Connectivity categories.

Key features:

  • Intuitive visual interface with easy-to-use medication reminder
  • Syncing family members’ devices and medications in real time
  • Prescription refill reminders
  • Medication progress reports that can be sent to a doctor or nurse
  • Reminders come through even if the mobile device is asleep
  • Notifications to designated contacts if the main user has forgotten to take medication or has ignored a reminder


Overall Rating:  5 stars

Sporting a clean and simple user interface, MyMeds touts the ease of managing medications. It also received an overall five-star rating, but received four stars in the Adherence Attributes and General Features categories.

Key features:

  • Daily medication and refill reminders via text, email or push notification
  • Clear information for helping users understand why to take their meds
  • Analysis of medication usage history
  • Price shopping of prescriptions near the user
  • Syncing with a healthcare team and loved ones


Overall Rating:  5 stars

Promoted as a mobile health manager, Care4Today has a broader focus beyond just managing medication schedules. It achieved an overall rating of five stars but fell short in the Connectivity and General Features categories.

Key features:

  • Notifications to help stay on schedule, including dosages
  • Reminders for prescription refills
  • Front and back stock images of the medications to be taken
  • Built-in reports that track medication consumption

Each of these med reminder apps is available for free on the App Store (i0S) and Google Play (Android). Residents who are able should consider downloading the best medication reminder app for their individual needs. This will ensure they’re taking the proper medications, in the right dosage, at the right time. They’ll be healthier in the long run and it might just save their life. For long term care administrators, financial and staffing resources will be better allocated toward providing the best proactive resident care possible.


Vaccine Options for Pneumonia Prevention

By holladay | January 20, 2016 | 0 Comments

Prevnar 13: What are the benefits?

The Prevnar 13 vaccine is a single injection approved for adults over the age of 50 to help prevent infection caused by pneumococcal bacteria. Prevnar 13 contains 13 different strains of the pneumococcal bacteria that can lead to serious infection; infecting the sinuses and inner ear, the lungs, blood, and the brain. These conditions can be fatal if they are not treated properly.

This vaccine works by exposing the patient to a small amount of the bacteria or a protein from the bacteria so that the body develops an immunity to the Pneumococcal disease. Although Prevnar 13 can cause the patient’s body to develop an immunity to the disease, it will not be able to treat an active infection that has already developed within the body.

There are very few risks associated with Prevnar 13. The most common reactions to the vaccine include redness, swelling, pain at the injection site, and limitation of arm movement. A few other side effects that have been reported include fatigue, headache, muscle pain, joint pain, decreased appetite, and chills. The risk of serious side effects remains extremely low when a patient receives the vaccine.

Pneumovax 23: What are the benefits?

Pneumovax 23 is also a vaccine given in a single injection that has been approved for patients aged 50 and older to prevent infections triggered by pneumococcal bacteria. Unlike Prevnar 13, Pneumovax 23 is able to cover up to 23 different strains of the pneumococcal bacteria.

This vaccine is very similar to Prevnar 13; it exposes the patient to a small amount of the bacteria to cause the body to develop an immunity to the Pneumococcal disease. The most common side effects patients experienced include injection-site pain, soreness, tenderness, swelling, induration, and erythema, as well as headache, fatigue, and myalgia.

How do they compare?

Both Prevnar 13 and Pneumovax 23 are great combattants of pneumococcal bacteria infections that many adults over the age of 50 may experience. With both of these vaccines covering numerous strains of the disease, Pneumovax 23 does cover more and would be more effective against more strains than Prevnar 13. Both of these vaccines are covered by medicare but each one must alternate after one year before a patient can take the next vaccine.

If you have questions about either of these vaccines please contact one of our Holladay pharmacists at 1-800-848-3446.

Continuous Glucose Monitoring: New Technology to Combat Hypoglycemia & Improve Outcomes

By holladay | December 23, 2015 | 0 Comments

As advances in technology have continued to evolve, more and more useful tools and machines have allowed geriatric patients to effectively monitor their health. One technology that has continued to improve over the years has been that of Continuous Glucose Monitoring (CGM). Though CGM is not as accurate as traditional methods of measuring blood sugar, it is continuing to make diabetics’ lives easier and safer.


While a traditional blood glucose meter only provides a brief “snapshot” of your glucose level, Continuous Glucose Monitoring devices allow patients to regularly see where their glucose levels are headed, and whether they are increasing or decreasing after certain activities throughout the day.  With 288 glucose readings per day (a reading every 5 minutes), CGMs are also able to send early notifications of upcoming high and low points so that you can take action early. This is possible through advanced, wireless technology. By inserting a small sensor underneath the patient’s skin, along with transmitting information through radio waves to a handheld device, a patient is able to see what their glucose level is as well as predict where it will go based on past trends. With these advanced features, diabetic geriatric patients will have the ability to take action early enough to prevent issues from getting worse later in the day.


With Continuous Glucose Monitoring, guesswork is minimized. One large risk that comes with diabetes guesswork is Hypoglycemia. Hypoglycemia occurs when there is too much insulin in the body. When blood-sugar levels drop it can lead to symptoms such as dizziness, sweating, and headaches. It can also cause falls, seizures and loss of consciousness in diabetics. Hypoglycemia is usually more common in people with Type-2 diabetes. Studies have shown that patients over the age of 60 with Type-2 diabetes, who have an average of 40 years with the illness, spend approximately 99 minutes a day in a hypoglycemic state, including 60 minutes with a glucose level of under 60 mg/dL (Hypoglycemia is defined as a level below 70 mg/dL). With the new CGM devices, diabetic patients are able to see at what points in the day they should take action to prevent the life threatening hypoglycemia from occurring. This is especially helpful for geriatric patients that live alone and that experience hypoglycemia day and night. As these patients age, they begin to lose the ability to “feel” if they are hypoglycemic.  Therefore, CGM devices can become a life-saving option.


Even though continuous glucose monitoring does not completely eliminate the need for blood glucose meter readings, the CGM’s do provide very valuable information that can lead to quicker and more accurate treatment decisions, as well as improved glucose control. Although these CGM devices are making diabetic patients’ lives easier and safer, it is very important to check on your insurance coverage before purchasing. Because this type of monitoring is such a new technology, currently Medicare and Medicaid are not covering them. These monitors can cost close to $1,000, with ongoing costs of about $400 a year; so these devices do come with a cost. With the expensive costs and the need for calibrating, these CGM devices may not be for everyone, but they can help get a better handle on an individual’s diabetes and hypoglycemic episodes.

How the Use of Vitamin Supplements with Prescribed Medications May Cause Negative Outcomes for Your Residents

By holladay | November 19, 2015 | 0 Comments

It’s undeniable that vitamins and supplements can be beneficial for some individuals. For example, it is not uncommon for older adults to have vitamin deficiencies due to their diets. In these cases, vitamins and supplements can be very valuable. However, for older adults who have certain medical conditions and/or live certain lifestyles,  vitamins and supplements are not always as beneficial as they’re often advertised.

Taking medications along with vitamins and supplements can sometimes be harmful to your health. Many elderly persons are often drawn to the supplements labeled as “natural.” The perception is that “natural” products could never be harmful due to their “all-natural” or “herbal” properties. However, when combined with other drugs these supplements can have negative effects. When taking blood-thinning medications like Coumadin or Plavix it is important to mention these medications to your doctor before any medical procedure such as surgery; especially if you are also taking vitamin E. Vitamin E, like Coumadin or Plavix,  also causes blood thinning and prevents your blood from clotting. In addition to vitamin E, warfarin (a prescription blood thinner), ginkgo biloba (an herbal supplement), and aspirin also thin the blood. By taking any of these products together, the potential for internal bleeding or stroke increases.

When taking these extra vitamins and supplements it is very important to check with your doctor or pharmacist so that you know the risks that may be involved in taking large amounts or combining vitamins with other medications. Many see vitamins and supplements as helpful and healthy for their bodies no matter the dosage, so people often take more than the recommended daily value. A few examples include vitamin C, vitamin B-6, and vitamin A. By taking more than the recommended 2,000 mg of vitamin C, many have been plagued with kidney stones and could also suffer from bouts of diarrhea – which can lead to dehydration. The kidneys’ ability to remove toxins from the blood progressively declines with age, so dehydration can be detrimental for geriatric patients.

Other examples of how taking more than the recommended dose of vitamins can be harmful to the body are with vitamins B-6 and A.  By taking more B-6 than the recommended daily value some consequences could include temporary nerve damage to the body. When taking more vitamin A than is recommended over a short period of time,  toxic effects on your body can occur. Some of these effects include nausea, vomiting, headache, dizziness, blurred vision, and muscular incoordination.

For more information on how the vitamins and supplements your residents are taking could be combining with their prescriptions and impacting their health please contact one of the Holladay pharmacists at 1-800-848-3446.