The Ketogenic Diet: What’s All the Hype?

By holladay | February 4, 2019 | 0 Comments

You’ve probably heard about the Ketogenic diet by now. Celebrities are losing weight and touting its benefits. If you haven’t heard, the ketogenic diet is a way of eating that restricts carbohydrates, includes moderate protein and high fat.

There are a growing number of physicians who don’t think a well-formulated keto diet is a fad but actually a very safe and effective way to not only lose weight, but to reverse diabetes. More than 1.4 million people are diagnosed with type 2 diabetes every day in the US. One in every 10 adults who are 20 years or older has diabetes. For seniors 65 years and older, that figure rises to more than one in four. It appears that a low carbohydrate diet is a safe and effective way to treat Type 2 diabetes.

Dr. Sarah Hallberg, a physician at the University of Indiana, has published one-year data from a study* for which she is the primary investigator where 349 patients were enrolled in either the study arm (262 people) or chose usual care (87 people). Patients in the study had type 2 diabetes for an average of 8.4 years and the average BMI was 40. After 12 months the average HgbA1c for study patients decreased from 7.6 to 6.3. Patients in the usual care arm had no change. Also, patients in the study arm lost an average of 30 pounds (13.2% of body weight). 94% of patients in the study arm either discontinued or reduced their insulin need and many of their other diabetes medications. Patients in the usual care arm increased their insulin requirement by an average of 15 units/per day.

One of the questions many physicians have about the keto diet is what happens to biomarkers for cardiovascular risk? While the LDL–C (“bad cholesterol”) went up slightly in patients in the study, the LDL-P (particle size) decreased and APO-B remained the same. HDL (“ good cholesterol” ) was increased and triglycerides went down.

Dr. Hallberg and her group hope to publish the two-year data sometime in early 2019. Stay tuned!

* Hallberg SJ, McKenzie AL, Williams P, et al. Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at One Year: An Open Label, Non-Randomized, Controlled Study. Diabetes Therapy. 2018; 9(2): 583-612. doi: 10.1007/s13300-018-0373-9

Please contact Holladay Pharmacy at 1-800-848-3446 if you have questions regarding the Ketogenic Diet.

Shingrix: Key differences from Zostavax that you should know

By holladay | January 15, 2019 | 0 Comments

Shingrix is the new shingles vaccine on the block; and it has led to some confusion among healthcare providers.  This has led to a number of reported medication errors via the Vaccine Adverse Event Reporting System (VAERS).  Errors have included incorrect storage, wrong route of administration, and incorrect reconstitution. 

There are some key differences to make note of between Shingrix and the older Zostavax vaccine. First and foremost, Shingrix is not a live vaccine (Zostavax is live).  Shingrix is supplied as a 2-vial set containing 1 vial of lyophilized varicella zoster virus glycoprotein E antigen and a single dose vial of AS01B adjuvant suspension.  The antigen component must be reconstituted with the adjuvant suspension.  While the Zostavax virus was to be stored frozen, the new Shingrix vaccine is stored refrigerated between 36-46 F. 

Also, the route of administration differs in that Shingrix is given as an intramuscular injection while Zostavax is subcutaneous. Shingrix is given in 2 separate doses. The second dose is administered 2-6 months after the first dose. Shingrix is also now the preferred vaccine to prevent herpes zoster. 

Please contact Holladay Pharmacy at 1-800-848-3446 if you have questions regarding this new vaccine.  

Celebrating 10 Years of Educating the Long Term Care Community

By holladay | December 17, 2018 | 0 Comments
By: Becky Cross, RN, BSN
Holladay Director of Customer Relations and Nurse Consultant
Holladay Healthcare Pharmacy will be hosting our 10th Annual Holladay Educational Learning Program (H.E.L.P.) on March 21st & 22nd, 2019.  The program will be held at the Proximity Hotel in Greensboro, NC.  H.E.L.P. offers attendees the flexibility to attend either 1-day or both days of the conference, with CE Hours being offered to both Administrators and Nurses. Register early as H.E.L.P. sells out every year!   Please visit our website –, starting in January for more information about the conference, including the agenda and registration details.  The conference offers pertinent LTC topics, an outstanding venue and excellent networking opportunities. See you at H.E.L.P. 2019!

CDC Gives Thumbs Up to SHINGRIX

By holladay | October 15, 2018 | 0 Comments

According to the Centers for Disease Control (CDC) website (accessed 9/6/2018) almost 1 out of every 3 people in the US
will develop shingles in their lifetime. The risk of shingles increases with age.
Shingles causes a painful rash or blisters that usually resolve in 2 to 4 weeks, but can also cause a
complication called post-herpetic neuralgia which is nerve pain in the area where the rash was located that
can last for months or years and be severe and debilitating.
A shingles vaccine known as Zostavax has been in use since 2006, but in 2017 the FDA approved a new
vaccine called Shingrix which is > 90% effective in preventing shingles and nerve pain in people 50 years
old and older, and is now the CDC preferred vaccine to prevent shingles. The CDC recommends that
healthy adults 50 years old and older get 2 doses of Shingrix 2 to 6 months apart, including those who
have had shingles in the past and those who previously received Zostavax at least 8 weeks prior.
Shingrix is now covered by many health insurance plans. If you have questions about shingles vaccine
feel free to contact your Holladay Healthcare Pharmacy pharmacist at (800) 848-3446.

Article by: Charlotte Matheny, PharmD, BCGP


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.