Monthly Archives: February 2013

Got Drugs?

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The question of what to do with leftover medications is a good one. As a healthcare provider, I need to know the answer for my patients, and wanted to pass the information I found on the FDA’s website along to my readers.

  • Medicine Take-Back Programs On April 27, 2013, there will be a National Prescription Drug Take-Back Event. Follow this link for your state information:
  • Disposal in Household Trash If no Take-Back Program is available, follow these steps to get rid of your unwanted meds:
  1. Mix medicines (do NOT crush tablets or capsules) with an unpalatable substance such as kitty litter or used coffee grounds;
  2. Place the mixture in a container such as a sealed plastic bag; and
  3. Throw the container in your household trash.
  4. Before throwing out a medicine container, such as a pill bottle, remember to scratch out all information on the prescription label to make it unreadable.
  • Flushing of Certain Medications Some medicines could be so harmful to others if taken that the best thing is to flush them down the toilet. These medications are:
Active Ingredient
Abstral (PDF – 1M)tablets (sublingual) Fentanyl
Actiq (PDF – 251KB), oral transmucosal lozenge * Fentanyl Citrate
Avinza (PDF – 51KB), capsules (extended release) Morphine Sulfate
Daytrana (PDF – 281KB), transdermal patch system Methylphenidate
Demerol, tablets * Meperidine Hydrochloride
Demerol, oral solution * Meperidine Hydrochloride
Diastat/Diastat AcuDial, rectal gel [for disposal
instructions: click on link, then go to “Label information”
and view current label]
Dilaudid, tablets * Hydromorphone Hydrochloride
Dilaudid, oral liquid * Hydromorphone Hydrochloride
Dolophine Hydrochloride (PDF – 48KB), tablets * Methadone Hydrochloride
Duragesic (PDF – 179KB), patch (extended release) * Fentanyl
Embeda (PDF – 39KB), capsules (extended release) Morphine Sulfate; Naltrexone Hydrochloride
Exalgo (PDF – 83KB), tablets (extended release) Hydromorphone Hydrochloride
Fentora (PDF – 338KB), tablets (buccal) Fentanyl Citrate
Kadian (PDF – 135KB), capsules (extended release) Morphine Sulfate
Methadone Hydrochloride, oral solution * Methadone Hydrochloride
Methadose, tablets * Methadone Hydrochloride
Morphine Sulfate, tablets (immediate release) * Morphine Sulfate
Morphine Sulfate (PDF – 282KB), oral solution * Morphine Sulfate
MS Contin (PDF – 433KB), tablets (extended release) * Morphine Sulfate
Nucynta ER (PDF – 38KB), tablets (extended release) Tapentadol
Onsolis (PDF – 297KB), soluble film (buccal) Fentanyl Citrate
Opana, tablets (immediate release) Oxymorphone Hydrochloride
Opana ER (PDF – 56KB), tablets (extended release) Oxymorphone Hydrochloride
Oxecta, tablets (immediate release) Oxycodone Hydrochloride
Oxycodone Hydrochloride, capsules Oxycodone Hydrochloride
Oxycodone Hydrochloride (PDF – 100KB), oral solution Oxycodone Hydrochloride
Oxycontin (PDF – 417KB), tablets (extended release) * Oxycodone Hydrochloride
Percocet, tablets * Acetaminophen; Oxycodone Hydrochloride
Percodan, tablets * Aspirin; Oxycodone Hydrochloride
Xyrem (PDF – 185KB), oral solution Sodium Oxybate

This information was taken from the Federal Drug Administration’s website.

For anyone concerned about about the impact on the environment, the FDA makes this statement:

“We are aware of recent reports that have noted trace amounts of medicines in the water system. The majority of medicines found in the water system are a result of the body’s natural routes of drug elimination (in urine or feces). Scientists, to date, have found no evidence of harmful effects to human health from medicines in the environment.

Disposal of these select, few medicines by flushing contributes only a small fraction of the total amount of medicine found in the water. When a medicine take-back program isn’t available, FDA believes that any potential risk to people and the environment from flushing this small, select list of medicines is outweighed by the real possibility of life-threatening risks from accidental ingestion of these medicines.”

Remember to never share your prescription meds with another person.

Now, have a good day and annoy others with your newfound knowledge!

CAGE yourself


Have you ever wondered if you drink too much? The CAGE questionnaire is a screening tool that can be used by yourself or your healthcare provider to see if you have a problem that needs evaluation. It’s not used to diagnose alcoholism, only as a way to see if a person possibly needs help or support.

The questions are:

  1. Have you ever felt you should cut down on your drinking?
  2.  Have people annoyed you by criticizing your drinking?
  3. Have you felt bad or guilty about your drinking?
  4. Have you ever had a drink first thing in the morning to steady your nerves
    or get rid of a hangover (eye-opener)?

If you answer “yes” to 2 or more questions, that’s an indication of an alcohol problem.

There are the different levels of misuse:

  • Risky or hazardous use–having more than 4 drinks in one day for men or more than 3 drinks in one day for women
  • Harmful use–drinking that causes physical or mental harm (i.e. falls, high blood pressure, unclear thinking)
  • Alcohol abuse–drinking that causes a person to lose his job or have decreased work or school performance, neglect home responsibilities, driving while drunk, and/or have legal or social problems
  • Alcohol dependence (alcoholism)–a craving for alcohol, physical dependence (get the shakes without a drink), loss of control over drinking, and a need to drink an increased amount to feel the effect.

For those with a positive screen that fall under the “Risky or hazardous use”or “Harmful use” categories, brief counseling with more than one session has been found to be effective. For those who fall in the “Alcohol abuse” or “Alcohol dependence” categories, brief counseling hasn’t been shown to work well; a treatment program with ongoing support would be more effective.

I’ve noticed that a lot of my patients are really not aware of what is considered “drinking in moderation.” For men, this would be no more than 2 drinks a day or no more than 14 drinks per week. For women, moderate drinking is no more than one drink a day or no more than 7 drinks per week. A drink is considered to be 12 oz of beer, 5 oz of wine, or 1.5 oz of liquor.


Please see your healthcare provider if you have questions or concerns about your alcohol use.


Get Your Pound of Cure

Did you know that the Affordable Care Act requires health insurance plans to cover preventive services with no cost sharing? This means your health insurance can no longer charge a co-pay, co-insurance, or deductible when you see an in-network provider for these services.


Services for Adults include screenings for:

  1. Abdominal Aortic Aneurysm
  2. Alcohol Misuse
  3. Aspirin use
  4. Blood pressure
  5. Cholesterol
  6. Colorectal Cancer
  7. Depression
  8. Type 2 Diabetes
  9. Diet
  10. HIV
  11. Immunizations
  12. Obesity
  13. Sexually Transmitted Infections
  14. Syphilis
  15. Tobacco Use

For more detailed information:

Services for Women and Pregnant Women include screenings for:

  1. Anemia (pregnancy)
  2. Bacteriuria (pregnancy)
  3. BRCA
  4. Breast Cancer Mammography
  5. Breast Cancer Chemoprevention
  6. Breastfeeding
  7. Cervical Cancer
  8. Chlamydia Infection
  9. Contraception
  10. Domestic and Interpersonal Violence
  11. Folic Acid
  12. Gestational Diabetes (pregnancy)
  13. Gonorrhea
  14. Hepatitis B (pregnancy)
  15. HIV
  16. HPV DNA Test
  17. Osteoporosis
  18. Rh Incompatibility (pregnancy)
  19. Sexually Transmitted Infections
  20. Syphilis
  21. Tobacco Use
  22. Well-woman Visits

For more detailed information:

Services for children include screenings for:

  1. Alcohol and Drug Use
  2. Autism
  3. Behavioral
  4. Blood Pressure
  5. Cervical Dysplasia
  6. Congenital Hypothyroidism
  7. Depression
  8. Developmental
  9. Dyslipidemia
  10. Fluoride Chemoprevention
  11. Gonorrhea
  12. Hearing
  13. Height, Weight, and Body Mass Index
  14. Hematocrit or Hemoglobin
  15. Hemoglobinopathies
  16. HIV
  17. Immunization
  18. Iron
  19. Lead
  20. Medical History
  21. Obesity
  22. Oral Health
  23. PKU
  24. Sexually Transmitted Infections
  25. TB
  26. Vision

For more detailed information:


When to see your healthcare provider for that cold

I found out quickly when I got out of school that a lot of people schedule an appointment to see their healthcare provider as soon as they get a stuffy nose, low-grade fever, or sore throat. When these patients came in to see me, most expected to get an antibiotic. According to the CDC, “antibiotic resistance has been called one of the world’s most pressing public health problems,”, so it might help to know how to tell the difference between a viral illness and bacterial illness.

A viral illness:

  1. usually begins with feeling achy, tired, maybe a fever of <100.5.
  2. may include a stuffy nose, sneezing, a cough and sore throat.
  3. tends to be worse the first three days or so, then you start feeling better, but may keep a stuffy nose and cough. (“I sound bad, but I feel better.”)
  4. may cause a stuffy nose, sneezing or a cough that can last up to two weeks.

With a viral illness, no antibiotic is needed. Over the counter products for symptom relief are recommended.

  1. Acetaminophen or ibuprofen is effective for sore throat, headache or body aches.
  2. Decongestants work really well for a stuffy nose (but are not recommended for people with high blood pressure).
  3. Saline nasal spray or a sinus wash work well for some people.
  4. A cough suppressant like Delsym or Robitussin can be effective.
  5. Throat spray and lozenges may be used for sore throat.
  6. Read the labels on combination products, like Tylenol Cold or Advil Sinus, to make sure you don’t double up on any ingredients.
  7. Remember, children under the age of 4 should not be given cough medications. Always read the label for age recommendations and proper dosing on any medications for children.

How do you know when to go and be seen by your healthcare provider?

  1. Fever > 100.4, or any fever that lasts longer than three days.
  2. No improvement after 7 days of being sick.
  3. Sore throat without a cough or runny nose.
  4. Symptoms that don’t improve with over-the-counter products.

Remember, it’s not the color of your mucous that means you need an antibiotic, it’s how long you’ve been sick and how bad your symptoms are. ¡Salud!


Chile Con Horsie

Europeans opting for a frozen meal may choose to prepare their own dinners now. Horse meat has been found in Bird’s Eye brand Chile Con Carne. Earlier, Nestle had taken some Buitoni beef pasta products off the market when traces of horse DNA were found in batches of meat used to make these meals. It seems that most countries in Europe have been affected by the contamination of beef with horse meat.

In a Reuters’ article, “Horsemeat blame game ricochets across Europe,” Alastair Macdonald states,  “Dutch prosecutors launched a criminal investigation into an as yet unnamed company believed to have been falsely labeling beef mixed with horsemeat after searching a plant in the south. They said it was “suspected of forgery, fraud and money laundering” and added: “It is believed the company processed horse carcasses from Ireland and mixed them with beef.” (end quote)

Thankfully, there have been no reported illnesses from those who have eaten the less than 100% beef, other those heartsick that they might have dined on Black Beauty or Ginger.

On a positive note, the local butchers are enjoying a surge in sales. Image

How to save a billion dollars a year

17 medical specialty organizations have come up with their top five tests or procedures that they feel are unnecessary or harmful to patients. For example, women younger than 21 and those who have had a hysterectomy for any reason other than cancer should not get Pap smears at all. This is a change from 2008 when I was in school, when we were taught that a sexually active woman younger than 21 years should have a pap smear every year for three years. If these were all normal, then it could be done every other year.

In Sharon Begley’s article,  “Just say don’t: Doctors question routine tests and treatments,” she states that “For the most part, the medical specialty groups did not consider cost when they made their lists”.  She quotes Dr. John Santa, director of Consumer Reports’ Health Ratings Center and a partner in Choosing Wisely as saying, “If their advice is followed, however, it would save billions of dollars a year in wasteful spending.” He calculated that in a practice with 300,000 patients, just doing away with routine EKGs and bone density scans would “reduce it’s billings by $1 million a year.” If done nationally, “that translates into some $1 billion in savings.”

Of course, less spending does translate into less revenue for the healthcare practitioner. A woman coming in every three years for her Pap means that my clinic will lose the revenue for the two she doesn’t get.

There’s always the question of, “What if I miss something because I followed these recommendations?” Ah….well, we are given the option in some cases of ordering a test if we suspect something unusual. Note that some procedures are questioned while some start with the word “don’t.”

For a complete list of organizations that gave their top fives, follow this link:

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