PATIENT COUNSELING Sound the Alert About Diabetes Risk Pharmacists can play an in1portant role in an upcon1ing nationwide outreach effort to identify the lnillions of Atneticans with undiagnosed diabetes. March 23 is National Diabetes Alert Day, a one-day call to action for people to get tested. To aid in the educational effort, the At11erican Diabetes Association has developed a sin1ple tisk inventory that can alert people who may have the disease or be at high tisk of developing it. Copies of the tisk inventory, "Take the Test. Know the Score," are available fron1 any local Atnetican Diabetes Association office. Pharmacists can participate
actively by lnaking the test available to patients and helping them understand the significance of their scores. According to the An1etican Diabetes Association, approximately seven Inillion Ameticans have diabetes but are unaware that they do. If left untreated, it can lead to ctippling or fatal cOIn plications such as heart disease, stroke, kidney disease, blindness, and lower lin1b alnputation. "Many people have diabetes but are not diagnosed for many years, says F. Xavier Pi-Sunyer, MD, president of the Atnetican Diabetes Association. "They don't know what the sylnptOlns are or their dangers, and the result can be tragic. "
Common Symptoms of Diabetes The following symptoms are typical in persons with diabetes. However, symptoms of non-insulin-dependent cliabetes may be so mild that they go lUl11oticed.
Insulin Dependent Frequent utination Excessive thirst Excessive hunger Sudden weight loss Weakness and fatigue Nausea and vomiting Irtitability
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Non-Insulin-Dependent Any of the insulin-dependent symptoms Blurred vision or any change in sight Tingling or numbness in legs, feet, fmgers Slow healing of cuts (especially in the feet) Frequent skin infections or itchy skin Drowsiness
Reducing Fatalities from A$thma Even though asthma treatment has improved tremendously over the past 20 years, those same two decades have seen a 71 % increase in the incidence of asthlna. With a concon1itant 46% increase in deaths caused by asthlna between 1980 and 1989, this affliction -ancient enough to have been wtitten about by Hon1er and Hippocrateshas been the focus of several recent studies. • Regular Use of Inhaled Corticosteroid Reduces Risk of Fatal or Near-Fatal Asthma. In a study published in theJournal o/the
American Medical Association (1992;268:3462-4) Pierre Ernst, MD, Department of Epidemiology and Biostatistics, Montreal General Hospital, and colleagues report that they found a significant reduction in the tisk of fatal or near-fatal asthma alnong patients who used 12 or more units of inhaled corticosteroids per year. The researchers note: "Our study seems to demonstrate a strong protective effect of inhaled corticosteroid use .. .. We conclude that our results provide strong support for current guidelines that recommend the use of inhaled corticosteroids in the treatment of lnoderate and severe asthma. " • Hospital Adnlissions for Asthma Vary According to Sex and Age. Another study (fAMA. 1992 ;268: 3437-40) concluded that \ "ERIC \ \ PH '\R~IAn
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there is a higher rate of asthma admissions among prepubertal males than prepubertal females and a higher rate among adult fenlales than adult males. In addition, adult female asthnlatic patients require a longer hospital stay. Enlil M. Skobeloff, MD, from the Department of Emergency Medicine, Medical College of Pennsylvania in Philadelphia, and colleagues note that these data "raise the possibility that hormonal and biochemical differences related to sex may playa role in the pathophysiology of asthma. " • The National Asthma Education Program (NAEP) of the National Heart, Lung, and Blood Institute (NHLBI) Develops Comprehensive Guidelines for the Treatment of Asthma. In August 1991 , NHLBI issued an expert panel report, Guidelines for the Diagnosis and Management of Asthma (publication number 91-3042), which is available through the Public Health Service of the National Institutes of Health. The publication recommends several strategies for at-risk patients: both patients and family members should be educated about the importance of asthma care; patients should learn to identify potential triggers at work, school, and home; and AMERICAN PHARMACY
patients should be enrolled in a special-care, follow-up program. In terms of drug therapy, the NHLBI/NAEP guidelines recommend inhaled beta2-agonists as first-line therapy for lnild asthma. For treatment of moderate to severe asthma, NHLBI/NAEP advocates an anti-inflammatory agent, such as inhaled corticosteroids and cromolyn sodium, in combination with bronchodilator therapy. In addition, oral corticosteroids lnay be used for severe cases of asthma.
Thermometers: What's Hot and What's Not! Probably the most common piece of "durable medical equipment" found in any hOlne is an oral fever thermometer. Many people have switched to the new generation of digital thermometers, which aren't breakable and provide an easy-to-read measurement of temperature in a short time. But many also remain loyal to the older mercury-in-glass thermometers, which are inexpensive, familiar, and easy to use and keep clean. If a patient asks you for advice on purchasing an oral thermometer, should you recommend one over the other? According to Thomas Lacknor, PharmD, a consultant in Minneapolis, there is not a single correct answer to this question. "Both thermometers are
Body Temperatures: Is 98.6 °F Still the Norm? Last fall, the results of a widely publicized study (lAMA. 1992;268:1578-80) suggested that 98.6° F had been dethroned as the single norm for body temperature in healthy adults. The study, which included 148 healthy men and women aged 18 through 40, demonstrated that the mean oral temperature was 98.2, not 98.6. Based on these findings, the researchers suggested that an early morning temperature of 98.9 and an evening reading of 99.9 should be regarded as the upper limits of normal oral temperature in healthy adults 40 years old or yOlmger. Does that mean that patients should no longer look to 98.6° F as a guideline for evaluating whether they're nmning a fever? According to Thomas Lacknor, PharmD, a consultant in Minneapolis, patients need to be made aware that temperature fluctuates. "Patients may fmd the new information frustrating, because a ftxed guideline is much simpler to evaluate, " he said. "As a result, pharmacists will fmd they are giving much more information to patients about fevers."
accurate when used appropriately, " he said. "The digital thermometers are nice because they are faster, but they are also more expensive. " The most important drawback to the older type of thermometer is that it is breakable. The danger, says Lacknor, is not in the mercury but in the glass fragments. According to Lacknor, the nlercury used in today's thermometers is nontoxic and cannot be absorbed through the gastrointestinal tract. If a mercury-in-glass ther-
mometer breaks in the mouth, the patient should rinse the mouth and lips thoroughly and examine the thenl carefully for serious cuts, Lacknor said.
Look for APhA's New Product Bulletin on Sumatriptan (lmitrex®) soon .
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