Got anything to help me stay awake to study?

As a college instructor, I am always somewhat amused by the panic that finals week seems to cause.  Seriously, it’s not like finals week is a surprise.  And it’s not like the content of a final is unknown – it could be anything that was covered in class.  And yet, students panic when it comes to finals week and look for ways to stay alert as they study late into the night trying to finish papers and prepare for exams.  For some this involves huge quantities of caffeine.  For others – study drugs.

This isn’t something new.  In the 70’s Ohio State students asked Dr. Spencer Turner, Director of Student Health Services, if he could recommend anything to stay awake while preparing for finals.  The study drugs back then were known as bennies or speed.  Today they are prescription stimulants like Adderall and Ritalin, for both the common component is amphetamine.  Used without a prescription, these drugs can be dangerous – not to mention illegal.

Dr. Turner stated that “the use of an amphetamine without proper medical supervision is unwise for several reasons:

  1. Pre-existing medical condition(s)
  2. Risk of adverse reaction(s) to even a single dose, especially when already fatigued
  3. Masking physical fatigue when this is the body’s signal for needed rest
  4. Likelihood of crashing at an inopportune time such as in the middle of a final or while driving
  5. Temptation to continue the drug’s use

These reasons continue to be valid today.  When prescribed, proper dosage has been determined by a physician based upon the medical condition of the patient.  The physician then monitors the patient regularly to ensure there are no adverse effects.  These are two key components – proper dosage and monitoring.  A pill obtained without a prescription, such as from a roommate or friend has neither of these. 

Study drugs can improve focus and motivation to study, but the short-term benefits of these substances do not come without their fair share of risks.  According to the National Institute on Drug Abuse, Adderall can cause hallucinations, impulsive behavior, paranoia, and irritability. These are among a long list of dangerous side effects that probably won’t help with that final!

You can read Dr. Turner’s article Sleep, finals week, ‘Bennies’ and you in the Lantern Online Archive, March 12, 1971

Submitted by Tina Comston, M.Ed.

Reviewed by Mary Lynn Kiacz, M.D.

Stinky Pee

buzzle.com

Early in my career, I was preparing to see a patient whose complaint was “strong urine.” What could it mean, I wondered as I stood outside the exam room? Smelly? Dark? Painful? Able to leap tall buildings in a single bound? Strong urine and I have since done battle many times. While primary care providers hear a number of common urinary complaints – pain, weird color and frequency, to name but a few – in my experience, “strong” combined with some variation of “urine” almost always means stinky pee.

What does stinky pee mean? Often nothing major. Let’s start with the benign causes:

  • Foods like asparagus can make urine smell. People who eat mostly vegetables can have a grassy odor to their urine.
  • Vitamins in general can make urine a little stinky (and colorful). B vitamins especially can impart a peculiar odor.
  • Dehydration can make urine smell more strongly of ammonia.
  • Certain medications can give urine a different odor and, like vitamins can cause a change in color. Many commonly used antibiotics change the odor of urine as well.

Certain persistent stinky pee issues might be more serious and require the attention of your primary care provider.

  • Foul-smelling urine, especially when it is associated with pain, frequency, urgency, fever, back pain, or an odd color (rusty, red, pink, purple) should be evaluated. All of these things suggest a bacterial infection somewhere in the upper or lower urinary tract.
  • Musty-smelling urine is quite unusual and can be associated with metabolic and liver diseases.
  • Sweet-smelling urine is sometimes associated with diabetes.
  • Urine with a scent of maple syrup can be associated with a serious metabolic disease with a yummy-sounding name: Maple Syrup Disease. Pancakes anyone?
  • Urine that smells like feces could mean that there’s a connection (called a “fistula”) between the rectum and the bladder or urethra.
  • Some vaginal infections have an odd odor that women tend to notice when they urinate.

Many of these more serious issues have symptoms besides stinky pee, but if you have any questions or concerns, make a “pit stop” at Student Health Services!

John A. Vaughn, MD
Student Health Services
The Ohio State University

Give Student Health Your Old Drugs!

legislatorford.gov

The Student Health Services Pharmacy will be holding our 2nd annual DEA-approved drug Take-Back Day this Wednesday, May 30th, from 9:00 a.m. to 2:00 p.m. 

All students, staff, and faculty are invited to bring unused or expired medicines to be disposed of in a safe, legal, and environmentally-friendly way.  This service is entirely free of charge and is completely anonymous.  No questions asked!  We will take any expired, damaged or and unused medications (even if they are a controlled substance like narcotic pain medication or ADD medication), as well as sharps containers (containers that store used needles). 

Please note: Do not remove medication labels before drop-off.  Syringes, needles, and thermometers will not be accepted.

Our goal is to address a vital public safety and public health issue by removing potentially dangerous prescription drugs from your backpacks and medicine cabinets. 

  • Since 2007, more Ohians have died from unintentional drug overdosing than motor vehicle accidents.
  • More than 7 million Americans currently abuse prescription drugs, according to the 2009 Substance Abuse and Mental Health Administration’s National Survey on Drug Use and Health. 
  • Each day, approximately 2,500 teens use prescription drugs for the first time to get high, according to the Partnership for a Drug Free America. 
  • Studies show that a majority of abused prescription drugs are obtained from family and friends, including the home medicine cabinet. 

These expired medicines can be as bad for our environment as they are for our health.  Measurable quantities of some common medications are showing up in lakes, reservoirs, and municipal water supplies, thought to be due in large part to improper flushing of medications down sinks and toilets.

So make the right choice and join us for our 2nd Annual Medication Disposal Day!  It’s a great way to keep yourself healthy and our campus safe! 

This event is jointly sponsored by Student Health Services (Office of Student Life), Department of Public Safety, and Generation Rx. 

Phil Anderson, RPh
Student Health Services
The Ohio State University

Get Smart About Antibiotics

photo: ehow.com

cardiophile.com

You wake up this morning with a stuffy nose, and your throat looks red and swollen.  You talk to your roommate, your mom, and your pillow pet, and all of them advise you to get in to see the doctor, and get some antibiotics.  Sounds good?  Well… perhaps not.

The CDC recormmends that you get smart about when antibiotics are appropriate – to fight bacterial infections. Taking them for viral infections, such as a cold, most sore throats, acute bronchitis and many sinus or ear infections:

  • Will not cure the infection;
  • Will not keep other people from getting sick;
  • Will not help you feel better;
  • Will not prevent a future bacterial infection; and
  • May cause unnecessary and harmful side effects.

What Not to Do

  • Do not demand antibiotics when a doctor says they are not needed.
  • Do not take an antibiotic for a viral infection like a cold or most sore throats.
  • Do not take antibiotics prescribed for someone else. The antibiotic may not be appropriate for your illness. Taking the wrong medicine may delay correct treatment and allow bacteria to multiply.

If your doctor prescribes an antibiotic for bacterial infection:

  • Do not skip doses.
  • Do not save any of the antibiotics for the next time you or your child gets sick.

What to Do

Just because your doctor doesn’t give you an antibiotic doesn’t mean you aren’t sick.

Talk with your doctor about the best treatment for your illness. To feel better when you have an upper respiratory infection:

  • Ask your doctor or community pharmacist about over-the-counter treatment options that may help you feel better;
  • Increase fluid intake;
  • Get plenty of rest;
  • Use a cool-mist vaporizer or saline nasal spray to relieve congestion; and
  • Soothe a throat with ice chips, sore throat spray, or lozenges.

Finally, always follow your doctor’s advice about when to return to be rechecked.  Viral infections CAN open the door for secondary bacterial infections.  So, if the doctor says that you should be feeling better in a few days and to return if you are still sick in a week, take that seriously.

Roger Miller, MD (OSU Student Health Services)

Is it OK to share my ADD medicines?

Don't end up like this guy!

ADD medicine

Q:  Is it OK to give my friend one of my ADD pills to help him study for a test?

A:  Before we answer that question, let me ask you another one.  Would you sell that pill to a stranger for $50?  I’m guessing – hoping – your answer is an emphatic “NO.”  Well, from a legal point of view, these two questions are identical.

Most ADD medications (such as Concerta, Ritalin, Adderall, Focalin, Metadate, Methylin, and Daytrana) are Schedule II controlled substances because of their serious side effects and potential for addiction.  They are monitored very closely by doctors, pharmacists, and the Drug Enforcement Agency (DEA).  We’re not lawyers here at Student Health, but we do know that… 

It is a violation of Section 2925.03 of the Ohio Revised Code (Ohio law) to sell another person a controlled substance.  The important thing to remember here is that the legal definition of “sell” includes “delivery, barter, exchange, transfer, or gift…”  

So even if you are just trying to help out your friend – and getting nothing in exchange for it – you are breaking the law.  And we’re not talking about a speeding ticket here.  You are committing a 4th degree felony, which is punishable by 6-18 months in prison and/or a $5,000 fine.  And assuming you are anywhere on or near campus, the felony gets bumped up to 3rd degree and you’re looking at 1-5 years in prison and/or a $10,000 fine.  Not to mention the fact that you could lose your financial aid and/or get kicked out of school.  

Now granted, the odds of someone busting into your dorm room and catching you in the act are very slim.  And unless you really don’t get along with your roommates or neighbors, odds are no one is going to turn you in.  But forget about the legal stuff for a minute.

  1. These medications are addictive and there’s a real chance your friend could get hooked on this stuff.  You don’t want to risk sending someone down that dark road.
  2. While these medications have a calming effect on people with ADD, they are actually central nervous system stimulants so in addition to things like headache, insomnia, anorexia, agitation, anxiety, tremors, vertigo, depression, and nervousness, they can cause life-threatening problems like heart attacks, increased heart rate, increased blood pressure, and heart arrhythmias.  Doctors evaluate people for these conditions prior to starting these medications and monitor them closely while they’re taking them.  Without knowing your friend’s health history, you could literally be putting his life at risk – and no test is worth that much. 

Managing your health is a serious responsibility and that’s especially true if you have ADD.  If you’re taking one of these medications, the best thing to do is keep it to yourself – if no one knows you have the pills, they won’t be able to ask you for one.  And if you have a friend who is taking these medicines, don’t pressure them into giving you one.  It’s more likely to hurt you than help you, and it’ll just put everyone at risk for serious trouble. 

If you have any questions about these or other medications you may be taking, the staff of Student Health Services pharmacy is always available to help!

Jason Goodman, PharmD, RPh (OSU SHS)

Do I need to avoid the sun if I’m on medication?

PhotoTOXIC reaction

PhotoALLERGIC Reaction

Certain medications cause your skin to become more sensitive to the sun.  Contrary to popular belief, they don’t make you more likely to burn, but actually cause a separate type of painful and itchy rash that can look like a bad burn.  There are two types of photosensitive reactions: phototoxic and photoallergic. 

Phototoxic is the most common.  This happens when the drug itself gets dispersed throughout the body and ends up in the skin, where it absorbs UVA light and causes cellular damage.  A phototoxic event typically happens within hours of initial exposure to sunlight.

Photoallergic reaction occur when the UV light alters the chemical structure of the drug and the body’s immune system sees this new compound as an intruder and attacks it.  A photoallergic reaction doesn’t usually happen right away; it requires longer, and often multiple, exposures to sunlight before it happens. 

Many commonly used medicines can cause photosensitivity:

Antibiotics such as ciprofloxacin (Cipro®), levofloxacin (Levaquin®), sulfamethoxazole/trimethoprim (Bactrim®) and doxycycline, tetracycline, and minocycline.

Acne medicines such as (isotretinoin (Accutane®/Claravis®), tazarotene (Tazorac®), and tretinoin)

Medicines to prevent malaria while traveling like atovaquone/proguanil (Malarone®) and chloroquine).

If you are taking a medication that can increase photosensitivity, you should avoid excessive exposure to sunlight and tanning beds.  (Of course, you already know that you should avoid tanning beds anyway).  If you don’t want to be a shut in while the sun shines, make sure you wear a broad spectrum (UVA/UVB) sunscreen with a SPF rating of 30 or greater.  This will decrease that amount of sunlight exposure to your skin and therefore the risk of a bad reaction.      

Sun Screen Tips:

  • Make sure it is broad spectrum (UVA & UVB)
  • Apply roughly one ounce of sunscreen for the full body
  • Apply one-half teaspoon of sunscreen to smaller body parts i.e. face/neck, each arm and shoulder
  • Apply one teaspoon of sunscreen to larger body parts i.e. legs, back
  • Apply 15-30 minutes prior to sunscreen exposure to ensure optimal protection
  • If swimming or being physically active use a “water resistant” sunscreen
  • Reapply liberally, especially if excessive swimming , sweating or toweling off
  • Minimally use a SPF of 15, optimally use a SPF of 30
  • If applying insect repellant, put the sunscreen on first, wait 15 minutes and then apply the insect repellant

If you are planning on spending a lot of time in the sun while on a medication, be sure to ask your pharmacist about possible photosensitivity side effects.   The pharmacy staff at the Wilce Student Health Center is always willing to answer any questions you may have.  Feel free to stop by or call us at (614) 292-0125.

Dean Wagner, PharmD candidate 2012
Student Health Services
The Ohio State University

Jason Goodman, PharmD, RPh
Student Health Services
The Ohio State University

Photos: www.medicine.net

Play the Medication Matching Game!

A

B

C

D

E

Last June, we did a post about generic vs. brand name medications.  Our point was that the generic (or “store brand”) version of a medication is identical to the brand name version, so all you are really paying extra for is the name on the box.  

So as promised – and in honor of finals week – here is a quiz to test your medication education.  Match the name of the generic medication below with the picture of its brand name counterpart to the right. (key below) 

Sure, unlike your real exams this test won’t help your GPA or get you into grad school or land you that job at a Big 6 accounting firm.  But it will save you a lot of money, which is practically just as good. 

Jason Goodman, PharmD, RPh
Student Health Services
The Ohio State University

1. Loperamide

2. Naproxen

3. Acetaminophen/Aspirin/Caffeine

4. Loratadine

5. Omeprazole

Answers:  1-D, 2-C, 3-A, 4-B, 5-E

The Ulcer Rap

You could spend the next 3 minutes reading about the risk of developing stomach ulcers from taking too much non-steroidal anti-inflammatory medications (NSAID’s), or you could just watch this “music video” made by an actual doctor rapping about ulcers courtesy of The ZBlogg.

 

We use NSAID’s all the time for aches, pains and fevers.  Odds are you’ve taken one within the last year, either alone or as an ingredient in one of those multi-symptom cold and sinus medicines.  The most common NSAID’s are ibuprofen (Motrin, Advil, Nuprin) and Naproxen (Aleve). 

These medicines really work well, but like all medications they have side effects, and one of the most serious – as ZDoggMD so eloquently points out – is ulcers in the stomach lining that can cause you to bleed internally. 

So if you need to use these medications, use as little as possible.  And if you develop fatigue, abdominal pain, black or tar-like stool, or bright red blood in your stool while taking them, make sure you get checked out right away.  In fact, if you need to take them that much, you should probably get checked out anyway.

And don’t worry – we don’t rap at the Student Health Center.

John A. Vaughn, MD
Student Health Services
The Ohio State University

A Medicine By Any Other Name

wikimedia commons

Medicines are as confusing as they are expensive.  Your doctor prescribes you Prevacid for your heartburn, but you get a bottle of something called Lansoprazole.  You ask your pharmacist for some Advil for your headache, but he grabs a bottle of Ibuprofen off the shelf.  What’s going on? 

What’s going on is a name game, my friends, and if you learn the rules, you will save yourself some serious cash over the next few years.

Medicines can have two names: a generic name and a brand name.  The generic name is the actual scientific name of the drug and the brand name is a specific trade name used by a specific manufacturer.  So are brand and generic medications the same?

For all intents and purposes – yes.  In order for a generic medication to be allowed onto the market, it has to have the exact same active ingredient at the exact same strength as the brand name. Where they are allowed to differ is color, shape, size, etc.  So unless you have an allergy to certain dyes, you shouldn’t have any problem with the generic version.

So why are brand name medications so much more expensive if they are the exact same medicine as the generic?  Unfettered greed on the part of the Big Pharma evil empire?  Not exactly…

A drug company may spend millions of dollars to develop a new medicine and bring it to market.  After the patent runs out, the drug’s secret formula is no longer a secret and generic manufacturers can swoop in and sell it without having to invest any of that time and money so they can charge a lot less. That’s good for us, but the brand manufacturer needs to cover their development cost and turn a profit so they are given the patent window to do so. 

Where it gets a little shady is in the realm of what you could call “copy cat” medicines.  When a brand name drug is about to go off patent, drug companies will sometimes launch a “new” drug that is really just a slightly tweaked version of the old one.  They’re technically different medicines so the patent clock gets reset, but they essentially do the same thing.  When your health care provider gives you a prescription, it can never hurt to ask if there is a generic equivalent available.  It can save you big bucks.

In my next post, I’ll give you a quiz – match the generic medicine to its brand name.  Unlike most of the tests you take here at Ohio State, this one could actually save you money!

Jason Goodman, PharmD, RPh

The truth about antibiotics and birth control!

cmdrc.com

Q: I heard that antibiotics interfere with birth control pills, but I’m on the birth control that gets implanted under my skin – will antibiotics interfere with that too?

A: I’m so glad you asked this question!  This is one of the biggest medical myths of all time; one that gets propagated in doctors’ offices, health clinics, hospitals, blogs, magazines – and OK fine, student health centers – every day.  So now, for the first time ever… in print… online… on this blog… the TRUTH!

The only antibiotic that has ever been shown to interfere with birth control levels and effectiveness is a medicine called rifampin which is used to treat tuberculosis.  Rifampin may also interfere with the birth control patch and vaginal ring so if you are taking it, be sure to use a back-up, non-hormonal (i.e. condom) form of birth control.

There are some other medications that can interfere with your birth control, however, and if you are taking any of them you should always use back-up contraception.

  • Griseofulvin
  • Phenytoin (Dilantin)
  • Carbamazepine (Tegretol)
  • Phenobarbital
  • Topirimate (Topamax)
  • St. John’s Wort (herbal supplement)

But in general, your birth control will not be affected by any run-of-the-mill antibiotic that you might be taking for things like sinus infections, strep throat, urinary tract infections, skin infections, acne, etc.  Some people believe that because antibiotics disrupt the normal bacteria in the gastrointestinal tract, they will interfere with the absorption of the birth control pills from your stomach.  But this is not an issue, and even if it were, it wouldn’t apply to birth control methods that don’t involve swallowing pills like the skin patch or the vaginal ring or Implanon.

Now, there are enough women out there who swear that they have little antibiotic babies running around the house that your health care provider will probably still tell you to use back-up just in case.  And birth control doesn’t do anything to protect you against sexually transmitted infections, so using a condom is a good idea no matter what medications you’re taking.  But you can rest assured that your birth control is just as effective when you’re taking antibiotics as when you’re not. 

John A. Vaughn, MD (OSU SHS)