Common anticholinergic drugs like Benadryl linked to increased dementia risk

One long-ago summer, I joined the legion of teens helping harvest our valley’s peach crop in western Colorado. My job was to select the best peaches from a bin, wrap each one in tissue, and pack it into a shipping crate. The peach fuzz that coated every surface of the packing shed made my nose stream and my eyelids swell. When I came home after my first day on the job, my mother was so alarmed she called the family doctor. Soon the druggist was at the door with a vial of Benadryl (diphenhydramine) tablets. The next morning I was back to normal and back on the job. Weeks later, when I collected my pay (including the ½-cent-per-crate bonus for staying until the end of the harvest), I thanked Benadryl.

Today, I’m thankful my need for that drug lasted only a few weeks. A report published online this week in JAMA Internal Medicine offers compelling evidence of a link between long-term use of anticholinergic medications like Benadryl and dementia.

Anticholinergic drugs block the action of acetylcholine. This substance transmits messages in the nervous system. In the brain, acetylcholine is involved in learning and memory. In the rest of the body, it stimulates muscle contractions. Anticholinergic drugs include some antihistamines, tricyclic antidepressants, medications to control overactive bladder, and drugs to relieve the symptoms of Parkinson’s disease.

What the study found

A team led by Shelley Gray, a pharmacist at the University of Washington’s School of Pharmacy, tracked nearly 3,500 men and women ages 65 and older who took part in Adult Changes in Thought (ACT), a long-term study conducted by the University of Washington and Group Health, a Seattle healthcare system. They used Group Health’s pharmacy records to determine all the drugs, both prescription and over-the-counter, that each participant took the 10 years before starting the study. Participants’ health was tracked for an average of seven years. During that time, 800 of the volunteers developed dementia. When the researchers examined the use of anticholinergic drugs, they found that people who used these drugs were more likely to have developed dementia as those who didn’t use them. Moreover, dementia risk increased along with the cumulative dose. Taking an anticholinergic for the equivalent of three years or more was associated with a 54% higher dementia risk than taking the same dose for three months or less.

The ACT results add to mounting evidence that anticholinergics aren’t drugs to take long-term if you want to keep a clear head, and keep your head clear into old age. The body’s production of acetylcholine diminishes with age, so blocking its effects can deliver a double whammy to older people. It’s not surprising that problems with short-term memory, reasoning, and confusion lead the list of anticholinergic side effects, which also include drowsiness, dry mouth, urine retention, and constipation.

The University of Washington study is the first to include nonprescription drugs. It is also the first to eliminate the possibility that people were taking a tricyclic antidepressant to alleviate early symptoms of undiagnosed dementia; the risk associated with bladder medications was just as high.

“This study is another reminder to periodically evaluate all of the drugs you’re taking. Look at each one to determine if it’s really helping,” says Dr. Sarah Berry, a geriatrician and assistant professor of medicine at Harvard Medical School. “For instance, I’ve seen people who have been on anticholinergic medications for bladder control for years and they are completely incontinent. These drugs obviously aren’t helping.”

Many drugs have a stronger effect on older people than younger people. With age, the kidneys and liver clear drugs more slowly, so drug levels in the blood remain higher for a longer time. People also gain fat and lose muscle mass with age, both of which change the way that drugs are distributed to and broken down in body tissues. In addition, older people tend to take more prescription and over-the-counter medications, each of which has the potential to suppress or enhance the effectiveness of the others.

What should you do?

In 2008, Indiana University School of Medicine geriatrician Malaz Boustani developed the anticholinergic cognitive burden scale, which ranks these drugs according to the severity of their effects on the mind. It’s a good idea to steer clear of the drugs with high ACB scores, meaning those with scores of 3. “There are so many alternatives to these drugs,” says Dr. Berry. For example, selective serotonin re-uptake inhibitors (SSRIs) like citalopram (Celexa) or fluoxetine (Prozac) are good alternatives to tricyclic antidepressants. Newer antihistamines such as loratadine (Claritin) can replace diphenhydramine or chlorpheniramine (Chlor-Trimeton). Botox injections and cognitive behavioral training can alleviate urge incontinence.

One of the best ways to make sure you’re taking the most effective drugs is to dump all your medications — prescription and nonprescription — into a bag and bring them to your next appointment with your primary care doctor. 

Source : Common anticholinergic drugs like Benadryl linked to increased dementia risk

Millions of adults skip medications due to their high cost

Medications can do wonderful things, from fighting infection to preventing stroke and warding off depression. But medications don’t work if they aren’t taken. Some people don’t take their medications as prescribed because they forget, or are bothered by side effects. A new report from the National Center for Health Statistics shines the light on another reason: some people can’t pay for their medications.

The survey, by NCHS researchers Robin A. Cohen and Maria A. Villarroel, found that about 8% of adult Americans don’t take their medicines as prescribed because they can’t afford them. Insurance coverage often influenced this money-saving strategy. Among younger adults (those under age 65), 6% who had private insurance skipped medicines to save money, compared to 10% for those with Medicaid and 14% of those with no insurance. Among the poorest adults — those with incomes well below the federal poverty level — nearly 14% did not take medications as prescribed to save money.

Other strategies that those surveyed said they used to save money on drug costs included asking doctors for lower-cost medications, buying prescription drugs from other countries, and using alternative therapies.

The findings were published online as a National Center for Health Statistics Data Brief.

Soaring medication costs

Given the range of health conditions that many adults face, from high cholesterol and high blood pressure to arthritis, diabetes, and more, it’s not unusual for some people to take five or more different prescription drugs per day. Some people I admit to the hospital have 10 or more different medications listed on their medical records. Even if they could afford them, managing that many different medicines is a challenge — and is often impossible.

Not taking medications as prescribed can cause serious problems. It can lead to unnecessary complications related to a medical condition. It can lead to a bad outcome, like a heart attack or stroke. It can also increase medical costs if hospitalization or other medical interventions are needed.

With the high price of most prescription drugs, it’s not surprising that many Americans choose not to fill a prescription or take it as directed to save money. Even with health insurance that includes a prescription drug benefit, the copayments alone can be a prohibitive.

New medications continue to be approved yearly; few are taken off the market. The price of new drugs is always high, and prices don’t always fall when drugs become available as generics.

Cutting medication costs the safe way

If you are having difficulty affording your medications, here are some questions to ask your doctor:

Which medicines are the most essential for me? If your medications have been prescribed by different doctors, ask one of them — preferably your primary care physician — which ones are really necessary. Get an explanation of how each drug improves your quality of life, keeps you out of the hospital, and/or helps you live longer.

Which medicines might I be able to stop with minimal risk to my health? There aren’t always easy answers to this question. You may need to do your own research to make a shared decision with your doctor.

Are there lifestyle changes I can make now that might let me stop some of my medications? For conditions such as high blood pressure and type 2 diabetes, lifestyle changes such as exercising more and following a healthier diet can often decrease the number and dose of drugs you take.

Here are some other cost-saving tips:

• If you have a prescription drug plan, ask your doctor to prescribe drugs that are “preferred.” These will be the least expensive.
• Ask your doctor or pharmacist if a generic version of your medication is available.
• If no generic is available, ask your doctor or pharmacist if a less-expensive brand name drug in the same medication family would work as well.
• Ask your doctor or pharmacist about pill splitting. With some medications, there is little or no cost difference between low-dose and high-dose pills. With a $5 pill splitter, you can buy the higher-dose version and save 50%.
• Shop around. Even with prescription medications, prices can vary a lot. I recently compared the price of a commonly prescribed antibiotic. I found one major drug store that charged one-third the price compared to another.
• Source : Millions of adults skip medications due to their high cost

Making one change — getting more fiber — can help with weight loss

Getting to a healthy weight and staying there is an important way to prevent heart disease, diabetes,

 some cancers, and other serious conditions. Many of us know firsthand just how hard it can be to reach and maintain that healthy weight. And there’s no shortage of ways to try to get there: You can count calories, carbs, or points. You can cut back on fat or sugar. You can try any number of popular diets that forbid certain foods, or focus on just one (the grapefruit diet, anyone?). Any of these approaches might work for you. Or they might not — in large part because they are complicated.

A study published in today’s Annals of Internal Medicine suggests that something as simple as aiming to eat 30 grams of fiber each day can help you lose weight, lower your blood pressure, and improve your body’s response to insulin just as effectively as a more complicated diet.

Researchers from the University of Massachusetts Medical School compared the effectiveness of two diets with help from 240 volunteers. Half were asked to follow the American Heart Association’s (AHA) diet for preventing heart disease, in which you try to eat more fruits, vegetables, high-fiber foods, fish, and lean protein but also cut back on salt, sugar, fat, and alcohol. The other half were asked to follow a diet in which the only goal was to eat 30 grams or more of fiber each day. Neither group received advice or recommendations for exercise. All of the volunteers had metabolic syndrome — that is, all of them had high blood pressure, high blood sugar, and high cholesterol, and were overweight. This cluster of health issues greatly increases the risk for developing diabetes, heart disease, and stroke.

The participants in each group averaged 19 grams of fiber a day. Both groups lost weight, lowered their blood pressure, and improved their response to insulin. Those following the AHA diet lost a bit more weight (5.9 pounds) than those on the high-fiber diet (4.6 pounds), but both groups were able to maintain their weight loss for 12 months.

The results of the study don’t prove that a high-fiber diet is necessarily as good (or better) for health than the AHA diet or the highly in-vogue Mediterranean diet. What it does tell us is that one simple step can make a difference and that encouraging healthy behaviors may be more effective than discouraging unhealthy ones.

“In addition to weight control, higher fiber diets can also help to prevent type 2 diabetes and cardiovascular disease,” says Dr. Frank Hu, professor of medicine at Harvard Medical School and professor of nutrition and epidemiology at the Harvard School of Public Health. But, he cautioned, it’s best to get fiber from food, not from supplements.

Adding fiber to your diet can be easy and delicious (see “Good sources of fiber,” below). A high-fiber cereal or oatmeal with berries on top is a great way to start the day. For lunch, enjoy a salad sprinkled with chickpeas or kidney beans and some nuts (almonds, peanuts, walnuts, or pecans). Make a stir-fry for dinner using a variety of vegetables, and top with pumpkin or sunflower seeds.

Snacks offer another opportunity to get fiber. Whole fruit, nuts, and seeds, or a berry smoothie with wheat bran or flaxseed are good options, as are dried fruit (prunes, raisins), popcorn, and bean dips paired with veggies or whole-grain crackers.

Good sources of fiber
Food	Serving size	Fiber (grams)
CEREALS
Fiber One	½ cup	14
All-Bran	½ cup	10
Shredded Wheat	1 cup	6
Oatmeal (cooked)	1 cup	4
GRAINS
Barley (cooked)	1 cup	9
Brown rice (cooked)	1 cup	4
BAKED GOODS
Whole-wheat bread	1 slice	3
Bran muffin	1	2
VEGETABLES
Spinach	1 cup cooked	4
Broccoli	½ cup	3
Brussels sprouts	½ cup	2
Carrots	1 medium	2
Green beans	½ cup	2
LEGUMES
Kidney beans (cooked)	½ cup	6
Lima beans (cooked)	½ cup	6
Baked beans (canned)*	½ cup	5
FRUIT
Pear (with skin)	1 medium	6
Apple (with skin)	1 medium	4
Banana	1 medium	3
DRIED FRUITS
Prunes	6	12
Raisins	¼ cup	2
NUTS AND SEEDS
Peanuts*	10	1
Popcorn*	1 cup	1
* Choose no-salt or low-salt versions of these foods.

Source : Making one change — getting more fiber — can help with weight loss

New vaccine is an important advance in stopping cervical and other HPV-related cancers

If you knew that a vaccine could prevent your daughter or son from developing a relatively common and potentially deadly cancer later in life, would you have her or him get it? Such a vaccine is available, and it’s about to get even better than it is now — but fewer than half of all teens have gotten it.

I am talking about a vaccine against the human papilloma virus (HPV). It is responsible for cervical cancer, which strikes 12,000 women each year in the United States and kills 4,000. Only 15% of women diagnosed with advanced cervical cancer survive for five years or more — a grim statistic. HPV also causes cancer of the vulva, vagina, penis, anus, mouth, and throat.

A key barrier against more widespread use of this vaccine is an issue that stops many conversations about teen health: sex.

A new HPV vaccine

Human papilloma virus isn’t a single virus. It’s a family of 150 or so related viruses. The first HPV vaccine, approved for girls in 2006 and for boys in 2009, attack four types of HPV that cause the majority of cervical cancers. The new vaccine covers nine HPV types, making it even more effective.

A report in today’s New England Journal of Medicine shows that the new vaccine was effective against 97% of cancerous or precancerous changes in the cervix, vulva, and vagina related to five HPV types not covered by the first vaccine. That means it is expected to be able to prevent most cases of cervical cancer — a very important advance in cancer prevention.

Low coverage

About half (57%) of American girls between the ages of 13 and 17 get the first dose of the HPV vaccine, while only one-third (32%) get all three necessary doses. Coverage for boys is even lower.

The recommended age for getting the vaccine is 11 to 12. One reason is that the body mounts a more powerful antibody response at that age than it does a few years later. Furthermore, children ages 11 and 12 are already scheduled to get vaccines for tetanus, diphtheria, pertussis, and meningitis, so adding the HPV vaccine would be convenient. Finally, HPV is spread mostly by sexual contact. Getting the vaccine by age 12 ensures that children will be protected before they enter their early teens, an age when a growing number of American youths begin sexual activity.

Some parents refuse HPV vaccination because they think it will encourage their children to become sexually active or sexually promiscuous. Several solid studies have refuted this.

As does a new one published last week in JAMA Internal Medicine. It took a novel approach to this issue. Dr. Anupam Jena, assistant professor of health policy at Harvard Medical School, and colleagues looked at rates of sexually transmitted infections among more than 200,000 young women before and after HPV vaccination. There were no differences in these rates, suggesting that being vaccinated does not promote risky sexual behavior.

Improving coverage

HPV isn’t a problem for women only. Boys develop HPV-related cancer, too, as highlighted by actor Michael Douglas’s revelation that his throat cancer was likely caused by HPV transmitted during oral  sex. Vaccinating boys as well as girls would also help stem the spread of HPV.

In an editorial in JAMA Internal Medicine that accompanied the report by Dr. Jena’s team, Dr. Robert A. Bednarczyk of Emory University wrote, “just as we do not wait until we have been in the sun for 2 hours to apply sunscreen, we should not wait until after an individual is sexually active to attempt to prevent HPV infection.”

I believe that HPV vaccination makes good sense for both girls and boys. The benefits of cancer prevention clearly outweigh any small risks, and the benefits will be further extended by the broader spectrum of the new vaccine. I urge parents to protect their children with this important preventive measure.

Source : New vaccine is an important advance in stopping cervical and other HPV-related cancers

How Administer Medicine to a Resistant Child

If your child takes medicine daily, it can be challenging. Here are a couple tricks to help you through.

1. Tailor your approach to the age of the child. You can approach a seven year old much differently than you can a 2-3 year old. Unless the seven year old is behaving like a 2-3 year old. Reason with your older child, medication is important. Rewards are good for good behavior. The odd case of bribery is not out of the question either.
   
2. Stop using liquid oral medication or chewables! They taste nasty and have too much saccharine and red dye to be good for anyone. Teach your child to swallow pills. This can and should be done as early as four. (See tips)
   

3. 
   

4. Have your liquid medication flavored. It costs $3.00 at most pharmacies and is well worth the money if it saves the fight. There are many kid friendly flavors, with flavorplus cherry and bubblegum being the most favorites. Know that every kid is different, so you may have to add a tad of water mixed in with their liquid medication or have them use water or sugar free juice as a chaser.  Use a chocolate chaser. For a child over the age of one, you can give them a chaser of Hershey's Syrup on a spoon following the bad tasting medicine. Have it ready on the spoon so there is minimal lag time. The chocolate syrup is thick enough to coat the mouth and hide the bitterness of certain medicines. You can also use a softened Hershey's kiss.
   
5. Find out why the child won't take the medicine (if your child is five or older). The child may have a legitimate reason that they are unable to verbalize effectively. Children may have innate reactions to ingredients without knowing why - MSG, nitrates for instance in food. The medication may well have a side effect that makes your child feel bad - see Tips.
   

se this method as a last resort (only use this technique if not to take the medicine would result in potentially immediate, harmful possibilities):

• Lay the child on the floor (this may require two people once the child gets wind of what's coming) with their head between your knees and their legs facing in front and away from you.
• Use your knees to hold the child's head still. Be careful, do not squeeze, just hold. This gives you both hands to administer the medication.
• Pinch the child's nose closed with one hand and squirt the medication into the mouth with the other. Don't let go until they swallow. When you pinch the nose, they will have to open their mouth to breath, no choice. With the nose plugged, they have to swallow or choke. Again, this is a last resort, temporary until better arrangements can be made.
• Do not praise the child after using this technique - make it a non-plus situation. Giving it any credit will only encourage a repeat episode.

  

Tips

• The correct medication, at the correct dose, at the correct time, for the appropriate condition, for the correct patient.
• All medications have side effects, some good, and some bad. That is the point. Again with the example of Amoxicillin the good (desired) side effect is that the medication actually causes the infection to grow too quickly, (bacteriostatic) making it weaker, allowing our body’s own immune system to beat the bug. It does not kill the bug on its own. Some of the bad (less desirable) side effects it may cause are nausea, diarrhea, hives, yeast infection, shortness of breath, swelling of the throat and anaphylaxis. These do not happen to everyone, they are only possible.
• Pharmacists carry the title Pharm D, doctor of Pharmacy. Their training specifically relates to you and your medications.
• If you read this insert before taking medication, you may never take anything again. The same side effects rules apply to homeopathic medications as well. If the insert says that there is a 2% chance of a given side effect, don't discount it. Frequently patients are allergic or sensitive to an inactive ingredient in the medication IE a preservative or a dye. If your child has ADHD and is sensitive to red dye, then the red dye in the Amoxicillin suspension may bother them.
• You may find some resistance from the pediatrician to write for tablets or capsules. Most seem to be programmed to write for liquid forms. Most dosages can be converted or are already equivalent. Example: Amoxicillin suspension is 250mg per 5ml (teaspoonful), Amoxicillin capsules come in 250mg each. This is the same and will have no therapeutic difference. Depending on the state, your pharmacist can convert the dose from one form to another. If the state law does not allow a pharmacist to make a form change, they can, and should call your doctor for you. However, this may take time, it is better if you have the prescription written for tablets or capsules to begin with (learn to read prescriptions.) Don't let the doctor tell you it makes no difference how they write it, because it does. Your pharmacist can also put a comment in the child's file as to preferences for medication form.
• If your older child is not taking medicine and you suspect an underlying reason besides bad taste, do your homework. Ask your pharmacist for the package insert from the medication. This is different from the Patient Information Sheet you are given with each new prescription. This is a small paper attached to the medication by the manufacturer. You can also go to the Public Library and look it up in a PDR (Physician's Desk Reference.) This paper will give you all of the side effects and interactions with other medications, food etc. along with more information than you probably would ever care to know. Read this document with caution, it is written for the medical professionals so don’t let the information frighten you.
• Begin when your child is not sick. A 4-year is perfect for this; physiologically their jaw is changing shape making swallowing adult food easier. Psychologically they want to do everything big, not be a baby.
  • Make it a game, working on it a little at a time. Start by showing the child a coin and explaining that this was the size of your throat when you were a baby. Crawl around on the floor and find anything smaller than a quarter. This gives them reinforced images of the size. Never tell a child that a tablet is too large for them to swallow, they may be more difficult due to shape or texture, but they are not too large. Unless it is bigger than a quarter, it will go down.
  • Next trip to the store engage the child by asking them which they like better, Skittles or regular M&Ms. Let them pick them out and give them a separate bag. Dump the candy into a special bowl just for them. Help the child separate all of the green candies and put them into a separate container. Put the original container away. Explain that they're learning to take grown up medicine so they won't have to have baby medicine anymore. Use the green candies for practice and when they swallow all of them, they can have the remaining candy as a reward.
  • Practice over several days so they get the hang of it. Show them how to put the "pill" on the back of their tongue, take a drink of water and swallow. Go Easy they are actually teaching the tongue to do something different. When a child nurses or drinks from a bottle they push the tongue to the roof of the mouth to force the milk out and swallow. When they do this with a pill, it sticks, melts and tastes horrible. They have to learn to hold the tongue down when they swallow. Never push or berate them, praise them for trying and assure them that with practice, this will work. Follow through on your promise to give them the rest of the candy, they earned it.
• Imagine how much easier this will make it for you, no measuring spoons, no refrigerators, no fights because of bad tasting medicine, no more spills.
• Counting pills and sticking stickers is only the beginning.
• If you discover a possible side effect or interaction, contact your pharmacist and discuss it with them. They are the experts. They have the knowledge and experience to help determine if what you have discovered is likely, and offer any alternatives. Take notes so you can clearly communicate to the doctor in his or her own language.
• Only after having spoken with the pharmacist, contact your doctor. Be persistent, but be patient, doctors cannot possibly have all of the side effect and interaction information in their head. A low incident reaction may require some research on their part. Do not be deterred by them discounting what you say. They may feel you are questioning their judgment and prescribing ability. Doctors are trained to be confident in their decisions, which often fly in the face of making "the right decision." If you do not get satisfaction, consider changing doctors, or at the very least, get a second opinion.

Source : http://www.wikihow.com/Administer-Medicine-to-a-Resistant-Child