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MComes RPH

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Everything posted by MComes RPH

  1. Anesthesia and C/L

    Waywrd, Thank for the info. I just answered another question on a post about, "if your pharmacy is out of your meds," that you may want to read. Once again, thank you
  2. Mylan C/L On Back Order?

    Most every pharmacy has it's own warehouse to get medications from, this is their main source of medication. Then, almost all pharmacies, except independent pharmacies, have a secondary wholesaler, which is usually McKesson or Cardnial. Oddly enough, while I was writing this I received a phone call from my pharmacy telling me my generic Sinemet CR 50/200 by Mylan, with a 3 month supply (quantity of #270) was ready to pick up. I asked him to order another 6 bottles of 100 tablets (6 extra months for me) of the Mylan brand, and he was able to. I talked with a friend of mine at Walgreens last night and he told me it was on backorder. Both of them use McKesson as their secondary wholesaler. This usually means that it is on a "first come, first serve basis. Since this appears to be the case, ask your pharmacist to check every morning, and night if they are willing to, to see if the generic you need is in stock Make friends with your pharmacist, it can go a long way. To me, all of my customers were my friends. I hope this helps and please keep me posted.
  3. question on c/l manufacturers

    Johnny Good to hear from you again. There has not been much is the subcontracting anymore. What seems to be the big, and I mean big, issue is that so many companies that make c/l are buying up other companies that make c/l. Some companies that have never produced it in the past are buying up companies that make c/l. This is causing many issues of back ordering and out of stock issues of certain brand of generic. As you know, once you find a company that works you want to stay with that company. So that is the main headache now. I think the out sourcing to smaller companies seems to be a thing of the past. As always, I hope that helps and please keep me posted. Don't be a stranger.
  4. Mylan C/L On Back Order?

    This is a problem all over the country. When I spoke with pharmacist and the company's I get the same answer that it's on back order. I wlways recommend that patients get their refills as early as possible, which is usually when about 80-85% of the medication is gone. This will then allow you to be able to save up extra in case of an emergency. I hope this helps a little and please keep me posted.
  5. Side Effect of Lorazepam?

    Jill, Sleep is so important for everyone, but especially for people with PD. Sleep is the only time the dopamine cells we have are able to replenish themselves. This is because we don't move much, therefore our muscles don't use up as much dopamine. I'm glad I could help and please keep me posted.
  6. Namenda

    I'm so glad to hear that. Please keep me posted.
  7. Anesthesia and C/L

    Waywrd, It was like I was telling you that one follows the other and then when the levels get to a certain point, the reaction occurs. I thought I put the dye being an issue in the first one, along with carbidopa. I think I got so deep into the kinetics that I may have forgotten to mention it. So, I believe it is either the dye or carbidopa. I know it's hard to remember what we did yesterday let alone 3 to 4 months ago, but if you could remember the generic brand than we can actually look up the color color. It makes it tough because they don't use a purple dye, they use blue #4, red #7, blah ba blah. But if you know the manufacturer we should be able to work backwards to the color. I'll throw my 2 cents in, I have never had a patient allergic to the fillers. They are stuff like starch, lactose, calcium salts. You will also find them on the label as "inactive ingredients. " I hope this helps and please keep me posted.
  8. Mylan C/L On Back Order?

    LllWaywrd, I filled my 50/200 CR by Mylan Brand filled 2 weeks ago at Kmart for #270. I also filled my Mylan Brand 25/100 for #720 at Kmart. I did call 2 different Rite Aid stores. One had Activis CR, Mylan 25/100, and Mylan 10/100. I will try and find out some more tomorrow. I hope this helps and please keep me posted
  9. Gradual transition to Rytary/expired samples

    Marketfocus, There are many ways in which the Rytary can be added to a medication regime. I have seen Rytary in the morning and Sinemet in the afternoon and night time for 1 week. Rytary morning and afternoon the next week. Then Rytary 3 times a day with no Rytary. Then you have to go through fine tuning the Rytary. I am not saying it is a bad medication, because it isn't. It has been a savior to people in my family, my friends, and patients. But, it was not for me. My true belief is that if a person is going to try Rytary, then the should start it all in one day, by itself, and keep a journal (which I believe everybody with Parkinson's should do). This journal (which should contain medication, strength, time of day, time of when and what you eat, the time you wake up and the time you go to bed) can show trends when off and on times occur and this will help you adjust your medication. I have also noticed that the exchange chart just works on total Sinemet used and not the Sinemet CR, but you should just add the dosage. What I have heard from patients and Dr's alike is that the exchange rate seems to give a Rytary dose that appears a little high, thus giving the patients dyskensia, headache, vomiting, and if long term it can cause obsessive disorders. This could possibly be not taking into consideration of the CR, but many Dr's are looking at the conversation table and dosing it down one notch. Also, c/l is carbidopa/ levodopa. So if the chart states (Situation A) you should start at 3 capsules of Rytary (each cap if 48.75/195) three times a day, some Dr's are choosing (Situation 4 capsules of Rytary (each capsule is 36.25/145) three times a day. The total levodopa difference between situation A and Situation B is 15mg of levodopa DAILY. But we all know how much a a different 15mg can make. I hope this help and please keep me posted.
  10. Side Effect of Lorazepam?

    Jill, This untoward effect could fall under muscle and/ or joint pain. I would also consider it an untoward effect of Lorazepam. I am not a fan of Lorazepam because the half-life is between 6.3 and and to all metabolites (even lorazepam) would take 18 to 24 hours. To me, this is a very long time to stay in the system and possibly have many medication and system issues. Also, this class of medications are called benzodiazepines and all have different half-lives. I prefer Xanax over Lorazepam because it's half-life is 6.3 to 26.9 hours. At first glance it may appear in line with Lorazepam. What you have to consider that the 26.9 hours. The actual Xanax active ingredient is out betwee 8.9 and 11.3 hours. As far as the face pain could be due to a variety things. A friend of mine who is a dentist said that MOST people bring their teeth, but will tell you they don't. He said that i did, so i put him to the test. He wanted me to only chew sugar free gum, and only when I'm working, working around the house (my wife and i are renovating oir "Florida" room (which in Michigan is called a walk in freezer) exercising, riding my bike, driving, and driving. Let me remind you that 6 months ago he took impressions, he took impressions that day, and would take them in 6 months. That 6 months ended last Wednesday November 6th and I went in for the re-check. I was blown away at the results. My grinding was, for the most gone. Most of it happened at night (so i bought a moth guard for use at night times). He also told me that driving and shopping were the 2 worst causes of grinding because (1) we can't yell at people in the store, and (2) you grit your teeth when you are driving because you know you NEED that car and are very possessive, and grind our teeth instead of road raging. In closing, your Dr. May want to try some sort of antidepressant, which can help, but I would rather see a low strength Xanax (probable 0.25mg) and have your Dr. can adjust it if needed. I hope this helps and please keep me posted.
  11. Namenda

    I am glad to hear that and I am also glad I could help. I'm glad I could you and please keep me posted
  12. Anesthesia and C/L

    Waywrd, This is a real issue that happens and is confirmed in the Allergy and Immunology for Clinicians. they have a great description of it, so I will quote it. Basically it states that exposure to allergens induces Mast cell degeneration. In this process chemical mediators are released and v attract inflammatory cells that infiltrate the airway wall. This causes bronchospasm, Mucosal edema, hyperactivity of the airway, and mucus secretion. The neglected component is vascular permeability, which is the hallmark of mast cell degranulation. Like muscle spasms, mucosal permeabolity happens rather quickly with the best antidote being an antihistamine. I hope this makes sense. This happens in severe allergic reactions and is quick to onset. I truthfully have not heard it happening with Carbidopa/levodopa. Since levodopa is naturally produced in the body, this could lead us to determine that the reaction is taking place because of a reaction to carbidopa, which is not naturally occuring in the body. I hope this helps and please keep me posted.
  13. Namenda

    Michelle, You are correct. Namenda is very commonly used for Lewy Body and Parkinson Disease Dementia. It does help with recall memory and hallucinations. This, as well as most Parkinson medications, should used by the "Start low and go slow method." The starting dose is 5mg and can be increased by 5mg every week until a maximum of 20mg is achieved. The other nice thing about this medication is that it also comes in an extended release formula. I hope this helps and please keep me posted.
  14. rytary and sleep

    Noah, I would probably try to take a regular Sinemet at 7:00pm, since you seem to be going off almost every day at about 7:30pm. Maybe just one tablet. Make sure you keep a journal then you can see the patterns and adjust accordingly. Also, as far as using Rytary, Sinemet CR, and regular Sinemet, I would probably try to stick with either the Sinemet and Sinemet CR and no Rytary or just Rytary and no Sinemet or Sinemet CR. I have found that it is very tough to use both at the same time and get consistent results. That has been my experience and the experience that I have heard from many patients. This is probably the best way to settle down the early evening. As far as the Trazadone goes. I would have the Dr, write for Trazadone 25mg, take 1 to 2 tablets at bedtime. This way you can cut 1 tablet in half, so then you can take 1 & 1/2 tablets at bedtime. This just may do the trick. I hope this helps and please keep me posted.
  15. Pain Meds interaction w/PD Meds

    Jeff, I'm sorry to hear that. I guess we knew our backs were against the wall and this was our "Hail Mary." As far as directions for your meds in the hospital. Bring in your bottles so that the staff can write them down. My hospital experience have gone pretty much the same way. The nurses are expected to deliver meds 4 times a day. As we know, Parkinson's does not work like that and it is very difficult to get the staff to change their habits. When it comes to taking your meds on time, I have either expressed to the neurologist on staff, or I have been told to bring mine from home. I hope this helps and please keep me posted.
  16. Pain Meds interaction w/PD Meds

    Stump, I'm glad I could help and if you have anymore question, you know where to find me. Good luck.
  17. Stem cell study will be done on human's next

    Noah, I have this study and several other ones bookmarked, so I will keep you posted.
  18. WORLD South China Morning Post Parkinson’s breakthrough as stem cells restore mobility in monkeys, with human trials coming soon Lab monkeys with Parkinson’s symptoms regained significant mobility after neurons made from human stem cells were inserted into their brains, researchers reported Wednesday in a study hailed as “groundbreaking”. The promising results were presented as the last step before human clinical trials, perhaps as early as next year, said the study’s senior author, Jun Takahashi, a professor at Kyoto University. Parkinson’s is a degenerative disease that erodes motor functions. Typical symptoms include shaking, rigidity and difficulty walking. In advanced stages, depression, anxiety and dementia are also common. Worldwide, about 10 million people are afflicted with the disease, according to the Parkinson’s Disease Foundation. Earlier experiments had shown improvements in patients treated with stem cells taken from human foetal tissue and likewise coaxed into the dopamine-producing brain cells that are attacked by Parkinson’s. Dopamine is a naturally occurring chemical that plays several key roles in the brain and body. But the use of foetal tissue is fraught with practical and ethical problems. They became more active, moving more rapidly and more smoothly JUN TAKAHASHI DESCRIBES HIS TREATMENT OF MONKEYS WITH PARKINSON’S SYMPTONS So Takahashi and his colleagues, in a medical first, substituted so-called induced pluripotent stem cells (iPSCs), which can be easily made from human skin or blood. Within a year, some monkey’s who had could barely stand up gradually recovered mobility. “They became more active, moving more rapidly and more smoothly,” Takahashi said by email. Animals that had taken to just sitting “start walking around in the cage.” “These findings are strong evidence that human iPSC-derived dopaminergic neurons can be clinically applicable to treat Parkinson’s patients,” he said. Experts not involved in the research described the results as encouraging. The treatment, if proven viable, “has the potential to reverse Parkinson’s by replacing the dopamine cells that have been lost - a groundbreaking feat,” said David Dexter, deputy research director at Parkinson’s UK. “Not only did the new cells survive... but they also integrated with the existing neuronal network,” he said. Neurons made from foetal tissue grafted into brains have been known to survive for more than a decade, and the researchers said they expected those derived from iPSCs to last just as long. Tilo Kunath, Parkinson’s Senior Research Fellow at the University of Edinburgh, said the outcome was “extremely promising,” and highlighted the advantage of avoiding stem cells extracted from human foetal tissue. “It means that this therapy can be used in any country worldwide,” including Ireland and most of South America, where medical use of human embryonic stem cells is banned. The results, reported in the journal Nature, were not the same for the dozen monkeys in the experiment, each of which received donor neurons from a different person. “Some were made with cells from healthy donors, while others were made from Parkinson’s disease patients,” said lead author Tetsuhiro Kikuchi, also from Kyoto University. The varying outcomes suggested that the quality of the donor cells might play a role, so the researchers looked for genes that might explain the differences. Eleven genes, especially one known as Dlk1, showed up in many of the most successful transplants, suggesting that screening potential donor cells may be critical. Other experts evaluating the study said that stem cell treatment targets only some symptoms. “No one expects that transplants will address the non-dopamine, non-movement aspects of Parkinson’s disease, such as dementia and falls,” said Tom Foltynie, a professor at the National Hospital for Neurology and Neurosurgery in London. In the experiments, the lab-made nerve cells were injected into the brain through a thin needle during surgery. “The needle is so thin that it causes almost no damage,” Takahashi said. In a companion study, published in Nature Communications, scientists from Takahashi’s laboratory tested ways to avoid rejection of implanted neuron cells. After organ transplants or skin grafts from donors, recipients must take drugs to prevent their immune system from attacking foreign tissue. In monkey-to-monkey experiments, they found that the neuron transplants worked better across animals who shared similar gene groups responsible for shaping the immune system. The same, they conjecture, will apply to humans. In addition, if the stem cells came from the patient’s own skin or blood, the problem would probably not arise in the first place, Takahashi said.
  19. Pain Meds interaction w/PD Meds

    DmCwolfe, Thank you for your input. Those are all excellent ways to help the body heal.
  20. Pain Meds interaction w/PD Meds

    Stump, I have copied your questions so I can answer each one for you. Since there's a chance I could need surgery in the near term (either a recurrent hernia or some other complication from the prior hernia surgery), I have a related question. I am allergic to most of the opioids I've tried in the past. I got a rash from Percocet and Dilaudid. I hallucinated after just 2-3 days on Viocodin. ANSWER: The rash is definitely an allergy to the Percocet and Dilaudid. The hallucinations you experienced while on Vicodin are more of an adverse effect as opposed to an allergy, and are usually dose related. Usually lowering the strength of the medication will usually avoid this from happening. This is further complicated as I am heterozygous positive for Factor V Leiden. As such the current protocol, at least for something like hernia surgery, is 1 week of daily injections of Lovenox. That contraindicates all of the NSAID options I'm aware of. Tylenol is not particularly effective as a pain reducer for me, and hasn't been since I was a small child. ANSWER: As far as you having the Factor V, the usual protocol is to use Lovonex. Sorry to be the bearer of bad news. My options for pain meds are running thin if I do have the surgery. And last time I was (involuntarily, and due to a screw up by the surgeon) without any pain meds for many hours after the surgery and it was about as bad on pain as it gets. Whether I'm just on the wrong end of that particular bell curve, or the surgery went wrong in some way I don't know about yet I don't know, but the assumption should be that I will need something effective at relieving pain for the first couple days after any surgery. ANSWER: Now there are a class of Medications called COX2 inhibitors (one example is Celebrex. I have seen these used for pain because they have very little effect on thinning the blood. But depending on how severe the Factor V is, it would be completely your Dr.s decision as to use it or not. If I do wind up needing surgery what are my best options? Some kind of antihistamine to go with an opioid? Is there an NSAID that is not also a blood thinner? Can high doses of blood thinning NSAID's moot the need for the Lovenox? You can take an antihistamine, like Benadryl, which may cause drowsiness, but the dose to overcome an allergic reaction to medications would have to be so high, and it probably won't even work due to the different histamine receptors we have. As far as the question "Can NSAIDS moot the need for Lovonox," the answer is, unfortunately "No." Every hospital now has opioid prescribing guidelines they must adhere to. So I think you will see a different type of medication therapy than what you had in the past. I hope this helps and please keep me posted.
  21. Pain Meds interaction w/PD Meds

    Flyingfoxone, Thank you very much for your advice. Nabumatone (brand name is Relafen) is a high powered class is medications known as NSAIDS (Non Steroidal Anti-Inflammatory Drugs). The majority are by prescription only, but there are a few you can purchase over-the-counter. Such as Aspirin, Ibuprofen (Motrin or Advil), and Naproxen (Aleve). Acetaminophen (Tylenol) is known as a non-aspirin pain reliever. The reason is because it can be used to relives fever and headache, but DOES NOT reduce inflammation. I hope this helps and please keep me updated.
  22. Pain Meds interaction w/PD Meds

    Jeff, If you are allergic to the opioid used in most pain meds, which is hydrcodone, then you're allergy stems from codeine. Hydrocodone is just a ramped up version of codeine, so anything in that class will have the same effect. The next best option would be a pain medication called Ultram (generic name is tramadol). Ultram is an opiate, but is a very distant cousin to codeine. Now if you were to add a muscle relaxer, the main concern would be drowsiness. Also, Ultram just works on pain and not inflammation. That is why you should also take ibuprofen (brand names are Motrin or Advil) to help with the swelling, inflammation, and mould pain. The main interaction is between Ultram and selegiline. The interaction is known a "Serotonin Syndrome" which can be serious but is very, very, rare. All of the Physicians, MDS, and Neurologist I have spoken with, none of them has ever had this happen to a patient. I hope this helps and please keep me posted.
  23. Nupro patch vs mirapex

    Absolutely. Keeping active, while you still can, is so very important to keep the symptoms to a minimum. Walking is actually one of the best exercises a person with PD can do. Even doing one step more today than what you did yesterday is progress, that is true with any person at any age.
  24. Hi everyone, I was just emailed by AbbVie Pharmaceuticals concerning a Parkinson's Research Study they are conducting. AbbVie Clinical Pharmacology Research Unit (ACPRU) is currently enrolling people ages 45 to 85 for research studies for people who have been diagnosed with Parkinson's Disease. There is no cost to participate and qualified participants may be eligible to receive compensation of up to $1,500 for study participation. Study staff will determine eligibility based on study criteria. To learn more about the study and to see if you qualify, call 1-800-827-2778 or visit abbviephase1.com. For more information, call: AbbVie Pharmaceuticals 1-800-827-2778 To find more specific information on this study, visit AbbViePhase1.com ***I, Mark Comes, have no ties to AbbVie Pharmaceutical Company with respect to financial relationships, stock entitlements, support for this information, money for this post. This information was sent to me because I am a pharmacist and have signed up to be notified of new medications, research studies, and FDA and DEA information about medications.
  25. Nupro patch vs mirapex

    LAD, Even though your MDS and I think the same way about this study does not necessarily mean you should not try other clinical trial study. You can find other trial studies on this website, Mayo clinic, Parkinson Disease Foundation, Michael J. Fox Foundation, parkinsontrial.ninds.hih.gov, and many more. I am glad you have found a medication that works this well for you. Many PD patients have to try several medications before the can find one that takes care of most of the symptoms. I hope this helps and please keep me posted.
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