• Are age 39 or older
  

• Are age 50 or older
• Have a family member with glaucoma
• Are of African-American heritage
• Have had a serious eye injury
• Are taking steroid medications

Brand Name

Phospholine Iodide®

Echothiophate

Trusopt®

Dorzolamide

Sympathomimetics

Apraclonidine

Epinephrine

Timolol

Prostaglandin analogues

Latanoprost

Challenges of Weight Management

Ninety-seven million adults in the US are considered to be overweight or obese. Since 1960, there has been an increase in the
percentage of people that are considered overweight or obese. Currently, 54.9% of people age 20 or older are considered to be
either overweight or obese. Ethnic groups, lower socioeconomic groups, and those with less education have been found to be more
likely to be overweight.

Why does obesity occur? The main reason obesity occurs is that more food is eaten than is burned off. To lose off one-pound/week
500 calories per day need to be decreased from the total caloric intake. Factors that help to promote obesity include a genetic
predisposition for obesity, an inactive lifestyle, and a high fat diet.

Why does it matter if we're overweight or obese? Obesity raises the risk for high cholesterol, high blood pressure, and diabetes.
Other risks associated with obesity include strokes, heart disease, arthritis, respiratory problems, and certain types of cancer.
Weight loss helps to decrease the risk for these conditions. Weight loss also improves self-image, confidence, mood, energy,
and endurance.

BMI, Body Mass Index, is used as an indicator of obesity. This measurement takes into account body weight and height.
To calculate your BMI:

Many web sites have a calculator that will determine your BMI for you. One such web site is Shape Up America!
(http://shapeup.org/bmi/start.htm).
Your BMI can also be determined from a chart like the one shown below.

Being overweight is defined as a BMI from 25 to 29.9 kg/m2 while obesity is defined as a BMI equal or greater than 30 kg/m2.

The American Heart Association dietary guidelines are listed in the table below, and the USDA Food Guide Pyramid is also shown
below.

Tips and facts about weight loss

• Physical activity such as walking 30 minutes a day most days of the week is beneficial in weight loss and keeping the weight off
  
• Physical activity is different from exercise. Physical activity includes housework, climbing stairs, walking across a parking lot
  to work, etc.
  
• More than two pounds of weight loss a week is considered unhealthy
  
• No less than 1,200 calories should be consumed by women daily and no less than 1,500 calories should be consumed by
  men daily to ensure that proper nutrition is maintained.
  
• Five servings of fruits and vegetables a day add health benefits as well as increasing the amount of fiber eaten daily which
  makes you feel full
  
• Eating fat-free and low-fat foods are better choices than food containing more fat, but calories still need to be taken into account
  
• By only weighing yourself once a week you have a better chance of not becoming overly encouraged or discouraged
  
• Food logs and portioning are types of behavior modification that can aid with weight loss
  

Fad diets - how can you tell?

To tell if a diet is a fad diet several things could be looked at. First, there are not any foods that burn fat. The way to burn fat is to
increase physical activity or decrease the amount of food consumed. Secondly, bizarre quantities of only one food or type of food
can cause a dietary imbalance and are a tip that it is a fad diet. Rigid menus, specific food combinations, rapid weight loss, and a
lack of warnings for people who have diabetes or highs blood pressure are also tips that it is a fad diet. Before starting a diet consult
a health care provider such as a physician, pharmacist, or dietician.

Herbals, Over the Counter Medications, and Nutritional Supplements - are they safe?

Herbal teas that contain senna, aloe, buckthorn, or other laxatives derived from plants can be harmful if used in excess for weight loss.
These products may cause diarrhea, vomiting, nausea, stomach cramps, chronic constipation, and even death. Ephedra
(Ma Huang), Ephedra plus Guarana, and St. John's Wort (hypericum perforatum) have also been used for weight loss.
THERE IS NOT A GREAT DEAL OF SAFETY AND EFFICACY INFORMATION ON THESE PRODUCTS
AND THEY ARE NOT REGULATED BY THE FOOD AND DRUG ADMINISTRATION. Furthermore, these products
have been associated with dizziness, increased blood pressure and heart rate, heart attacks, and seizures. Chromium picolinate,
garcinia cambogia, chitosan, and conjugated linoleic acid have also been purported to be effective in causing weight loss.
However, there is not any evidence to back up these claims.

The use of laxatives for weight loss is dangerous and chronic use of these agents can lead to colon or heart problems. Over the
counter medications for weight loss are not very effective and can have serious effects when used in patients with diabetes, heart
disease, high blood pressure, or thyroid disease.

Prescription Medications

The most common medications indicated for weight loss include phenteramine (Fastin Weight loss is not a quick process.
Losing weight takes time and will power. However, weight loss can help prevent some of the morbidity associated with obesity.

Useful Web Sites

http://www.obesity.org

http://www.naaso.org

http://www.deliciousdecisions.org/ee/wbd_easy_main.html

American Heart Association Dietary Guidelines

http://www.americanheart.org/catalog/Health_catpage5.html

American Heart Association Dietary Recommendations

High Cholesterol

Cholesterol is a naturally occurring substance found in the diet as well as made by the liver. Cholesterol is necessary for the production of bile salts and steroid hormones. It is also used in the structure of cells and is essential for life.

Because cholesterol and other fatty substances are insoluble in water, they combine with proteins to form a soluble lipoprotein complex. The three major lipoproteins are very low density lipoprotein (VLDL), low density lipoprotein (LDL), and high density lipoprotein (HDL).

VLDL particles carry about 15-20% of the total serum cholesterol and most of the triglycerides. LDL particles contain about 60-70% of the total blood cholesterol. LDL particles carry cholesterol to blood vessels where it can be deposited and cause coronary heart disease (blockage of heart vessels). HDL particles carry cholesterol from the cells of the body to the liver for breakdown. Therefore, high concentrations of HDL particles are beneficial and protective against the formation of coronary heart disease.

The National Cholesterol Education Program (NCEP) was established in 1993 and offer recommendations for therapeutic options in treating high cholesterol. Additionally, this program lists risk factors for coronary heart disease. Ideal cholesterol levels can vary depending on other diseases (i.e. diabetes) and number of risk factors present.

The HMG CoA Reductase Inhibitors also known as "Statins"

• atorvaststatin (Lipitor®)
  
• simvastatin (Zocor®)
  
• pravastatin (Pravachol®)
  
• lovastatin (Mevacor®)
  
• fluvastatin (Lescol®)
  
• cervistatin (Baycol®)
  

These medications inhibit a certain step in the body’s production of cholesterol. Using these drugs can lower your body’s production of cholesterol.

HINTS and Reminders:

-The statins are to be taken at bedtime (or after the evening meal) because your body makes most of its cholesterol during the night. The only exception is Lipitor® which can be taken anytime during the day.

-It is recommended that you do not drink grapefruit juice one hour before or two hours after taking these medications.

-Let your doctor or pharmacist know if you experience any muscle pain while taking a statin. This is especially true if you are taking more than one type of cholesterol-lowering medication.

Fibric Acid Derivatives

• clofibrate (Atromid S®)
  
• gemfibrozil (Lopid®)
  
• fenofibrate (Tricor®)
  
• colesevelam hydrochloride (Welchol ® )
  

Your body has to process the fatty foods you eat. There are certain chemicals that digest the triglycerides (fats) that you ingest. Fibric acid derivatives enhance the rate at which the triglycerides are broken down. Therefore your triglycerides are decreased in addition to your total cholesterol.

Hints and Reminders

-Fibric acid derivatives can increase blood sugar. If you have diabetes, make sure you are testing the blood daily so you know how it is affecting control of your diabetes.

-Let your doctor and pharmacist know if you experience muscle pain

Bile Acid Sequestrants

• cholestyramine (Questran®/Questran Light®)
  
• colestipol (Colestid®)
  

Your body converts cholesterol into bile through various chemical reactions. These drugs keeps the bile in the intestines and are excreted in the feces. The amount of bile in the digestive tract is lowered so your body needs to use more cholesterol to make more bile.

Hints and Reminders

-These medications can cause stomach upset

-If you can not tolerate the texture of the powder, ask your doctor about changing to the tablet form

-Take other medications one hour before or two hours after the bile acid sequestrants because they can cause a decreased absorption of the other medications

-Drink plenty of fluids with the powder and tablet formulations

Nicotinic Acid

• Niacin (Niaspan®/Nicolar®)
  

No one is sure exactly how niacin works to decrease cholesterol. It’s mechanism of action is similar to fibric acid derivatives.

Hints and Reminders
-Flushing and itching are common adverse effects of this drug, especially during the first two weeks of therapy. Often it is recommended that you take aspirin before taking the niacin to avoid this. However check with your doctor or pharmacist to make sure this is appropriate.
-Niacin can be bought over the counter but it can have serious effects. Please ask your doctor before buying this yourself

Benecol® Take Control®
Benecol® and Take Control ® are margarines that contain an ingredient that inhibits the absorption of cholesterol into the bloodstream.

Hints and Reminders
-Use three times a day with meals. The product will not work properly if it is used inconsistently

Garlic

Garlic is a member of the lily family that has been reported to lower cholesterol and blood pressure. The active compound, allicin, causes the distinctive odor and is suspected to be responsible for the health benefits. The evidence that garlic lowers cholesterol is based only on case reports. Due to this controversy, ask your doctor before taking a preparation of this herb. The FDA does not regulate herbal products so be cautious.

Fiber

Recommendations for dietary fiber for adults are 20 to 35 grams per day or 10 to 13 grams of dietary fiber per 1,000 calories. Fiber lowers LDL (bad cholesterol), but does not have any effect on the HDL (good cholesterol). Individuals with higher initial cholesterol levels tend to respond more favorably to soluble fiber (sources include oats, peas, legumes or beans) than those with lower cholesterol. Fiber is thought to decrease cholesterol by binding to and increasing the excretion of bile acids. Always look for products that list the amount of soluble and insoluble fiber because soluble is the only fiber that effects cholesterol. Add fiber slowly to your diet because it can act as an irritant if you increase the amount too quickly.

ALLERGIES

By Katrina Kalb, PharmD. Candidate
March 2, 2001

GENERAL INFORMATION:

The medical term for allergies is allergic rhinitis. The term hay fever or pollinosis is also used to describe the condition. Allergic rhinitis affects more than 30 million children and adults in the United States (20% of the population). There are two types.

• Perennial - chronic; through the year
  
• Seasonal - symptoms occuring during particular times of the year
  

This condition is caused by the immune system being over sensitized to certain substances. Normally, the immune system protects the body from harmful toxins, bacteria or viruses. An allergy occurs when the body reacts to substances (allergens) that are usually harmless and do not cause an immune response. Antibody production is triggered when an allergen enters the body of a person with a sensitized immune system. Histamine and other chemicals are released by tissues as part of the immune response which causes itching, swelling and mucous production.

CAUSES:

People are not born with allergies, but those with a family history are more likely to develop symptoms spontaneously after repeated exposure to allergens such as:

• Dust mites feces
  
• Pollen-tiny particles from trees, grasses and weeds
  

- The pollen count represents the concentration of pollen in the air in a certain area at a specific time. Pollen counts are the highest in the early morning on dry, breezy, warm days.

• Molds
  
• Animal dander
  
• Common in patients with a family history of hives, asthma and/or eczema (skin rashes/dry skin)
  
  

SYMPTOMS:

Sneezing
Watery eyes
Coughing due to postnasal drip
Itching of the nose or eyes
Irritability
Runny nose

TREATMENT:

Non drug
Avoidance is the most effective treatment, but other suggestionsare:
1) use air conditioning in the summer
2) keep doors and windows closed
3) wash bedding in water that is 130 degrees F to kill dust mites
4) limit outdoor activities during peak times

- grass: afternoon and early evening

- ragweed: early midday

- mold spores: some peak in damp/rainy weather and others during warm, dry, windy condtions

Drug Treatment

• When you see "Nondrowsy" on a over the counter label, that means it contains no antihistamine
  
• Always check with your pharmacist or physician before taking an over the counter product because some allergy products should not be used in patients with heart disease, diabetes or thyroid problems
  
• Follow the package warnings. Over the counter antihistamines cause sedation and patients should NOT drive or operate heavy machinery while taking them
  
• READ READ READ labels. You are ultimately responsible for your health. Be informed.
  
• Do not share medications.
  

FOR MORE INFORMATION

National Institute of Allergy and Infectious Diseases www.niaid.nih.gov
Asthma and Allergy Foundation of America www.aafa.org
American Academy of Allergy, Asthma and Immunology www.aaaai.org

Flu Vaccine

Information about the Influenza Vaccination (Flu Vaccine)

Why do I need a flu vaccine?

Influenza can be a serious illness and may lead to death. The flu vaccine is one means of protecting yourself against the flu virus or if you do get the flu, the course of the illness will often be a milder case. Everyone can benefit from the flu vaccine, however those at high risk should be vaccinated first.

When is “flu season” and when should I be vaccinated?

Flu season is usually from November to April. The optimal time for vaccination in the high-risk population is October through November, however you can receive the vaccination throughout the entire flu season.

Who is considered high risk?

The populations that are considered high risk and should be vaccinated each year include:

• People who are 65 and over
• Residents of long term care facilities and people who are taking care of the residents
  

People (children and adults) with on going health problems which includes:

• Asthma or other lung problems
  
• Kidney diseases
  
• Heart disease
  
• Diabetes
  
• Anemia
  
• Other blood related disorders, such as HIV/AIDS or anyone who is taking chemotherapy
  
• Other diseases or medications that affect the immune system
  
• Children/Adolescents (ages 6 months to 18 years of age) who are on long-term aspirin therapy
  
• Pregnant women who will be at least 3 months pregnant during the flu season-Recommended by Centers for Disease Control and Prevention but these women should be vaccinated by their OB/GYN physician
  

Who else should receive the vaccination?

It is highly recommended that people over the age of 50, health care workers, and children and adults who live with or take care of those who are at high risk should receive the flu vaccine.

Who should not receive the vaccination?

Talk with your physician before receiving the vaccination if you have an allergy to eggs, have had a serious reaction to the vaccine in the past or have a history of Guillain-Barre Syndrome. If you are ill or have a fever, it is recommended that you wait to get the vaccine when you are well.

Can I still get the flu even if I have been vaccinated?

There are different types of influenza and the vaccination does not cover all of them. The vaccination will cover those that are felt to be the most common forms of influenza; therefore it is possible to still get the flu even though you have been vaccinated. The importance of this is that people who have been vaccinated will often have a much milder case than those who have not been vaccinated.

Can I get the flu from the vaccine?

No, the virus from which the vaccination is made is dead. Currently this is the only type of influenza vaccination approved in the United States.

Where can I get more information?

Ask your pharmacist or physician. You can also visit the Centers for Disease Control and Prevention (CDC) web site at www.CDC.gov. Or call them at 1-800-311-3435.