The Pharmacist Answers Podcast

Liver Lesson #1: Digestion [Show Notes]

 in Podcasts  tagged bile / Cholesterol / digestion / gallbladder / hepatocyte / intestines / Liver by

Review

Liver shaped like a triangle – check!

Lobule, hepatocytes, vessels – check!  Hundreds of thousands – got it! 

A colored sketch of a liver lobule with labeled parts.

Bile Basics

Hepatocytes make bile.

It’s colors green due to red blood cell waste (bilirubin).

Bile consists of water, salt, cholesterol, bilirubin.

Bile moves from hepatocytes in liver to the gallbladder.

When you eat fats, the intestines triggers the gallbladder to send bile to help digest fat.

The fats are used in the energy-making process.

Bilirubin makes bile green.  It also makes the skin yellow in jaundice.  Makes poop brown.

For babies, it’s because baby hangs on to extra red blood cells from mommy after birth, and the liver has to learn what to do with all of them after they die (RBC’s only liver 120 days!).  For adults with hepatitis, it’s because their liver is damaged and can’t work as efficiently as it used to.  If your poop is the wrong color, it can indicate there is a major liver problem.

If you are gallbladderless, there is no where for the bile to be stored.  So, it gets send to the intestines continuously.  Also, if you have a meal heavy in fats, the intestines will just dump the food it can’t process faster towards the exit.

High levels of bilirubin in infants can lead to cerebral palsy.  If the liver can’t handle all the bilirubin in a timely manner, the only other way to get it to breakdown is UV light. 

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page

How to Hear Your Liver [Show Notes]

 in Podcasts  tagged detoxification / digestion / immunity / Liver / metabolism / percussing by

Liver Basics

Your liver is shaped like a lumpy triangle.  

It is part of the digestive system, so having it close to the organs that carry your food means that blood doesn’t have to travel very far to get things to and from this organ.

During a physical exam, your doctor finds its location and size by percussing (aka tapping on it – just like a percussion instrument).  Here is a video demonstrating the technique.

Microscopic Level

Hepatocytes (liver cells) build together into Lobules.  Lobules build together into Lobes.

A colored sketch of a liver lobule with labeled parts.

6 Functions

  1. Digestion
  2. Metabolism
  3. Storage
  4. Detoxification
  5. Production
  6. Immunity

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page

APAP vs NSAIDs

 in Blog  tagged advil / APAP / Aspirin / fever / headache / inflammation / naproxen / NSAIDs / OTC / pain / tylenol by

FAQ

What’s the difference between acetaminophen (Tylenol) and ibuprofen (Advil/Motrin)?

APAP

Acetaminophen (A-SEET-a-men-o-fin, APAP) is in a class all by itself and science isn’t 100% sure how it works. There is a suspicion that there is an enzyme in the inflammation cascade that is only found in the central nervous system, and that enzyme is inhibited by APAP. But because it’s central, this is why APAP works on pain and fever but not swelling. APAP is metabolized by the liver, and that metabolism pathway produces a very toxic by-product if it gets into a traffic jam. This is why APAP dosing limits have been adjusted, and APAP overdoses are so dangerous, even if one does not have liver disease or consume alcohol.
Podcast Episode: Too Much Acetaminophen

NSAIDs

Ibuprofen is in a class many call NSAIDs (non-steroidal anti-inflammatory drugs – because the other medications used to treat inflammation are steroids). NSAIDs, including ibuprofen work on a specific enzyme step in the inflammation process that result in pain, swelling, and fever. That is why joint and muscle injuries respond well to NSAIDs. It is also why the inflammatory response due to viral or bacterial infections are subdued easily by NSAIDs. NSAIDs are metabolized and processed through the kidneys. An overdose can lead to kidney damage, as well as kidney disease can be worsened if these medications are used.  Aspirin is also a NSAID, as well as naproxen.

Bottom Line

In my personal experience, APAP works well on fever and overall body aches (think the flu). Ibuprofen and naproxen work well on injured joints and muscles, as well as sore throat symptoms due to viral infections.  Aspirin doesn’t get recommended for the same things as NSAIDs, mostly because it has such a big reputation as a blood thinner.

Treating Injured Muscles [Show Notes]

 in Podcasts  tagged injury / muscles / pain / RICE / strains / treatment by

How Muscles Work

Muscle contractions depend on the muscle cells trading Potassium (K⁺) and Calcium (Ca⁺⁺).

As your muscle uses up energy to do work, the by-product is Lactic Acid.

Muscle fibers are “woven” together – kinda like fabric.

Contracting and relaxing a muscle causes the fibers to grip together and then spread back out.

Bilateral muscles = symmetrical muscles.  They look the same on each side of your body and worktogether to move your body in both directions from your center (left and right).

How Muscles Get Hurt

Stretching a muscle causes the muscle fibers to extend.

Over-extending a muscle can lead to a strain or pull/torn muscle. 

Inflammation happens in the tiny fibers of your injured muscle.

Treatment Options for Injured Muscle

Anti-inflammatory medications work great for strained muscles.
– Ibuprofen (Advil, Motrin)
– Naproxen (Aleve)

R.I.C.E.
Rest: stop using it, or at least give it a little break with only light use
Ice: yep, that cold, frozen water stuff
Compression: for smaller muscles, they can be wrapped to help limit inflammation and hold muscle fibers in a inoffensive position.
Elevation: smaller muscles that can be affected by gravity pulling blood to it, can benefit from being elevated and allowing gravity to pull blood away from it for a short time.

Here’s a link with a concise explanation of when to use ice vs when to use heat.

Prescription steroids help relieve inflammation.

Prescription muscle relaxers keep the muscle from knotting up.

Holla

@_KevinBuchanan used 800 mg ibuprofen for his injury.  800 mg should be taken every 8-12 hours, no sooner, or GI side effects may occur.

Recap

1. Stop the offending activity.

2. Ice the injured muscle (24-72 hours after injury)

3. Take anti-inflammatory pain relievers.

4. Apply heat to keep muscle relaxed

5. Gentle use or stretches

Behind the Scenes

Wearing a toddler while cleaning the kitchen can cause sore or injured muscles. Wear toddlers and clean kitchens with caution!

Since baby sister was born, Jossalynn gets one-on-one time with me by riding in the “backpack”, which is a woven wrap by Pavo Form.

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page

Cleaning Up Bacteria’s Mess [Show Notes]

 in Podcasts  tagged antibiotics / bacteria / infection / resistance / toxicity by

Bacteria and Antibiotics

MIC stands for Minimum Inhibitory Concentration, and is the lowest amount of antibiotic required to stop the bacteria.

Antibiotics either kill the bacteria or slow it down enough that your own immune system can get rid of it.

Antibiotics are designed to keep a certain amount of medicine in your body over a certain number of days to ensure the infection is completely gone.

Do not take antibiotics that you have left over because you most likely do not have enough medicine for a full course of treatment.

Here’s a Metaphor

Think about a spot of dirt on the floor:

Dirt + a few drops of water = mud

Dirt + a whole pitcher of water = a watery mess

Dirt + a wet rag = clean floor

Relate it to Bacteria

Infection + too little antibiotic = resistance

Infection + too much antibiotic = side effects

Infection + the right dose of antibiotic = you get better

The Take Away

The gap between the lowest effective dose and the highest, non-toxic dose is called the Therapeutic Index.  This is the information that is used to determine the dose of many medications and how they should be taken. 

That is why you should always take antibiotics exactly as directed and until they are all gone.

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page

Ear Wax Removal [Show Notes]

 in Podcasts  tagged clean / ear wax / impaction / removal by

Ear Wax Basics

Ear wax is produced by your ear to keep junk out and away from your ear drum – like a slimey booby-trap.

Allergens and other things that go in your ears (like water, especially dirty water, like lake water) causes the production of ear wax to increase to the point it can become a problem.

When you swim under water, the deeper you go, the harder the pressure of that water pushing down on you gets, including the pressure of the water pushing in your ear.  This pressure can smoosh wax up against your eardrum.

A quick tip to get water out of your ear – use a capful of rubbing alcohol.  Alcohol evaporates quickly at room temperature, so when it mixes with the tiny amount of water in your ear, it helps that water evaporate faster.

Three Steps Ear Wax Removal (or maybe four)

1. Debrox (Carbamide Peroxide) – This is an OTC drop that helps dissolve ear wax if you have ear wax buildup. It can also soften an impaction (glob of wax smooshed against ear drum).

2. Take a hot shower.  Ear wax – just like other waxes – when it gets warm, it will soften.

3. Irrigation with an ear bulb

     1. Fill sink up with comfortably warm water.

     2. Fill bulb with water.

     3. Point affected ear down towards sink.

     4. Put tip of bulb in your ear.

     5. Squeeze water into ear and let water and wax drain back out.

4. Use a capful of alcohol to dry water droplets left over (optional)

NO EAR CANDLES!!

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page

Allergy Attack

 in Podcasts  tagged allergies / antihistamines / otc medication / reactions by

An image of dandelions in the two forms - yellow flowers and white puffs against a black background. Several white seeds from the puffs are floating up in the air. These are responsible for triggering allergies.

Allergy Basics

Seasonal allergies can lead to nasal congestion and throat irritation, eye irritation with itchiness or watery eyes, or asthma-like symptoms.

If you can’t breathe or swallow or see, call 911.

At first sign of allergic reaction, take Benadryl (diphenhydramine).  It’s an antihistamine to counteract the histamines that are part of an allergic reaction.

Benadryl also comes as a topical.  The other option is Cortisone (hydrocortisone) – a steroid.  This can’t be used all over your body because it can soak all the way through your skin and get in your bloodstream, which would lead to systemic effects of steroids.  If you need systemic effects, it’s best to get a steroid prescribed by a doctor.

Antihistamines

1st Generation: Benadryl – drowsy side effects, works fast but wears off fast.

2nd Generation: Claritin, Zyrtec, Allegra – all have generics, all OTC, just take 1 time a day.

Steroid nasal sprays are newly OTC – Flonase and Nasacort.  Localized steroids in your sinus passages can help block the other chemicals involved in allergic reactions, not just histamines.

The only medication that requires a doctor’s prescription is Singulair – it works best for asthma-like reactions that is produced in the lungs.

Also, Albuterol inhalers can be used for people who have asthma-like symptoms to open the airways back up quickly.

Audience Question

Is poison ivy cumulative in your body? (from @steve_tessler)

When you come in contact with an allergen (poison ivy leaves), you body recognizes it as a “bad guy”.  Once your body deals with the offender, it “remembers” poison ivy, so the next time you come in contact with it, your body’s systems can be more efficient at taking care of it (antibodies).  A problem arises if your body does “too good” of a job or gets overzealous.  This can lead to a more serious reaction or possibly anaphylaxis.

Poison ivy is typically a topical offender.  It would require an unusual type of exposure  (i.e. burning it and inhaling the smoke) for it to affect other systems of you body than just your skin.

Avoid poison ivy, poison oak, poison sumac, and any other poisons if you can help it.

Note:  I told a story on the live broadcast. Afterwards, I checked my facts and found out I told it wrong, so I cut it out.  Here is the real story (to the best of my knowledge – I reserve the right to add or correct details as I learn the full story)…

True Story

My husband’s grandfather burned a pile of brush that included some poison ivy or poison oak.  He ended up breathing in some of the smoke which allowed it to go through his lungs and even into his bloodstream.  It obviously caused a terrible, widespread reaction.  And he would have an allergic reaction every year after that at about the same time as the original reaction.

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page

The Lady Who Caught on Fire

 in Podcasts  tagged burns / emergency / fire / heat by

An image of crumpled paper as it burns, with flames visible around the edges.

Burns: Rule of Thumb

If total burned area is larger than a softball, get medical attention.

A Quick Physics Lesson

Heat is a result of increased energy.  Energy likes to flow from places of high energy to places of low energy until it’s equaled out.  So heat will flow from the hot thing to the cool thing until they are the same temperature.  Because the temperature difference between the hot thing and your skin is so large, the heat transfers really quickly, to the point that the water in the cells evaporates and causes cell injury.

Burns can lead to dehydration due to the loss of moisture from that area.  Burns can also lead to infection due to cell injury and possible broken skin from blisters. 

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page

Drink Your Water

 in Podcasts  tagged hot / hydrate / summer / Water by

An image of a clear glass of water reflecting the light of an orange swirl of light on the left and a blue swirl of light on the right.

Water for Life

Avoid becoming dehydrated. Drink water, lots of water. Eight 8 oz glasses of water a day, at least.

Your body is mostly water. If you end up in a deficit, heat sickness or heat stroke may ensue.

Drink room temperature water to be able to drink more and absorb more. Here’s a website that explains different situations in which you should drink water at different temperatures.

If you feel thirsty, you’re already at a deficit and needs to be corrected ASAP.

Make sure kids are drinking water and staying hydrated. And your pets too!

Temperature References

Water freezes at 32º F
Refrigerated water is between 35-45º F
Room temperature is between 68-78º F
Body temperature is 98.6º F
Your hot water heater is probably set somewhere between 110-140º F
Water boils at 212º F

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page

Stomach Acid Overview

 in Podcasts  tagged antacids / medication / reflux / stomach acid by

A yellow fruit submerged in a clear liquid, with bubbles of many sizes clinging to the outside of the fruit. This demonstrates the activity of stomach acid when food is introduced.

Stomach Acid Basics

Stomach acid causes heartburn.

Long-term reflux problems leads to a GERD diagnosis.

Stomach acid has a pH of 2.

Low pH = acid; High pH = base

Stomach acid is Hydrochloric acid (HCl)

Some Biochemistry

The molecules of the acid like to spend their time joining together and breaking apart. So by attaching to something else instead of each other is how it can be dangerous but also how it helps digest food quickly.

Your stomach is designed to hold this strong acid safely.

There are pumps in the cells of the lining of your stomach that produce the acid.

Proton pumps work kind of like a water wheel – they move protons from inside the cell to outside to the stomach cavity.

Hydrogen atoms are made up of 1 proton (positive charge) and 1 electron (negative charge). So if you take the electron away from hydrogen, you are left with a proton with a positive charge.

Another process that helps create acid in the stomach relies on histamines.

They are not quite the same as the histamines that you hear about in relation to allergies. But there is a particular type of histamine that is only in your stomach.

Acid-reducing Medications

There is a class of medications for reflux called Proton Pump Inhibitors (PPI). These medications turn off the pumps so they pump less protons into the stomach.

The medications for the histamine process are called Histamine 2 Receptor Blocker (H2RB).

H2RB’s work faster than PPI’s. Just like you can take an antihistamine and it block histamines causing allergies in just a dose or two, H2RB’s can work as fast as one or two doses. That is why they are advertised to treat heartburn after you eat or to help prevent heartburn before you eat.

PPI’s take up to 2 weeks to reach maximum effect.

The third option for heartburn are your antacids. They are bases that go into your stomach acid and help neutralize it.

OTC Medications (by class)

Antacids: Tums, Rolaids, Maalox, Mylanta – fastest

H2RB’s: Pepcid, Zantac, Tagamet – all have generics, all OTC

Tagamet can have drug-drug interactions with other prescription medications, so caution is advised.

PPI’s: Prilosec, Prevacid, Nexium – some generic, newly OTC – slowest

Cautions

The downside to having reflux medications available OTC and people having the opportunity to self-treat is if there are any cellular changes in your esophagus.

Your esophagus is not designed to be in contact with that level of acid. As those cells are injured, they eventually change and can become cancer.

Fun Tidbit

Just like the cells of your skin are epithelial cells and their job is to keep the inside things in and the outside things out. Your digestive tract is also lined with epithelial cells. So technically the food you eat doesn’t go inside your body, it just moves through this tract that is “outside turned in”.

Holla

@steve_tessler‘s question: After he eats, he coughs for 30 minutes, and sometimes sneezes. Is this considered GERD? Cannot eat nuts or seeds due to diverticulitis. If he sits and rests it doesn’t get so bad, but if he has to be active right after a meal, it is.

Recommendation: try a H2RB morning and night and see if it contains the acid after meals. The next option could be a slight food allergy, possibly gluten, so cutting out certain foods would be necessary.

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page