Three new things learned in this modules readings:

1. With treatment of iron deficiency anemia the first change noted in blood values is an
increase in reticulocyte count as soon as 4 days.
2. Plavix should not be taken with a PPI, PPIs decrease the effectiveness.
3. Estrogen receptors have been found in bone, is associated with bone formation, and
protects from osteoporosis.
Two things that I will change about how I prescribe or use a medication in practice:
1. Some multivitamin preparations contain vitamin K and should not be taken with
anticoagulants. I will remember to educate my patients about this when prescribing
anticoagulant drugs.
2. Anticoagulant effects can differ between brands of medication. I will remember to
educate my patients about switching pharmacies, because the manufacturer used may
differ from pharmacy to pharmacy and labs may need to be repeated.
One question I still have about this modules topics:
I know that aspirin taken with viral infections have been associated with Reyes syndrome. What
causes this to happen when the two are combined?

Penny,
I understand your concerns with patients not only on medications that have been prescribed to
them, but also taking OTC and herbal preparations as well, not realizing there could be potential
interactions between the medications. I did some research and here are a couple helpful websites
I found. Web MD has an interaction checker, which checks drugs versus herbal supplements
(http://www.webmd.com/interaction-checker/default.htm). Medscape also has a drug interaction
checker, on this site you can type in several medications, prescription, as well as herbal
supplements, and it will tell you if any medications in the list you give interact with each other
(http://reference.medscape.com/drug-interactionchecker). The University of Maryland Medical
Center also has a similar tool (http://umm.edu/health/medical/drug-interaction-tool).
I know that pharmacists are also invaluable resources! I do not think that nurses or providers
give pharmacists enough credit for the knowledge they have. They have taken many classes on
medications (prescription, herbal, and alternative) and how these medications interact with and
affect the body, as well as how they interact with each other. I realize that, like us, their time is
valuable and limited, so it is important to have other resources as well.

Cynthia,
I have often wondered the same thing about the safety of electronic cigarettes. According to
Pruitt (2016), there are limited amounts of data with long-term effects of e-cigarettes. I do not
have much in-depth knowledge about electronic cigarettes and how they work. However, I had a
patient that was smoking one of those in the room, and within a few minutes of being in the room
and explaining to him that he could not do that inside the hospital, it bothered my allergies and
asthma to the point I had to leave the room and use albuterol myself. In my opinion, how is
being exposed to a chemical vapor any different from being exposed to other substances that
cause pneumonias, lung disease, lung cancers? For example, chemicals, wood or coal dust
(causing brown and black lung) and the prolonged irritation and inflammation that all of these
things cause, making one more susceptible for abnormal cells to develop, causing cancer.
Pruitt, B. (2016). E-cigarettes: Many questions, few solid answers. RT: The Journal for
Respiratory Care Practitioners, 29(4), 18-21. Retrieved from:
http://web.a.ebscohost.com.ezproxy.king.edu/ehost/pdfviewer/pdfviewer?sid=b7844200-76cd-
4fbb-85a3-3615d8893438%40sessionmgr4007&vid=12&hid=4114