Written by Kyle Farina
Asthma is a disease which affects the lungs and makes it more difficult to breath. The lung tissue constricts and spasms and makes getting adequate oxygen more difficult, requiring the patient to breathe more frequently and feel like they are short of breath. Currently, the two types of medication which are used to treat Asthma are inhalers, which are broken down into rescue inhalers and controller inhalers. Control inhalers, such as Advair, are used daily to help delay the progression of Asthma, whereas rescue inhalers are used only when you are experiencing shortness of breath. Both rescue and control inhalers are only available by prescriptions; however, the FDA has recently considered re-approving and over-the-counter rescue inhaler option for patients.
Primatene Mist® was an over-the-counter inhaler that was available for patients to buy and use as a rescue inhaler. It was taken off the market in 2011 because it had chlorofluorocarbon. This compound was found to deplete the ozone layer and the FDA removed it from the market for this reason. Primatene Mist® contains epinephrine, which is similar to albuterol in that it works to stimulate receptors in your lungs and cause your lungs to relax and not spasm. Many patients, especially those with mild Asthma symptoms, objected to the product being removed, as they were using the inhaler successfully and it was readily available for them.
Although we live in a world of convenience now and an over-the-counter option for rescue inhalers sounds appealing, there are some downsides to re-releasing these products. One concern is that an over-the-counter product makes it seem as though Asthma is not a serious disease and is a “do-it-yourself” management job.
This is not the case whatsoever!
Asthma is a very serious disease and should be managed by a healthcare provider. The second concern is that patients who do not have Asthma will still use the medication for inappropriate reasons, such as to increase heart rate to help with workouts or potentially abuse the epinephrine to try and lose weight. This medication is not approved to be used in anyone other than an Asthma patient, and it should never be used to lose weight or to increase performance.
As a healthcare professional, it is important that we give our patients the most up-to-date information and recommendations for these new products. Primatene Mist® is going to be released on the market soon and it’s important for patients to be aware of the product and its usefulness, while also understanding its downsides. Primatene Mist® works similar to albuterol inhalers and should only be used as a rescue inhaler while experiencing shortness of breath. The medication is currently not recommended in the GINA guidelines (clinical guidelines to managing Asthma), and this medication should not replace you visiting your healthcare provider.
As always, feel free to reach out to us or stop in if you have any questions. We look forward to helping you get the best quality care!
Written by Kyle Farina
It is not uncommon to have side effects to certain medications. Some of the common side effects we hear about on a day-to-day basis are stomach upset, nausea, dizziness, and headache. However, there are times when medications do not cause side effects, but rather, the patient is allergic to the medication. These allergic reactions are more severe in nature and present differently than side effects, and it is important for patients to be able to tell the difference.
What is an allergic reaction? An allergic reaction is the process by which your body recognizes something foreign as a threat, and it sends the immune system to try and destroy the foreign object. This is our body’s natural defense and helps us fight off infection. The body will recognize a foreign substance – in this case, bacteria – and it will send immune cells to destroy the bacteria. During this time, patient’s usually present with a fever, potentially have some inflammation, and feel a little run down. This is okay; it means that the body’s defense system is working! However, there are times when our body’s recognize common substances and our immune system will try to get rid of it. When our body sends the immune system to attack some commonplace items, such as peanuts, tree pollens, and potentially medications, we experience the same inflammatory response as when we are fighting an infection.
There is no way to prevent an allergic reaction from happening and no way to predict whether someone will be allergic to one substance or another. It is important to recognize the signs of an allergic reaction. The two most common presentations of true allergic reaction are hives/rash and anaphylaxis. Hives/rash is pretty easy to identify for most patients. The skin becomes irritated, red, itchy or painful, and also sometimes has bumps on it, which are called hives. The second type of reaction, anaphylaxis, is more dangerous and needs to be treated as soon as possible. With anaphylaxis, the patient’s lips and throat will swell and breathing becomes more difficult. Both of these reactions are considered to be true allergies, and patients should be advised to avoid whatever items cause these flareups.
In regard to medications though, why is it important for patients to know the difference between allergic reaction and medication side effects? Allergy information is a critical piece of patient history and will guide therapies prescribed by your provider. For example, sometimes patients will say they have an allergy to an antibiotic – let’s say amoxicillin – and you forget to tell us that the allergy was upset stomach (which is a common side effect of most antibiotics).
Now that we have this allergy listed in our system, we will be unable to dispense amoxicillin to you because you said you have an allergy to it. But that’s not all – because this medication is a penicillin based antibiotic, we are going to be unable to dispense penicillin-based antibiotics and may even be weary of dispensing cephalosporin antibiotics, such as Keflex, because they are similar molecules. Now, the provider and pharmacist have to work to come up with a different antibiotic to use for your infection which may not be the best to treat your infection or it may have worse potential side effects.
It is important to remember that there is a huge difference between medication side effects and being allergic to a medication. If you have questions regarding allergies and whether or not you may be experiencing and allergic reaction or side effect, feel free to give the pharmacy a call! We are more than happy to help you and ensure you get the best available healthcare available!
Written by Kyle Farina
As we continue to develop new technologies and innovations, we – as people – are becoming used to having whatever we want at the tip of our fingers and we are able to get it fast. As a result, we tend to want things done as soon as possible for our convenience. One of the common things we hear everyday at pharmacies all over the country is, “why does it take so long to fill my medication?” and “you just move one the pills from one bottle to the other, right?” It is completely understandable that patients want their medications readily available at all times; however, the life of a prescription is not necessarily as simple as moving pills from one bottle to the next.
First, your prescription starts at your providers office. In New York State, your provider is required to send an electronic prescription to a pharmacy of the patient’s choosing. So, as you’re getting ready to leave the office, your provider informs you of a new medication he will be starting you on and you he will send the script right away. Great! You can run to the pharmacy now and pick-up said medication, right? Not quite…
In an ideal world, the prescription will be sent to the pharmacy right away; however, there are a couple obstacles in the way. For example, some providers will write all of their prescriptions for the day and save them, then “release” them to all the pharmacies at a specific point in the day. All providers are different and there is no way to determine whether the provider placed your prescription in with the later batch or sent it right away. Also, there are the hiccups associated with needing electronic prescriptions. Power outages, connection issues, mis-clicking, etc. are all possible errors that may delay your prescription from arriving to the pharmacy. At this point, the prescription which was sent to the pharmacy while you were leaving may not have even left the provider’s office.
Once the prescription arrives to our pharmacy electronically, we enter the data into our system and – uh oh! – we found an error in the prescription! Something does not add up on the prescription and we need to clarify the order with your doctor. I am more than happy to call the office for you, but this takes time, as I now have to get into contact with your provider or nurse and they are also busy seeing patients. Unfortunately, this process takes time, as we do not want to make guesses as to what the prescription should be and hurt the patient.
Once the prescription was clarified and we are good to go, we can start counting out your prescription and getting it labeled and ready to be verified. However, when we went to grab your medication from our shelf, we found out that we don’t have enough to fill the prescription and have to order more. We can supply you with a couple days’ worth, but we will not be able to give you the full prescription until we receive the new order, which may take up to 2 days depending on shipping, weather, etc.
While these are some common issues we encounter on a day-to-day basis, it is important to know that this does not happen all the time. Not every prescription will come be sent at the end of the day. Not every prescription will have something mismatched or interact with another medication that you are taking. Most common medications are also readily available and in-stock at your pharmacy. Unfortunately, there is no way for us to predict whether or not your prescription may encounter these hiccups – and we wish there were so we could inform you – and your prescription may not be ready for pick-up immediately after leaving the doctor’s office.
There are things you can do to help! Calling your pharmacy beforehand is a great way to get started and see if the prescription has reached the pharmacy yet and to make sure that we have the medication in stock. Talking with a member of our staff is also a great way to check if the medication interacts or if we are working to resolve an issue with your prescription. The pharmacy is also working on a lot of other prescriptions as well, and we can give you a better idea of when your prescription is going to be ready for pick-up! This does not just benefit the pharmacy; we want to make sure that you are also benefitting and not wasting a trip only for us to tell you that we do not have medication.
As always, feel free to call us or talk with a member of our staff if you have any questions. We are more than happy to help you!
Written by: Kyle Farina
Opioids have gotten, and continue to get, a lot of attention in the news. We hear about the opioid epidemic all the time and how scary these drugs can be. While there are downsides to using these medications, it is important to understand that, when used appropriately, these medications are helpful in treating patients with chronic pain. In fact, ~4% of the United States population uses opioids in order to manage their pain.
These opioids act by blocking mu-receptors in your body. When these receptors are blocked in the nerves, it slows down the feeling of pain and reduces pain for the patient. However, these receptors are found in other areas of your body as well, including your stomach and intestines. Similar to the sensation of pain, these medications also cause your stomach and intestines to “slow-down” and results in the medication’s most common side-effect: constipation! Unfortunately, opioid-induced constipation is something that patients will experience on opioids and do not develop a tolerance, which means constipation is possible for as long as a patient may be on opioids.
While this may seem disheartening, there are plenty of options available, both prescription and over-the counter, which are available to help alleviate constipation caused by these medications. Below, you find a list of some of the common medications which help manage these side effects:
|Drug||Dose||Over the Counter?||Generic?||Side Effects?|
|Colace (Docusate)||100 mg twice daily||YES||YES||Well-tolerated in most patients|
|Senna (Sennosides)||Two, 8.6mg tablets once daily||YES||YES||Stomach Cramps
|Dulcolax (Bisacodyl)||5 – 15mg once daily||YES||YES||Stomach Cramps
|Miralax (PEG-3350)||17g (one capful) once daily||YES||YES||Diarrhea
|Movantik (Naloxegol)||25mg once daily||NO||NO||Stomach Cramps
|Relistor (Metylnaltrexone)||Oral: 450mg once daily
Injection: 12mg once daily
These are just some of the options available to help manage constipation caused by opioids. You might be asking yourself, “which medication should I choose first?” It is recommended to start with the over-the-counter (OTC) options above, which include docusate, senna, bisacodyl, and miralax. These medications are available at all pharmacies, are relatively cheap for a large supply, and have very few side effects, which make them great choices! Just make sure to give them 2-4 days, as these medications take a bit of time to work in the intestines. However, if the OTC options are not helpful, the two prescription medications above can help manage constipation and you can discuss with your primary care provider.
If you need help managing constipation related to opioids, feel free to stop in and speak with our staff! We are always more than happy to help in selecting the right product for you!
- Crockett SD, Greer KB, Heidelbaugh JJ, et al. American Gastroenterological Association Institute Guideline on the Medical Management of Opioid-Induced Constipation. 2019 Jan;156(1):218-226.
- Lexi-Comp Online [database on the internet]. Hudson (OH): Lexicomp Inc: cited 16 Mar 2019. Available from: https://online.lexi.com. Subscriptio
Many of you have probably heard about the recent drug recalls of a variety of blood pressure medications. While there are a lot of names of medications being thrown around as recalled, this situation centers around one drug in particular, Valsartan. Valsartan is part of a class of blood pressure medications known as angiotensin receptor blockers, or ARBs. The drug was originally recalled months ago due to trace findings of an impurity within the tablets. This impurity is N-nitrosodiethylamine (NDEA), which has possible carcinogenic (cancer causing) properties. This means that miniscule amounts of what may or may not be a cancer causing agent had contaminated the tablets. This also means that the drug Valsartan itself is not a cancer causing agent.
Only certain manufacturers are involved in this recall, meaning that just because you take a product containing valsartan, does not mean your tablets are affected. Only certain lots, or batches, of the drug from certain manufacturers are involved. These manufacturers include Mylan and Teva pharmaceuticals. The identified lots of Mylan and Teva products containing the contaminated valsartan includes combination products that have other drugs in them. This is why you have seen the names Amlodipine and Hydrochlorothiazide (HCTZ) thrown around in recall news. The products recalled were combination drugs of Valsartan + Amlodipine, Valsartan + HCTZ and Valsartan + HCTZ + Amlodipine. However, Amlodipine and HCTZ as stand alone products ARE NOT included in the recall and do not contain the impurity. If the product you are taking does not contain the drug valsartan it is NOT contaminated and you should continue taking the drug as prescribed.
How do you know if your medication is part of the recall? When a recall is announced ALL pharmacies are notified via a form that lists all of the recalled products that they use to check their stock. Every pharmacy must return this form stating whether they do or do not have the product being recalled. If they DO have the product the pharmacy must print a report of all individuals who have the contaminated drugs and notify them. If you have NOT already been contacted by your pharmacy stating that you are in possession of a recalled drug, your medication is safe and you should continue taking it as prescribed.
If you have been notified that your medication is part of the recall, do not worry. The risk involved with the impurity is nearly negligible. Once you have been notified, there are 2 options you can take. Your pharmacy can issue you a replacement supply of your medication from a different lot or manufacturer that is not contaminated. It is possible that your pharmacy may not have any replacement stock to give you, due to the increased demand and decreased supply of the products. If that is the case, you or your pharmacist can contact your doctor for an alternative medication to replace the one you have been taking. The ARB class of medication contains other drugs that work the same as valsartan, including losartan, irbesartan and olmesartan. These drugs should be equally as effective for you at controlling your blood pressure. These products also come in combination forms like valsartan, in the event that you are taking the combination product.
If you are unsure if your medication is involved in the recall, contact your pharmacy as soon as possible to inquire. Do NOT stop taking your medication until you are told that your medication is part of the recall. The risk involved with stopping your medication is greater than the risk involved with taking the contaminated product. Your Four Corners pharmacist or pharmacy student is always available to answer any question you may have about the recalled drugs and exactly what that means for your medication.
We hear about it everywhere; a relative has it, your doctor and pharmacist want you to get vaccinated against it, tv commercials mention it, but what exactly is the flu? The flu, or influenza, is a viral infection (like the common cold we mentioned in the last blog post) caused by haemophilus influenza virus A or B. The virus attacks your upper and lower respiratory tracts, including your nose, mouth, throat and chest areas. These are also the areas from which is spreads. The virus is spread through contact with the respiratory secretions of an infected person. This means coming into contact with something an infected person has coughed on, sneezed on, eaten off of or drank out of. Flu symptoms include coughing, sneezing, runny nose, chest and sinus congestion, headache, fatigue, body aches and a high fever. These symptoms are likely to begin 1 – 4 days after coming into contact with the virus.
How is this different from the common cold? The symptoms you experience with both are similar, however, these symptoms will be much more severe if you have the flu. If you have a cold, you should not have body aches or a high fever, those symptoms are more likely to occur with the flu. You will feel more weak and tired with the flu than a common cold, so much so that you may not feel like you can get out of bed or go about your daily life. When your cold symptoms become so severe that you feel the need to call out of work, or can’t get out of bed, you should see your primary care provider.
Like the common cold, antibiotics are ineffective at treating the flu. However, unlike the common cold, there is an antiviral medication that your doctor can prescribe to help fight the virus. This medication is called oseltamivir, better known as Tamiflu. This medication works by preventing the replication of the virus in your body, eventually causing it to die off. Depending on how it is prescribed, it can be used to reduce getting the flu, if exposed to a known case or to shorten the duration and severity of the flu if you have an active case. In both cases, it needs to be taken within 48 hours of first signs of symptoms. Possible side effects of Tamiflu include, nausea, vomiting and headache.
The best and only way to prevent the flu is to get vaccinated against it. Why do we do this every year? Influenza is a smart virus that changes every year in order to evade the vaccine given the previous year. The vaccine produced each year is effective against the strains of the virus that scientists think are most likely to infect people each year. This means the vaccine is not 100% effective against the flu because we cannot exactly predict how that pesky virus will change, but we can come pretty close!
If you are thinking that you don’t need that vaccine because never get sick or you can tough it out if you do, think about those whose immune systems are weaker than yours and are more susceptible to consequences if they do get the flu! These people include children, people over 65 years old and people with weakened immune systems due to medications or disease states. I bet you know someone that falls into one of those categories! Those people have a harder time fighting the flu, which could lead to pneumonia. Pneumonia is an even bigger beast to tackle, and can result in hospitalizations and death in severe cases. So if you don’t get vaccinated for yourself, get vaccinated for those you care about!
The flu vaccine is covered with a $0 copay under most insurances, so it’s of no cost to you! Flu vaccinations do not require an appointment at our pharmacy, but the best time for us is between 8 AM and 10 AM any day of the week. If you have any questions at all about the flu itself or the flu vaccine your Four Corners pharmacist or pharmacy student would be happy to answer them!
The common cold, sometimes also described as a sinus infection, is a viral infection. This means it is caused by a virus, NOT a bacteria, as the word “infection” might indicate. The main difference between the two being that a bacteria is a living cell, while a virus is not. A virus instead inserts itself into your already existing cells, making you sick. The virus will continue to make you feel sick until the cells it has inhabited dies. Unfortunately, this means a virus needs to run its course, which can range from a few days up to 3 weeks in extreme cases.
As discussed above, the virus causing your common cold cannot be killed. This means that antibiotics DO NOT have any effect on the common cold. Yes, you read that right. Antibiotics kill bacterial cells, however, they do not have that same effect on the cells inhabited by a virus. You can, however, treat the bothersome symptoms you may experience. Symptoms of the common cold can range from mild to so severe that they inhibit your day-to-day life. These symptoms may include, a runny nose, cough, chest congestion, sinus pressure, headache and body aches. Below we will discuss each symptom and how to alleviate it.
- Symptom: a runny nose/post-nasal drip
- What to use: An antihistamine like cetirizine (Zyrtec), loratadine (Claritin) or fexofenadine (Allegra)
- Why it works: These drugs block the histamine receptors that are causing your sinuses to leak fluid resulting in dry sinuses
- Hint: These products are also used for seasonal allergies
- Symptom: Productive cough (phlegm in your throat after you cough)
- What to use: guaifenesin (Mucinex)
- Why it works: guaifenesin helps your body break up the mucus stuck in your chest and sinuses
- Hint: You will cough more for a short period of time while your body works out all of that newly broken up mucus
- Symptom: Dry cough
- What to use: Dextromethorphan (Delsym)
- Why it works: Dextromethorphan prevents coughing by suppressing your cough reflex
- Symptom: Chest and sinus congestion
- What to use: pseudoephedrine (Sudafed)
- Why it works: pseudoephedrine reduces swelling in your chest and sinuses by shrinking the blood vessels in this area, causing the pressure to be relieved
- Hint: This is behind the counter and requires a valid driver’s license for purchase
- Hint: Consult with your pharmacist (or pharmacy student!) before purchasing if you take any medications for heart disease – they can recommend an alternative product called phenylephrine that works in the same way!
- Symptom: Headache/body aches
- What to use: Acetaminophen (Tylenol)
- Why it works: acetaminophen is NOT an anti-inflammatory pain reliever, like ibuprofen or naproxen, meaning it provides pain relief without the extra property that can cause kidney and intestinal damage if used to often
- To boost your immune system and help fight the cold
- What to use: Zinc lozenges (Cold-Eeze)
- Why it works: Zinc may prevent the virus from multiplying in your system, as well as prevent it from lodging itself in the mucous membranes of your throat and nose
- Hint: Take every 2-3 hours starting within 24 hours after you begin feeling cold symptoms
In addition to these over-the-counter remedies, FLUIDS and REST are key to kicking a cold. This helps your body grow and shed those infected cells!
Not sick yet, but trying to prevent it? There are a few very easy things you can do to help prevent yourself from catching the common cold this season. Those same fluids and rest that you’re stocking up on when you’re sick, are just as important at preventing you from getting sick! Make sure you’re drinking lots of water and getting at least 7 hours of sleep each night. WASH YOUR HANDS! Do this at every opportunity you get, including after you go to the bathroom, after using the signature pad at the pharmacy or grocery store, and before and after eating. Echinacea has also been proven to be effective at preventing the common cold by increasing your body’s immune response to both viruses and bacteria, and may be worth taking daily during cold season.
If you have any questions about how to prevent or treat your cold symptoms, or about what products are best for you, feel free to ask your Four Corners pharmacist or pharmacy student! We are happy to answer any questions you may have!
Article written by Nick Demenagas
When you pick up your prescription from the Pharmacy, you might hear a Pharmacist say: “This drug might cause increased sensitivity to the sun.” But what does this mean? Certain medications (seen below) can cause your skin to be more sensitive to the sun’s UV rays. This means that even a little exposure could end up becoming a severe burn. The following drugs can lead to photosensitivity:
- Fluoroquinolones (ciprofloxacin, levofloxacin)
- Retinoids (Accutane)
- Antimalarial (quinine)
- Some chemotherapy
- Sulfonylureas (glyburide, glipizide, glimpiride)
- Tetracyclines (doxycycline, minocycline)
- Thiazides (Hydrochlorothiazide- a water pill, and other thiazide-like diuretics)
A photosensitivity reaction to a medication can lead to an itchy, red rash on the skin, hives or blisters. The symptoms can start within 2-3 hours of being exposed to the sun and go away within 24 hours. You can use NSAIDs for pain, steroid creams for inflammation and antihistamines for itching from the burn.
The best way to prevent photosensitivity is to avoid the sun. This can be done by staying in the shade from 10 am to 3 pm, by wearing protective clothing and sunscreen. Some important tips about sunscreen. First, you want to choose a sunscreen that is broad spectrum. This means it protects against UVA and UVB light. Having this dual protection means that the sunscreen is helping to prevent sunburn, skin cancer and early aging. When choosing the SPF of your sunscreen, it is important to know that the SPF, or sun protection factor, indicates how long you can stay in the sun without being burned, compared to no sunscreen. For example, SPF 6 allows you to stay in the sun 6 times longer without being burned than not having sunscreen. The higher the SPF, the more protection. SPF 15 will block 93% of UVB rays and SPF 30 will block 97%. The maximum SPF is 50, because anything higher has no added benefit.
In addition, if a sunscreen says it is water-resistant, that means it is effective for 40 minutes in water and for 80 minutes while sweating. So even water-resistant sunscreens need to be re-applied after some time. In conclusion, to avoid being sunburned you should use a liberal amount of SPF 30 or more for times where you are going to be exposed to the sun.
As always, if you have any questions feel free to reach out to your neighborhood Pharmacist at Four Corners Pharmacy and check out our sunscreen stock in the pharmacy!
Photosensitivity. Micromedex. In: Care Notes [database on the Internet]. Greenwood Village (CO): Truven Health Analytics; 2018 [cited 2018 Jun 15]. Available from: www.micromedexsolutions.com. Subscription required to view.
Hester SA. Shedding Light on New Rules for Sunscreens. Pharmacist’s Letter. 2016 July. Available from www.pharmacistsletter.com. Subscription required to view.
In the past couple weeks, we have discussed seasonal allergies and Over the Counter medications that you can take to treat them. But, what if these aren’t enough to treat your symptoms?
Well, there is a bit of good news for you, because there are still more options. There are inhalers, nasal sprays and prescription medications that you can ask your doctor about, depending on your symptoms.
If you are experiencing a lot of nasal congestion and runny nose, you can ask your Four Corners pharmacist about pseudoephedrine, a decongestant. It comes alone and in combination with the second generation antihistamines that we talked about last week. It is dosed 60 mg every 4 to 6 hours or 120 mg twice per day for the extended release 12-hour formulation. The maximum amount you can take in one day is 240 mg. If you have high blood pressure or other cardiac conditions, you’ll want to talk to your doctor before taking this.
Another OTC medication that you can buy for your nasal congestion is Flonase, or generically fluticasone. Fluticasone is an intranasal steroid. This is a nasal spray that you can use 2 sprays daily in each nostril to alleviate your congestion. Before using this, you’ll want to blow your nose to clear out your sinuses. Also, make sure you wipe the tip of the nasal spray after each use. It may take up to a week of using this to see maximal benefits.
A more short-term nasal spray is Afrin, or oxymetazoline. This will work in a different way than Flonase to relieve your nasal congestion. However, you cannot use this for more than 3 days in a row. Doing so will lead to something caused rebound congestion, which means the spray will cause congestion, instead of helping it. These are just two of the nasal options that are available. For more information, feel free to stop in and ask your Pharmacist for help!
If you are having trouble breathing, there are a couple options that you will have to get a prescription from your doctor for. The first is Singulair, or montelukast. This is usually dosed 10 mg in the evening. It works to open your airways, by making the muscles relax. The most common adverse effect of this medication is headache. This is a medication that you should take daily during the allergy season.
Other medications you can use are Ventolin or Proair, which are both albuterol inhalers. These are rescue inhalers that you should only use when it is hard to breathe, or you can’t stop coughing. This medication works in a different way to relax the airway muscles. Both are prescription only medications that you will need to talk to your doctor before getting a prescription. They are also commonly used for treating Asthma.
As always, if you have any questions, please feel free to call or stop in and ask your neighborhood Pharmacist at Four Corners Pharmacy!
Seidman MD, Gurgel RK and Lin SY. Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology- Head and Neck Surgery. 2015; 152(1S): S1-S43.
Micromedex. In: In Depth Answers [database on the Internet]. Greenwood Village (CO): Truven Health Analytics; 2018 [cited 2018 Jun 7]. Available from: http://www.micromedexsolutions.com. Subscription required to view.