Useful Info (Original Patient Education) JASE Medical - Page 7

Planning a Cruise?

Be sure to pack these Jase add-ons

An outbreak of vomiting and diarrhea has been reported on the luxury cruise ship, the Queen Victoria. As of last count, at least 154 people have taken ill since the ship set sail in early January. The number of passengers on board total 1,824, with 129 of them taken ill. The total number of crew is 967, with 25 of them being taken ill.

The 55 day, multi country cruise had departed from Hamburg, Germany on January 9, 2024. It is currently in route to Samoa with its destination set to arrive in Sydney, Australia on March 4th. There have been no updates available on the CDC website since February 8th.

Historically, almost all outbreaks of gastrointestinal illnesses on cruise ships have been from Norovirus, except for one outbreak of E. coli and Salmonella in 2023. That year, there were 15 gastrointestinal illness outbreaks, 14 from Norovirus and one from salmonella and E. coli. In past years norovirus vastly outnumbered cruise ship outbreaks of gastrointestinal illness. Over 90% of diarrheal outbreaks are caused by Norovirus. However, Norovirus outbreaks on cruise ships account for only 1% of all reported Norovirus outbreaks.

Since there haven’t been any recent any updates on the cause of the outbreak, we may assume that the Norovirus is a likely candidate.

What is Norovirus?

Norovirus is an extremely contagious disease that causes diarrhea and vomiting. It is also sometimes called the “stomach flu”. It is not related to the influenza virus, however. It is the leading cause of foodborne illness in the United States, with around 50% of all outbreaks of food related illnesses caused by Norovirus.

Symptoms usually develop between 12-48 hours after exposure. Symptoms usually last from 1-3 days.

Symptoms include:

  • Diarrhea
  • Vomiting
  • Nausea
  • Stomach pain and cramps
  • Fever
  • Headache
  • Body aches

Transmission

Norovirus spreads through contaminated food, water and surfaces contaminated with the virus. It is present in the feces and vomit of a person who is infected. Over half of norovirus outbreaks in the United States occur in long-term care facilities.

Examples of how Norovirus spread are:

  • Touching a surface contaminated with Norovirus.
  • Tiny drops of vomit from a person with Norovirus spray through the air, landing on surfaces or entering another person’s mouth.
  • Diarrhea when Norovirus splatters onto the surface.
  • Not washing hands thoroughly after using bathroom or changing a diaper.
  • Food grown with contaminated water, such as oysters or fruit and vegetables (especially leafy greens) that are watered with contaminated water in the field.
  • Schools, colleges, and childcare centers also experience frequent outbreaks.

How is Norovirus Diagnosed?

Samples of stool, vomit, food, water, and other environmental specimens are tested using a variety of testing methods. Most public health laboratories use the reverse transcription- real-time polymerase chain reaction (RT-qPCR) assays to detect Norovirus.

Norovirus can strike anywhere. If you are traveling on a cruise ship, or on a cross country trip, or if your local area is experiencing an outbreak, it is prudent to be prepared and avoid being forced to track down medications when you are ill. Norovirus is not treated with any specific medicine. Symptoms are managed until the illness runs its course.

Prevention

Wash contaminated surfaces with a bleach solution (1 part bleach to 10 parts water). Hand sanitizer doesn’t kill Norovirus. (5-25 tablespoons of household bleach per gallon of water). (See CDC site for further instructions). Be sure to wear disposable gloves, using paper towels to wipe entire areas and discard in plastic trash bag. In addition, leave the bleach solution on the affected area for at least 5 minutes. Once done, use soap and water and clean the area.

  • If sick with Norovirus or anyone in your family is, be sure to thoroughly wash hands for at least 2 weeks or more after you feel better. Norovirus can still spread during that time.
  • Wash laundry in hot water.
  • If you or someone you know has been exposed to Norovirus, stay home when sick and for two days after symptoms subside.
  • While sick, avoid preparing food for others and for two days after symptoms subside.
  • Thoroughly rinse fruits and vegetables and thoroughly cook shellfish.

Treatment

Treatment is symptomatic, there are no antibiotics or antivirals to treat Norovirus.

Norovirus can cause dehydration, especially when symptoms of vomiting and diarrhea are severe.

This can be serious in the very young and elderly.

  • Drink plenty of fluids. Be sure to pack electrolyte powders to restore electrolyte balance.
  • Two highly effective medications, loperamide, for diarrhea control and ondansetron, for nausea and vomiting can help relieve symptoms and avoid dehydration. These medications are available to add to the Jase Case.

When on a cruise ship, you may not have the opportunity to disembark and find a pharmacy that carries these medications. And if there is an outbreak of Norovirus or other gastrointestinal illness, the ship may not have enough medication stocked for everyone who falls ill. Consult with the medical staff before taking either of these medications, if available.

  • Stock OTC fever and pain relievers (acetaminophen and ibuprofen are both Jase add-on items) for fever, body aches and headache.
  • And in case the outbreak is bacterial, the Jase Case, which includes antibiotics that are effective against a wide variety of bacterial illnesses- has got you covered.

- Brooke Lounsbury, RN

Medical Content Writer

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A Rare Case of the Plague Was Found in Oregon

Could you be next?

Early this week an Oregon resident was diagnosed with bubonic plague. This is the first diagnosed case in nearly a decade. It is believed the person contracted the disease from their cat. Cats that hunt rodents can become infected and spread the plague to their owners.

Mention “plague” and it strikes fear in many people’s hearts. However, plagues, in this modern era are easily diagnosed and treated, given modern antibiotic therapy. In the past, people weren’t so fortunate. Fatality rate was estimated to be between 66 and 93 percent before the introduction of sulfonamide antibiotics in the 1930s.

The Black Death, once a historical plague, is now categorized as a biological weapon.

For over 5,000 years, the bubonic plague, one of three types of plague caused by the bacterium Yersinia pestis, has sickened and killed whole populations. The term “Black Death” is attributed to the bubonic plague pandemic that struck Europe spanning the years 1346-1353 and killed as many as 50 million people, which represents an estimated 30-50 percent of the population.

Yersinia pestis- a tier one biological weapon.

Today, Y.pestis is classified as a  tier one bioterrorism Select Agent, the highest risk category of biologic agents and toxins with the potential to pose a severe threat to public health and safety. Officials are concerned of a scenario for a bioterrorist attack that would involve dispersing Y. pestis into the air, leading to primary pneumonic plague. The World Health Organization has estimated that a release of 50kg of Y. pestis into the air over a city of 5 million persons could result in 150,000 cases of pneumonic plague and 36,000 deaths. On top of this, infected animals could spark a local epidemic. Another concern is intentional contamination of the food or water supply with Y. pestis leading to an outbreak.

Study leads to some interesting correlations

A study published in 2022 revealed that a strong immune response was exhibited in persons with a genetic immunity to Y.pestis (bubonic plague). This study was conducted to determine why some people didn’t succumb to the plague after being exposed. Researchers studied DNA extracts from two different European populations before, during and after the Black Death. The study focused on genetic variants that were identified and shown to be protective against the Black Death.

Interestingly, the same protective genetic variant, that protected against the plague, was found to be associated with increased susceptibility to a multitude of autoimmune diseases. One was Crohn’s disease. However, many other autoimmune diseases have been discovered to carry the same genetic susceptibility. In other words, the researchers discovered a correlation between immunity from Black Death and the hyperimmune response involved in many autoimmune diseases. Protection from Black Death may correlate to increased risk for autoimmune disease.

How Bubonic Plague is Transmitted

(Excerpt from CDC website)

Plague occurs in rural and semi-rural areas of the western United States, primarily in semi-arid upland forests and grasslands where many types of rodent species can be involved. Many types of animals, such as rock squirrels, wood rats, ground squirrels, prairie dogs, chipmunks, mice, voles, and rabbits can be affected by plague. Wild carnivores can become infected by eating other infected animals.

The plague bacteria can be transmitted to humans in the following ways:

Flea Bites

Plague bacteria are most often transmitted by the bite of an infected flea. During plague epizootics, many rodents die, causing hungry fleas to seek other sources of blood. People and animals that visit places where rodents have recently died from plague are at risk of being infected from flea bites. Dogs and cats may also bring plague-infected fleas into the home. Flea bite exposure may result in primary bubonic plague or septicemic plague.

Contact With Contaminated Fluid or Tissue

Humans can become infected when handling tissue or body fluids of a plague-infected animal. For example, a hunter skinning a rabbit or other infected animal without using proper precautions could become infected with plague bacteria. This form of exposure most commonly results in bubonic plague or septicemic plague.

Infectious Droplets

When a person has plague pneumonia, they may cough droplets containing the plague bacteria into the air. If these bacteria-containing droplets are breathed in by another person, they can cause pneumonic plague.

Typically, this requires direct and close contact with the person with pneumonic plague. Transmission of these droplets is the only way that plague can spread between people. This type of spread has not been documented in the United States since 1924, but still occurs with some frequency in developing countries. Cats are particularly susceptible to plague and can be infected by eating infected rodents. Sick cats pose a risk of transmitting infectious plague droplets to their owners or to veterinarians.

Several cases of human plague have occurred in the United States in recent decades because of contact with infected cats.

Symptoms

Plague symptoms depend on how the patient was exposed to the plague bacteria. Plague can take different clinical forms, but the most common are bubonic, pneumonic, and septicemic.

Bubonic

  • Incubation period after exposure: 2-8 days.
  • Fever, headache, chills, and weakness along with one or more swollen, painful lymph nodes.

Septicemic

  • Incubation not known, but believed within days of exposure.
  • Fever, chills, extreme weakness, abdominal pain, shock, and possibly bleeding into the skin and other organs. Skin and other tissues may turn black and die, especially on fingers, toes, and the nose. Septicemic plague can occur as the first symptom of plague or may develop from untreated bubonic plague. This form results from bites of infected fleas or from handling an infected animal.

Pneumonic

  • Incubation is between 1-3 days after exposure.
  • Patients develop fever, headache, weakness, and a rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery mucous. Pneumonic plague may develop from inhaling infectious droplets or may develop from untreated bubonic or septicemic plague after the bacteria spread to the lungs. The pneumonia may cause respiratory failure and shock. Pneumonic plague is the most serious form of the disease and is the only form of plague that can be spread from person to person (by infectious droplets).

Diagnosis and Treatment

The CDC recommends immediate treatment before diagnosis of plague is suspected.

Diagnosis is based on:

  • Travel to Western States where plague is endemic
  • Samples taken of blood or part of swollen lymph gland
  • History of flea bite
  • Exposure to cats or other animals that hunt

Treatment

Gentamicin and fluoroquinolones are first-line treatments in the United States. The Jase Case includes ciprofloxacin, a fluoroquinolone antibiotic. The CDC recommends antibiotic therapy until fever has resolved.

jase case product

- Brooke Lounsbury, RN

Medical Content Writer

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Antibiotic Shortage Leads to Increase in Syphilis Cases

According to the CDC:

“Reported syphilis cases increased 80% in the United States between 2018 and 2022, (from 115,000 to more than 207,000), compounding a decades-long upward trend. If untreated, syphilis can seriously damage the heart and brain and can cause blindness, deafness, and paralysis. When transmitted during pregnancy, it can cause miscarriage, lifelong medical issues, and infant death.”

On January 30th, 2024, the U.S. Department of Health and Human Services (HHS) released a statement titled ,”HHS Announces Department Actions to Slow Surging Syphilis Epidemic”, in response to the surging number of syphilis and congenital syphilis cases nationwide.

History of Syphilis

There is controversy surrounding when syphilis was discovered. Theories range from syphilis being transmitted to Europeans from the Americas by the crew(s) of Christopher Columbus. Another theory links the discovery of a 9,900 year old skeleton found in a Mexican cave in the Yucatan Peninsula who had contracted a syphilis like infection.

Syphilis also holds the dubious honor of being the first identified sexually transmitted infection.

With the introduction of the dark field microscopy in 1906, scientists could visualize the spirochete of syphilis. A few years later, in 1910, German bacteriologist Augus Wasserman developed the first serologic test. It wasn’t until 1949 that a specific test for syphilis was available, called the Treponema Pallidum immobilization test. This enabled medical practitioners to detect and appropriately treat the infection.

How syphilis was treated in the recent past was almost as deadly as the disease itself. Some of the treatments included ingesting mercury or turpentine, and a potion made from the guaiac tree that induced diarrhea and excessive perspiration.

We now know that these treatments are dangerous and toxic. The discovery of highly effective antibiotics- namely Penicillin- discovered by Alexander Fleming in 1928 has saved many lives worldwide.

“In the United States, syphilis was close to elimination in the 1990s, so we know it’s possible to reverse this epidemic,” said Jonathan Mermin, director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention.

On January 30th, 2024, the U.S. Department of Health and Human Services (HHS) released a statement titled  ”HHS Announces Department Actions to Slow Surging Syphilis Epidemic”, in response to the surging number of syphilis and congenital syphilis cases nationwide.

What is Syphilis?

Syphilis is a spirochete (a group of spiral-shaped bacteria), some of which are serious pathogens for humans. It is a systemic disease (affecting the entire body). It has a long latent period during which individuals have no signs or symptoms but can remain infectious.

How Transmitted

Syphilis doesn’t live outside the body very long; however, a person can have syphilis and not even know it due to lack of symptoms.

Primarily transmitted via sexual contact with body fluids.

  • Although uncommon, syphilis can be transmitted via kissing someone with lesions. Infants have been known to contract syphilis through chewed food given to them from someone with active sores in the mouth or lips.
  • Syphilis can also be transmitted from pregnant women to their baby, which is called congenital syphilis (CS). See statistics and symptoms below under types of syphilis.

The Great Imitator

Syphilis symptoms are often mild, painless, or even hidden inside of the body, where they can’t be seen. This means they may be overlooked or brushed off as something less serious. Syphilis has been called the “great imitator” because its symptoms are so similar to other infections and diseases.

At any stage, syphilis can spread and cause damage to the brain and nervous system (neurosyphilis) and the eye (ocular syphilis).

Stages of Syphilis

(from CDC website)

Primary Syphilis

The first sign of syphilis is usually:

  • A small painless sore called a chancre, which develops within 3 weeks of infection. However, symptoms may not appear until 10-90 days after infection. Chancres are usually painless so many times a person may not even know they have the sores if they are hidden, such as in the genital area and in the vagina. Chancre sores can also appear on the lips or mouth.

 The chancres clear up on their own within 3-6 weeks, but the infection still lingers.

Secondary Syphilis

While a chancre is healing or several weeks after it has healed, a person with syphilis may progress to the secondary stage. This stage, just like primary stage, can appear to go away but syphilis infection remains.

Secondary syphilis symptoms include:

  • Skin rash that doesn’t itch
  • Sores in the mouth, vagina, or anus
  • Fever
  • Headache, muscle aches
  • Swollen glands in neck, groin, or armpits
  • Weight loss
  • Hair loss
  • Sore throat
  • Fatigue

With or without treatment, syphilis stays in the body, and the infection can progress to the latent or even tertiary stage of syphilis.

Latent Syphilis

Latent syphilis symptoms: 

  • No symptoms– even for years

Although latent syphilis is silent with no visible signs or symptoms of syphilis present, the infection isn’t gone. During the early part of the latent stage, a person is contagious, even when no signs are present.

Tertiary Syphilis

Many people with untreated syphilis don’t develop tertiary syphilis. However, when it happens, it’s very destructive. Tertiary syphilis can impact many different organ systems and cause serious problems and even death.

Tertiary syphilis symptoms may include:

  • Large sores called gummata, which appear inside the body or on the skin
  • Strokes
  • Numbness
  • Deep, boring bone pain
  • Heart problems

Congenital Syphilis (CS)

CS cases have more than tripled in recent years. Over 10 times as many babies were born with syphilis in 2022 than in 2012. This is the highest number reported in one year since 1992.

Congenital syphilis can be dangerous. The Centers for Disease Control and Prevention (CDC) reports that up to 40% of babies born to women with untreated syphilis may be stillborn, or die from the infection as a newborn. Babies born with congenital syphilis can suffer from deformed bones, severe anemia (low blood count), brain and nerve problems, an enlarged liver and spleen, and skin rashes. If there is a syphilis sore on the breast or nipple, mothers shouldn’t breastfeed since contact with the sore can spread syphilis to your baby.

Syphilis can be treated with antibiotics during pregnancy to both decrease the risk of spreading it to the baby and stop the infection’s progression in the mother.

While syphilis can be treated at any stage, treatment does not reverse the damage that has already been done.

Diagnosis and Treatment

Without treatment, syphilis can cause serious health problems including damage to the heart and brain, and can cause blindness, deafness and paralysis. If transmitted during pregnancy, it can cause miscarriage, infant death and lifelong medical issues. With the right antibiotics, syphilis can be cured.

Syphilis is usually diagnosed with a blood test.

High-risk individuals and pregnant women should be tested for syphilis, according to CDC guidelines.

High risk is defined as:

Mandatory Reporting but Confidential

All STIs, including syphilis, are required to be reported and results are kept confidential. The reporting requirements differ by state. Follow up and notification of sexual partners vary within jurisdiction.

The FDA webpage can assist you in locating home and lab testing centers here: Find All FDA-Approved Home and Lab Tests. From there, you can link to the FDA approved home tests locator.

Antibiotic Shortage

Over the past year, there has been a shortage of Bicillin, an antibiotic used to treat syphilis. In addition, last year all U.S. states lost funding for STD (STI) prevention, affecting the ability at a statewide level to respond to the syphilis outbreak.

One Antibiotic That Has Proven Efficacy

Doxycycline an antibiotic has proven to be an effective treatment to treat many STIs, including syphilis. Because of the shortage of Bicillin, it could be used as an alternative antibiotic. If exposure to syphilis or any sexually transmitted infection is suspected, seek the guidance of a healthcare professional.

Stigma Preventing Treatment

Unfortunately, there is still a stigma surrounding any sexually transmitted infection. Because of this, many fail to get tested. Many fail to notify those they had sexual encounters with. Because of this, many sexually transmitted infections continue to spread unchecked.

Syphilis, along with other infections, if not treated, can lead to permanent and serious health consequences. The CDC estimates that approximately one in five people in the U.S. had a sexually transmitted infection (STI) on any given day. In other words, STIs are more common than you may think. Don’t let the stigma prevent you from seeking treatment.

- Brooke Lounsbury, RN

Medical Content Writer

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Ivermectin for Scabies- and More

Discovered in the late 1970s and approved as a commercial product for animal health in 1981, ivermectin, an antiparasitic drug was initially used by veterinarians to treat mite and heartworm infections.

In 1988, ivermectin was approved to treat Onchocerciasis (known as river blindness) in humans.

Origins in Japanese Soil

Under the guidance of Satoshi Omura (former head of the Antibiotics Research Groupof Kitasato University) his team isolated a strain of Streptomyces avermitilis from a fermented a sample of Japanese soil. Merck Research Labs parasitology specialist, Willima C. Campbell began testing samples as a potential treatment for parasitic worms. The Streptomyces avermitilis strain was isolated. The group of drugs isolated is called a avermectins. From this group, eight different structures, including ivermectin, were isolated, and modified. It was discovered that ivermectin was 25 times more potent than existing treatments for parasitic worms.

Avermectins possess anticancer, anti-diabetic, antiviral, antifungal, and are used for treatment of several metabolic disorders.

Nobel Prize Awarded

Omura, along with Merck Research Labs parasitology specialist, William C. Campbell were awarded the 2015 Nobel Prize in medicine for developing ivermectin. As part of two global disease elimination campaigns, Ivermectin was responsible for lowering the incidence of river blindness and lymphatic filariasis, both caused by parasitic worms. Dubbed a “Wonder drug”, Ivermectin proved to be a safe, effective, and well tolerated drug. It is now being distributed and used free of charge in campaigns to eliminate both diseases globally which have devastated the world’s poor.  It quickly became used to treat other parasitic conditions, from hookworms, roundworms, ear mites and scabies.

The Many Uses For Ivermectin

As a broad spectrum antiparasitic medication, ivermectin is included in the World Health Organizations Essential Medicines List.

Scabies– are microscopic mites that can live on your skin for months. It is a highly contagious condition that is spread through direct skin contact. The distinctive, raised rash may be skin color, red, brown or violet depending on skin tone.

Initial exposure can take 2-5 weeks to manifest symptoms. If prior exposure to scabies, symptoms can manifest in as little as 4 days.

Symptoms include intense itching, rash, hives or bumps under the skin. The burrow tracks can be seen on the skin as thin, raised discolored lines.

Common sites for scabies rash to appear include the wrist, elbow, armpit, nipple, penis, buttocks, waist and area between the fingers.

Side effects of ivermectin, although uncommon, include fever, itching, and skin rash.

There are several drugs that interact with ivermectin. Check out these drug interactions here.

Pregnant women are told not to take ivermectin due to its potential effect on the fetus.

Ivermectin is one of the medications found in the Jase add on list that you may add to your Jase Case.

Powerful Antiviral Against Many Viruses

In addition, the antiviral activity of Ivermectin has been shown to be effective against a wide range of RNA and DNA viruses, for example, dengue, Zika, yellow fever, and others.

Off Label Use- Covid 19

The CDC, FDA and World Health organization do not recommend ivermectin as a treatment for Covid-19 unless ivermectin is used in a research setting, as part of a clinical trial.

However, a meta-analysis published in the American Journal of Therapeutics (July/August2021 edition) titled, “Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines” reviewed and analyzed 15 trials found that ivermectin reduced the risk of death compared with no ivermectin. (See paper here).

Ivermectin is considered to be one of the world’s most valuable and lifesaving drugs and has earned a place alongside penicillin for its impact on saving lives.

- Brooke Lounsbury, RN

Medical Content Writer

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How Should I Store My Jase Case and Add-ons?

You recently made the proactive decision to purchase the Jase Case and some add-ons. This investment is a hedge against interrupted medication supplies due to natural disasters, travel to medically underserved regions of the world, and world events leading to extended drug shortages.

You want to protect our investment and the most important step is to store them properly.

To begin with, what is shelf life and expiration dates for?

Understanding shelf life and expiration dates- What’s the difference?

Shelf life: “The time period during which a drug product is expected to remain within the approved shelf-life specification, provided that it is stored under the conditions defined on the container label.”

Expiration date: The expiration date is the final day that the manufacturer guarantees the full potency and safety of a medication. U.S. pharmaceutical manufacturers are required by law to place expiration dates on prescription products prior to marketing. (many of these dates are arbitrary and are usually 1-5 years)

Shelf life and expiration dates are guidelines. Actual studies tell the whole picture.

Take doxycycline, for example:

Established in 1986, the Shelf-Life Extension Program a joint initiative of the FDA and Department of Defense tested 122 drugs for potency after their expiration date. Doxycycline (included in the Jase Case) maintained its potency well past 66 months- over 5.5 years. In fact, doxycycline potency has proven well beyond this time frame.

In fact, a paper from African Health Sciences titled” Drug expiry debate: the myth and the reality” revealed that of the drugs they tested “many drugs retain 90% of their potency for at least five years after the labeled expiration date, and sometimes longer. Even 10 years after the expiration date many pharmaceuticals retain a significant amount of their original potency.”

Below are the storage guidelines for most medications:

  • Don’t store your medicine in the bathroom or an area of the home of high humidity. Humidity can break down your medication and even change the medication’s chemistry. Packing your medication in a pouch with silica gel desiccants can help prevent moisture from ruining your medication.
  • Avoid extreme heat and cold. Both extremes can alter the chemistry or degrade the medication’s effectiveness. When traveling, keep medication on you or in your carry on. Don’t store it in your car for extended period of time.
  • Keep unused portions of medication in its original packaging. Whether that is the bottle or foil pouch it came in or was provided, doing this avoids contamination and excessive moisture build up.
  • Ideal places to store medications at home include dresser drawer, closet shelf or anywhere dark, dry and stays at room temperature. Always store with original label and out of reach of children and vulnerable adults (Alzheimer’s, dementia patients, etc.)

Jase Case and Jase add-ons storage guidelines

Jase Case

Store between 15°C and 30°C (59°F and 86°F)., and follow guidelines above (avoid excessive heat, cold, moisture and light).

If stored correctly, many antibiotics are still 90 percent or more potent even decades past their expiration date. See doxycycline post: “How Long do my Meds Last? A look at doxycycline”.

Jase Case add-ons

Below are the storage requirements/guidelines for Jase Case add ons:

Medication Use Don’t Freeze Ideal storage temperature/avoid excessive heat Notes
Acetaminophen Antipyretic (fever reducer), analgesic (pain reliever) X X Protect from light
Acetazolamide Acute altitude sickness, glaucoma (acute angle-closure)   X Protect from light
Albuterol HFA Bonchospasm, COPD exacerbation   Room temp or refrigerate Keep unused vials in foil pouch
Atovaquone-Proguanil Anti-malarial   X  
Celecoxib Acute pain (general, menstrual, gout)   X  
CiproDex Otic Otitis externa (swimmers ear) X X Protect from light
Dexamethasone Acute altitude/mountain sickness (moderate to severe), high altitude cerebral edema, asthma   X  
Diphenhydramine Allergic reaction, hives, insomnia, motion sickness, nausea/vomiting   X  
EpiPen Auto Injector Alpha/beta agonist X X Keep in plastic carrying tube,avoid excessive heat and protect from light
Famotidine Histamine H2 blocker X (liquid form) x Dispose of unused liquid form after 30 days
Fluconazole Vaginal candidiasis   X  
Hydroxyzine Insomnia, itching, hives   X Avoid excessive light
Ibuprofen Fever reduction, pain relief   X  
Ivermectin Antiparasitic, scabies   X  
Loperamide Acute and chronic diarrhea   X  
Methylprednisolone Corticosteroid   X  
Naloxone HCL nasal spray Opioid overdose X X Protect from light
(remains chemically stable even after 28 day extreme heat/thaw cycle)
Ofloxacin ophthalmic suspension Conjunctivitis
(bacterial)		   X Protect from light
Ondansetron Nausea/vomiting   X Can store in refrigerator
Oseltamivir Influenza X (don’t freeze suspension) x Suspension at room temp up to 5 days, in refrigerator up to 35 days
Permethrin Antiparasitic   X  
Salbutamol inhaler Increases air flow to lungs   X Store unused vials in foil pouch or refrigerator
Scopolamine patch Motion sickness   X Do not bend or roll patches
Silver Sulfadiazine Cream Topical antibiotic   X  
Triamcinolone cream Dermatitis, psoriasis X X  
Valacyclovir Herpes simplex   X  

- Brooke Lounsbury, RN

Medical Content Writer

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Hidden Dangers of Indoor Air Pollution

(Especially in the Winter)

People spend at least 90 percent of their time indoors, and this is especially true during winter months in the Northern latitudes. Cooler air, treacherous driving conditions, high winds, rain, ice, and snowstorms force many to stay inside, shuttering windows and winter-proofing the home as much as possible. The lack of circulating air, however, can come at a cost to you and your loved one’s health.

Indoor air can be two to five times more polluted than outdoor air, especially during the winter months when we seal up our homes to conserve heat, trapping pollutants.

Sources of indoor air pollutants

  • Vehicle emissions and exhaust seeping in through garage and air vents
  • Radon (EPA estimates that radon contributes to between 7,000 and 30,000 lung cancer deaths each year)
  • Leakage from underground storage tanks (oil, gas, etc.)
  • HVAC – improper venting of ductwork, dirty ducts, moisture, or debris in ductwork

Furniture and building materials

  • Improper plumbing leading to sewer gas escaping from traps
  • Emissions from new furnishings, flooring, paints, etc.
  • Excessive moisture buildup, standing water from leaks

Other indoor sources – VOCs

VOCs are chemicals that vaporize at room temperature and can cause a variety of health problems

  • Cleaning supplies, pesticides, secondhand smoke
  • Fireplace and woodstove heat
  • Personal care products
  • Art supplies (dry erase markers, adhesives, chalk, etc.)

Biological agents

  • Animal dander
  • Body fluids- saliva, urine
  • Bacteria
  • Cockroaches
  • House dust mites
  • Mildew
  • Molds (can be distributed throughout the home through air ducts)
  • Pollen
  • Dust
  • Viruses
  • Plants
  • Animals

Symptoms of poor air quality

Infectious illnesses are transmitted through the air. In poorly ventilated homes the air can trap and spread infections such as influenza, measles, and chicken pox. Molds and mildews release disease-causing toxins. Symptoms of health problems caused by biological pollutants include:

  • Eye, nose throat irritation
  • Dizziness, nausea
  • Shortness of breath
  • Sinus congestion, cough, sneezing
  • Lethargy
  • Watery eyes
  • Digestive upset

Poor indoor air quality health can lead to

  • Exacerbation of asthma
  • Respiratory disease
  • Hypersensitivity pneumonitis
  • Immune system suppression (from medications, chemotherapy, radiation, or disease)

Clear the air, improve your health

The long-term health consequences of clean air in your home cannot be overstated. Below are some tips to clean the air:

  • Increase ventilation. This alone can help reduce infectious particle concentration, which in turn lowers transmission risk. Open windows, allow fresh air into rooms during the day.
  • Inspect and maintain exhaust ventilations systems in areas such as kitchens, cooking areas, etc.
  • Use and periodically change air filters- both portable and in air duct/use HEPA filters, run continuously even when not in room to capture mold, dust and lung irritants.
  • Limit the VOCs used in the home. Opt for safer, less toxic cleaning and personal care products. The Environmental Working Group has rated cleaning products according to toxicity. They also have personal care product ratings and much more.
  • Use fireplaces and woodstoves only if needed. Clean and service annually.

Monitor and aim for between 30 and 50% moisture in home

  • Check for excessive moisture in areas where there is plumbing- laundry room, bathrooms, kitchens. If there is excessive moisture but no plumbing leaks, run the bathroom fan during and 30 minutes after bathing. Install a dehumidifier to prevent mold growth.
  • Check for condensation on your windows and furniture. Wipe down condensation where water collects.
  • When cooking, cover post and use the exhaust fan above the stove.
  • Move furniture at least 2 inches away from walls to allow circulation behind the furniture.

Have your home tested for radon

According to the CDC:

“Radon is the second leading cause of lung cancer deaths in the United States after cigarette smoke.

Radon is an odorless and invisible radioactive gas naturally released from rocks, soil, and water. In outdoor environments, radon levels are very low and generally not considered harmful.

Radon can get into homes or buildings through small cracks or holes and build up to higher levels. Over time, breathing in high radon levels can cause lung cancer.”

The CDC goes on to report:

“According to estimates from the Environmental Protection Agency:

  • Radon causes about 21,000 lung cancer deaths each year.
  • 1 in 15 homes in the United States have high radon levels.”

Common sources: Radon forms naturally in ground water when naturally occurring uranium, radium, and thorium break down. Showering, washing dishes, and doing laundry can disturb the water and release radon gas into the air you breathe.

Removing it from drinking water: Treat water using aeration or GAC treatment where the water enters your home (point-of-entry device) so that it will all be treated. Point-of-use devices, such as those installed on a tap or under the sink, will only treat a small portion of your water and will not reduce radon in your water.

 Aeration treatment—spraying water or mixing it with air and then venting the air from the water before use.

GAC treatment—filtering water through granular activated carbon. Radon attaches to the carbon and leaves the water free of radon. Disposing of the carbon may require special handling if it is used at a high radon level or if it has been used for a long time.

- Brooke Lounsbury, RN

Medical Content Writer

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