Antibiotics - JASE Medical - Page 2

A Dementia Diagnosis Can Be Challenging

Rule out other causes of decline first

Dementia is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life. Alzheimer’s is the most common type of dementia. It takes a toll on families and especially caregivers. Holidays and get togethers can be challenging for both families and the patient.

Some symptoms of early onset of dementia are:

  • Confusion
  • Loss of coordination-tripping, unable to hold items
  • Memory loss especially short term
  • Inability to reason complex situations
  • Emotional lability- anger, sadness, depression.

As dementia progresses symptoms become more pronounced, and leads to physical inability to take care of self independently

Risk factors for dementia

  • Genetics
  • Age- older adults are more at risk for a dementia diagnosis
  • Alcohol abuse
  • Smoking
  • Social isolation

Types of dementia

Alzheimer’s dementia

  • Twice as many women as men are diagnosed with Alzheimer’s dementia
  • Most are over 65 years.

Alzheimer’s disease leads to nerve cell death and tissue loss throughout the brain. Over time, the brain shrinks dramatically, affecting nearly all its functions.

Symptoms are mild to start and progress over time. Early symptoms are forgetfulness- of names or items such as keys are, unable to recall family or friends names along with forgetting special dates or appointments

As disease progresses changes in mood, depth perception and inability to organize thoughts and cognition are apparent. In later stages of Alzheimer’s the person experiences hallucinations, delusions and is physically incapable of performing basic hygiene.

Frontotemporal

Frontotemporal dementia (FTD), also called Picks disease is one of the less common types of dementia. It covers a range of different conditions that can affect personality, behavior, and language. FTD is mostly diagnosed in people under 65. Average onset is between 40 and 60 years, however it can occur as early as 20 years old.

Dementia with Lewy bodies

Dementia with Lewy bodies (DLB) is caused by Lewy body disease. In this disease, tiny

clumps of proteins – known as Lewy bodies – appear in the nerve cells of the brain, and progresses to decline in reasoning, independent function. and cognition. It can be hard to diagnose because it presents similar to many psychiatric symptoms

Vascular Dementia

 This type of dementia- which is sometimes called “Post Stroke Dementia” is different from Alzheimer’s or Lewy Body Dementia. Vascular Dementia is brain damage caused by bleeding or harm in the brain-such as a stroke. Symptoms that identify Vascular Dementia are observed immediately following a stroke and can include:

  • Changes in personality,
  • Depending on the area of the brain that has been affected- thinking short attention span
  • Difficulty reasoning organizing and analyzing thoughts

Correct diagnosis of dementia can be challenging

Many medical conditions, physical and emotional factors, along with medications can mimic dementia.

Medical conditions that can present as dementia like symptoms:

  • Liver and kidney disease– accumulation of toxic metabolic waste products in the blood can cause confusion and inability to form cohesive thoughts.
  • Infections– notably urinary tract infections can cause confusion and personality changes.This is more common in older population, symptoms of urinary tract infection sometimes present with different symptoms than younger population. Other infections should also be ruled out, such as syphilis or Lyme disease.
  • Cancer-especially brain cancer- by tumor pressing on the brain- or an immune response in which antibodies against the brain are formed, producing a “paraneoplastic syndrome”.
  • Endocrine dysregulation– such as thyroid gland (hypo or hyperthyroid) or diabetes- both of these conditions can alter mood, ability to coordinate and concentrate.
  • Head trauma– concussion
  • Depression– which can alter and slow thought processes and cause inability to make decisions along with irritability and mood changes.

Physical conditions that can present as dementia like symptoms

  • Poor vision– resulting in tripping, falling and bumping into furniture, walls, stairs, etc
  • Hearing lossA Lancet Commission report on hearing loss showed a link between hearing loss and cognitive decline, leading to a diagnosis of dementia.
  • Lack of sleep– inability to concentrate or pay attention can mimic dementia, however research points to altered sleep patterns , even one nights sleep disruption has been shown to increase the beta amyloid plaque – the protein that causes dementia in the brain.

Medications that can mimic dementia

Some medications can take a long time before symptoms set in, so if you notice any cognitive changes even without a change in medication- either over the counter or prescription review with your care provider your concerns.

  • Anticholinergic medications-such as tolterodine or oxybutynin, often used to treat urinary incontinence, Benadryl used for allergies and for sleep,
  • Tricyclic antidepressants such as amitriptyline for example
  • Antipsychotics such as Seroquil
  • Benzodiazepines such as Valium, Xanax, and Librium
  • Sleep aids such as Sonata and Ambien
  • Corticosteroids such as Prednisone
  • Narcotic pain relievers- such as morphine
  • Anti-Parkinson drugs such as trihexyphenidyl (Artrane)

It is important to make sure all other causes of confusion, memory loss, poor coordination, mood changes and other dementia mimicking signs have been considered before a diagnosis of dementia is made. Many medical conditions, physical conditions and drugs mimic the symptoms of dementia, take the time to review them and discuss with your care provider.

If a definite diagnosis of dementia has been made there are many resources available. One is the Alzheimers.org online support group and help with finding local resources to help with caring for your loved one.

- Brooke Lounsbury

Medical Content Writer

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

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Keeping you informed and safe.

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Pulse Oximeters – Helpful or Harmful?

Over the counter pulse oximeters saw a surge in use during the pandemic. They are widely available, inexpensive, and easy to use. A panacea- or too good to be true?

What is a pulse oximeter and how does it work?

Pulse oximeters come as either a small unit with a built-in finger/toe clip, or as a small handheld device that has a wire probe with adhesive pads that can be applied to your finger, toe or earlobe.

“The pulse oximeter uses a cold light source that shines a light through the fingertip, making the tip appear to be red. By analyzing the light from the light source that passes through the finger, the device is able to determine the percentage of oxygen in the red blood cell.” Excerpt from the American Lung Association.

There are two categories of pulse oximeters: prescription use and over the counter (OTC).

According to the FDA “Prescription oximeters are reviewed by the FDA, receive 510(k) clearance, and are available only with a prescription. The FDA requires that these pulse oximeters undergo clinical testing to confirm their accuracy. They are most often used in hospitals and doctors’ offices, although they may sometimes be prescribed for home use.

Over-the-counter (OTC) oximeters are sold directly to consumers in stores or online and include smart phone apps developed for the purpose of estimating oxygen saturation. Use of OTC oximeters has increased as a result of the COVID-19 pandemic. These products are sold as either general wellness or sporting/aviation products that are not intended for medical purposes, so they do not undergo FDA review. OTC oximeters are not cleared by the FDA and should not be used for medical purposes.”

Limitations of OTC pulse oximeters

  • A study done in November 2021 comparing white, black and Hispanic patients revealed the limitations of over the counter (OTC) pulse oximeters. Skin pigmentation plays a role in how accurate the pulse oximeters are. These devices work by absorbing light in hemoglobin, where oxygen is carried. However, darker pigmented individuals repeatedly had false high oxygen levels (3 times more than white individuals) because the light source from the oximeter can’t tell the difference between the hemoglobin and skin pigmentation. The darker the skin, the less accurate the reading. This prompted the FDA to review and issue a warning to the public on the use of these OTC devices.
  • A program launched March 2020 by Penn University called “Covid Watch” to remotely monitor patients with COVID-19 who were well enough to stay home to recover found that questioning the patients on symptoms, such as shortness of breath or use of pulse oximeters did not change outcomes of patients’ recovery from Covid 19.
  • Smokers read artificially high levels of oxygen -Instead of carrying oxygen on the red blood cells, which the pulse oximeter reads, carbon monoxide- from smoking, cooking over a grill or other forms of smoke- may be attached to the red blood cell receptors. The pulse oximeter cannot tell the difference between oxygen and carbon monoxide. This can produce a false high reading.
  • Other factors can affect accuracy of OTC pulse oximeter such as poor circulation, nail polish on the finger being tested and even skin thickness.

The FDA advises the following:

  • Do not rely only on a pulse oximeter to assess your health condition or oxygen level.
  • If monitoring oxygen levels at home, pay attention to other signs or symptoms of low oxygen levels, such as:
  • Bluish coloring in the face, lips, or nails;
  • Shortness of breath, difficulty breathing, or a cough that gets worse;
  • Restlessness and discomfort.
  • Chest pain or tightness; and
  • Fast or racing pulse rate.
  • Be aware that some patients with low oxygen levels may not show any or all of these symptoms. Only a health care provider can diagnose a medical condition such as hypoxia (low oxygen levels).

Sometimes we rely too heavily on technology to assess and make healthcare decisions. This may be one of those cases. Use these OTC devices only under the supervision and care of your primary care provider. As stated above, physical assessment can tell just as much if not more than the popular OTC pulse oximeters. If you need to use one of these devices, ask for a prescription level device and receive proper instruction in its use.

- Brooke Lounsbury

Medical Content Writer

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

Recent Posts

Keeping you informed and safe.

These Days are The Most Deadly for Heart Attacks

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Prepared Equals Peace of Mind

Prepared equals peace of mind

What is labeled “prepping” or being a “prepper” used to be how everyone lived as recent as 50 years
ago. Our just- in- time supply chains weren’t around back then. Amazon, and online shopping didn’t
exist. Back then, if you wanted something you had to either call the company and place an order or mail
a check in.

The Sears catalog, along with many other catalogs would arrive and you and your family would spend
hours poring over the pages. These pages were filled with almost anything you may need or want, from
bed sheets to tools for the shop. In essence, those catalogs were the modern-day equivalent of Amazon.
Sometimes it would take a month or so for the much-awaited order to arrive. This was normal. Back
then, if you wanted something you had to plan for it.

Just in time supply chain

Fast forward to today. With all the wonderful technology, the same day deliveries, and almost any item
at our disposal within a few days, we have become complacent. Don’t get me wrong, we have used this
system to receive much needed items, in some cases almost immediately. This is the wonder of our
technological age. But it comes at a price. We take for granted that these supply chains will always be
running smoothly. Our world economy, for the past several decades has made life more convenient and
opened our lives to new experiences and time saving devices.
Technology- double edged sword

Our global world is a double-edged sword. The convenience we so much rely on, can and has been in the
process of failing over the past few years. The consequences to our healthcare system have been
devastating. Medical supplies such as contrast dye and drugs, have been in short supply or altogether
unavailable with no end in sight. This illustrates how fragile our medical system is. We are only one
natural or manmade disaster, pandemic, political or civil unrest from the complete shutdown of life
saving drugs and medical supplies.

Pharmaceuticals outsourced

The last major pharmaceutical manufacturing operation closed its doors and left the United States in
2004. Since then, nearly all the active ingredients for antibiotics and chronic medications – even
vitamins – are produced overseas, mainly in China and India.
Take, for instance the current amoxicillin shortage.

Across the country many pharmacies have reported a limited or not available supply of amoxicillin.
Amoxicillin is one of the first antibiotics used to treat strep throat, ear infections, urinary tract infections
and many other infections. The shortage includes amoxicillin in pill form, powder to mix with water to
make a suspension, and chewable tablets.

The American Society of Healthcare Pharmacists maintains a database of drug shortages and
manufacturers. They have listed amoxicillin manufacturers who have reported shortages or no
availability.

• Aurobindo, with facilities located throughout the world, refuses to provide availability
information.
• Hikma, based out of the UK, did not provide a reason for the shortage.
• Rising, based out of New Jersey has amoxicillin capsules and tablets available, but doesn’t state
whether they have amoxicillin powder available
• Sandoz, headquartered in Switzerland did not provide a reason for the shortage.
• Teva, which is based out of Israel did not provide a reason for the shortage.

However, the FDA states the only shortage is amoxicillin in powder form. This is because if even one
manufacturer can supply the necessary drug there is no perceived shortage.

This is very disturbing. All it takes is that one manufacturer to declare either a shortage or the drug
not available at all and the US supply is dried up.

Augmentin, (amoxicillin / clavulanate) is one of the antibiotics included in the Jase Case (see below how
to order a Jase Case). This can be substituted for amoxicillin if amoxicillin isn’t available.

Generics less likely to be manufactured

An analysis conducted by the US Pharmacopeia, a group that sets standards around the world for
medicines, found that antibiotics are 42% more likely to be in shortage in the US compared to other
types of drugs. Most antibiotics are now generic.

According to an analysis by the FDA Report “Drug Shortages: Root Causes and Potential Solutions”
identified three root causes of drug shortages.

1. Lack of incentives for manufacturers to produce less profitable drugs. (Generics aren’t very
profitable)
2. The market does not recognize and reward manufacturers for “mature quality systems” that
focus on continuous improvement and early detection of supply chain issues; and
3. Logistical and regulatory challenges make it difficult for the market to recover from a disruption.
The fragile global supply chains mean that if a pharmaceutical factory is down in China, you may not be
able to find your prescription at the neighborhood pharmacy. Lifesaving antibiotics are at risk of running
out faster than any other medicine. Medicines that are now available could easily run out. This could
lead to dire consequences.

Jase Medical is on a mission

JASE Medical is a telemedicine company with a singular focus to change all of that. This platform offers
access to basic emergency preparedness medications for every family in America.

And how will they do that? Well, it won’t happen overnight. But JASE Medical has done its homework
and established a nationwide network of physicians trained to evaluate individual needs, assess
conditions, and prescribe appropriate prescriptions for emergency preparedness purposes. From there,
licensed pharmacists fill your prescription, and the Jase Case is sent to your home.

These are the medications that will become lifesaving for you and the people you care about. And it’s all
done online through the JASE Medical portal.

How it works

When you log on to the platform and begin your consultation, you will find a simple and user-friendly
experience. The consultation takes little over five minutes to complete. After a licensed Jase healthcare
provider has reviewed your health history and any allergic reactions to medications, your prescriptions
are filled, and your Jase Case is shipped to your front door.

What’s in the JASE Case?
The kit contains the following antibiotic medications:
 Amoxicillin/Clavulanate.
 Azithromycin.
 Ciprofloxacin.
 Doxycycline.
 Metronidazole.
(Substitutions are made if allergic to one of the antibiotics)

All medications carry a level of risk, but these five antibiotics were selected for their effectiveness and
optimal patient safety. Guidance from the CDC says it best: “Antibiotics … save lives, and when a patient
needs antibiotics, the benefits usually outweigh the risks of side effects and antibiotic resistance.”

Some of the infections a Jase Case can treat
 Anthrax, plague and tularemia (resulting from bioterror).
 Bite wounds.
 Cellulitis.
 Diverticulitis.
 Intra-abdominal infections.
 Tooth infections.
 Ear infections.
 Pneumonia.
 Sinusitis.
 Strep throat.
 Urinary tract infection.
 and more.

When access to your healthcare provider isn’t possible (you are on vacation, etc.) your Jase case
includes a symptom and antibiotic use handbook titled the “Emergency Antibiotic Guide “with easy-to-
follow instructions to ensure proper use of the antibiotics if indicated.
What about chronic conditions?

Soon, the JASE Medical platform will provide emergency preparedness medicines for those with chronic
medical conditions (such as blood pressure and other chronic conditions). JASE Medical’s same
physician network will assess your condition and the need for appropriate preparedness medicines.

Ongoing support

As part of its mission to prepare you medically, JASE Medical provides unlimited ongoing support from
their physician network for questions about any of the medications prescribed.

What about shelf life?

The good news about antibiotics is that they last longer than you think. The FDA’s Shelf-Life Extension
Program found that 88% of the drugs studied maintained their potency and safety beyond the published
expiration date. The extended usability of these medications ranged from 5.5 years to as many as 23
years beyond their printed expiration!

The JASE Case antibiotics all carry the FDA’s required expiration dates. JASE Medical endorses those
dates.

Value and peace of mind

At the end of the day, this is all about peace of mind and knowing that you are ready for the
unexpected. Knowing that you have found a solution, priced at a fraction of what it would otherwise
cost you, adds to that peace of mind.

Go to JaseMedical.com and secure your emergency medications, an emergency antibiotic guide,
unlimited physician consultation and a team of professionals who are on a mission to keep you and your
loved ones prepared and safe during these uncertain times.

- Brooke Lounsbury

Medical Content Writer

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

Recent Posts

Keeping you informed and safe.

These Days are The Most Deadly for Heart Attacks

These Days are The Most Deadly for Heart Attacks

(Heart healthy hacks series)According to the American Heart Association. the 3 deadliest days in the calendar year for cardiac deaths are: in first place, December 25th, second is December 26th  and third deadliest is January 1st . There are several possible reasons...

Is There Really a Shortage of Amoxicillin?

A widespread shortage of a common antibiotic, amoxicillin has swept the country. Amoxicillin is one of the first antibiotics used to treat strep throat, ear infections, urinary tract infections and many more. The shortage includes amoxicillin in pill form, powder to mix with water to make a suspension, and chewable tablets. 

The American Society of Healthcare Pharmacists maintains a database of drug shortages and manufacturers. They have listed amoxicillin manufacturers who have reported shortages or no availability. 

  • Aurobindo, with facilities located throughout the world, refuses to provide availability information.
  • Hikma, based out of the UK, did not provide a reason for the shortage.
  • Rising, based out of New Jersey has amoxicillin capsules and tablets available, but doesn’t state whether they have amoxicillin powder available
  • Sandoz, headquartered in Switzerland did not provide a reason for the shortage.
  • Teva, which is based out of Israel did not provide a reason for the shortage.

However, the FDA states the only shortage is amoxicillin in powder form. This is because if even one manufacturer can supply the necessary drug there is no perceived shortage. 

This is very disturbing. All it takes is that one manufacturer to declare either a shortage or the drug not available at all and the US supply is dried up. 

Augmentin, (amoxicillin / clavulanate) is one of the antibiotics included in the Jase case. This can be substituted for amoxicillin if amoxicillin isn’t available. 

Generics less likely to be manufactured

An analysis conducted by the US Pharmacopeia, a group that sets standards around the world for medicines, antibiotics are 42% more likely to be in shortage in the US compared to other types of drugs. Most antibiotics are now generic.

According to an analysis by the FDA Report  “Drug Shortages: Root Causes and Potential Solutions” identified three root causes of drug shortages.

  1. Lack of incentives for manufacturers to produce less profitable drugs;
  2. The market does not recognize and reward manufacturers for “mature quality systems” that focus on continuous improvement and early detection of supply chain issues; and
  3. Logistical and regulatory challenges make it difficult for the market to recover from a disruption.

The world supply chain is in dire straits. Even if medicine is available, the pending diesel shortage and possible rail strike could make getting the lifesaving medication to you. Talk to your care provider and pick up extra medications, both prescription and over the counter. If you haven’t already, get your Jase cases for your family.  This winter could prove to be a rough one for those not prepared.

 

- Brooke Lounsbury

Medical Content Writer

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

Recent Posts

Keeping you informed and safe.

These Days are The Most Deadly for Heart Attacks

These Days are The Most Deadly for Heart Attacks

(Heart healthy hacks series)According to the American Heart Association. the 3 deadliest days in the calendar year for cardiac deaths are: in first place, December 25th, second is December 26th  and third deadliest is January 1st . There are several possible reasons...

6 Tips to Keep Your Medicines Cool and Safe From the Heat

*Note: Some of the content below is for general medication best practices while other tips are specific to the medication mentioned.

As the summer heat wave in most parts of the country rages on, and rolling blackouts threaten our grid and safety, one area of particular concern is heat sensitive prescription and over the counter medications.

Most medications need to be stored at room temperature (59-86 degrees F) and ideal humidity under 60% to maintain their strength and quality. Some, such as insulin and other hormone related medications require refrigeration after opening. Many medications lose potency when exposed to heat, and are not toxic or dangerous, however this alone can cause life threatening results for those using insulin, heart or respiratory medications.

6 Tips to keep medications cool and safe

  • Store in original container, out of heat and light. Bathroom or kitchen cabinets are ideal for this. If your bathroom or kitchen areas are too humid or hot, consider a bedroom closet shelf to store your medicines. In addition, ask your pharmacist if there are any special precautions or needed care when storing your medicine.
  • If you use a medication that needs to be refrigerated invest in a separate small cooler with ice packs to store your medication in. Do not use this bag for anything else other than refrigerated medicines. Only open the bag when necessary to maintain the cooler temperature. Medications that need be refrigerated should always be kept between 36° and 46°F. A TSA approved insulin pen cooler, which can last up to 74 hours may be a good investment
  • Use this same cooler for plane trips. Don’t check in medications, always carry on your medications. Temperatures in holding areas are not temperature controlled. Plus it is best to always have your medications with you when traveling (lost luggage, etc)
  • If traveling in a car with your medications, take them with you, don’t leave them in a hot car.
  • If you use mail order services for obtaining your medication, ask for heat resistant packaging or overnight delivery. Nitroglycerin is sensitive to environmental changes, and most patients using this are aware and have their pills exchanged on a regular basis. Thyroid hormones are also sensitive to excessive heat. Update: This tip is NOT relevant to the Jase Case or any antibiotics we provide.

A study done on Formoterol capsules (Foradil Aerolizer) , powder filled capsule used in an inhaler, was heated to 115 degrees F, the temperature of an Arizona mailbox, for 4 hours. The capsules were removed from packaging and dispensed into the manufacturers filter tube. Results showed that filter weights of heated medications were less than half of those unexposed to heat, showing that a significantly less amount of the drug had been dispensed after it had been heated. In addition, capsules exposed to heat were grossly distorted in appearance and showed visible clumping. Medication had stuck to the sides of the gelatin capsule. It would not have been available to the patient.

  • Treat your over the counter medicines the same way you treat your prescription ones. These medicines can lose their efficacy when exposed to excessive heat and humidity also (Tylenol, Aleve, etc).

As rolling blackouts and heatwaves continue this summer in many parts of our country, staying cool is more important than ever. In addition to keeping our bodies and food cool, remember medications, both prescription and over the counter require attention and preparation also.

 

 

 

 

Antibiotic Stewardship

 

According to many scientists and clinicians, antimicrobial resistance is one of the greatest threats to human health worldwide. However, without a clear understanding of the vital role of antimicrobials, and more specifically, antibiotics in modern life, a statement like ‘antimicrobial resistance is the greatest threat to human health worldwide’ may seem like hyperbole. 

The discovery of antibiotics in the 1930s fundamentally transformed the way physicians care for patients. Treatment-focused approaches based on antibiotic use allowed physicians to save countless lives. 

Since then, we have seen the top causes of mortality in humans change from things like kidney disease, gastrointestinal infections, and pneumonia to cancer and heart disease. More than eight decades later, the medical advances enabled by antibiotics are now threatened by rising antibiotic resistance. Without effective medications to treat infections, many fields of medicine will be hindered. Care of the critically ill, surgery, transplant medicine, neonatology, and the treatment of cancer patients, among others. Our ability to respond to national security threats like bioterrorism or pandemics will also be affected.

The causes of antimicrobial resistance are multifactorial and complicated. Chief among them is the lack of antibiotic stewardship. According to the Centers for Disease Control and Prevention (CDC), antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance.

The CDC lists four primary efforts to address antibiotic stewardship in an outpatient setting. They are: 1 – a means to measure antibiotic prescribing, 2 – improve antibiotic prescribing by clinicians and use by patients so that antibiotics are prescribed and used when needed, 3- minimize misdiagnoses or delayed diagnoses leading to underuse of antibiotics, and 4- ensure that the right drug, dose, and duration are selected when antibiotics are needed. 

Over the last 10-20 years, the medical community and general public in developed nations worldwide have made considerable gains in the implementation of antibiotic stewardship. For example, there has been a concerted effort to increase awareness about the inappropriateness of prescribing and using antibiotics to treat viral infections. At JASE, we strive to continue this trend while empowering our patients to care for themselves when access to appropriate and timely medical treatment may not be available.

The effectiveness of antibiotics is a limited resource, and we must treat them as such. Nevertheless, they are crucial to our health and well-being, and we should respect them as powerful medications that save lives but can cause significant harm when misused.