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Without a doubt, taking medications can not only be expensive, but also confusing. In the United States, generic prescriptions are widely used, with 9 out of 10 people choosing them over a name brand. Pharmacists are a great resource to help us understand the benefits and side effects of any medication. We asked Adam Porath, PharmD, Vice President of Pharmacy at Renown Health, to answer some common questions about generic drugs. What is a generic drug? A generic drug has the same active ingredients of brand-name drugs. Brand-name drugs have a patent (special license) protecting them from competition to help the drug company recover research and development costs. When the patent expires other manufacturers are able to seek approval for a generic drug. However, the color, shape and inactive elements may be different. Per the U.S. Food & Drug Administration (FDA), a generic medicine works in the same way and provides the same clinical benefit as its brand-name version. Why do they cost less? Generic drug makers do not have the expense of costly development, research, animal and human clinical trials, marketing and advertising. This savings is passed on to the public. Also after a patent expires, several companies will compete on a generic version of a drug, further driving down prices.

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When it comes to each patient’s healthcare journey, medication is often a key chapter. After all, medication is one of the most common treatment methods to help patients on the road back to health. In 2023, 4.83 billion prescriptions were filled in the U.S., and with this number only anticipated to rise annually, having an expert pharmacy team on your side to make certain you are prescribed the ideal dosage to treat your condition, prepare your prescriptions on time and help you manage your medications responsibly is important.  Fortunately, at Renown Health, we have best-in-class inpatient and outpatient pharmacy teams to fill both prescriptions and promises for excellent care. Renown Pharmacy plays a vital role in helping us foster a health system that prioritizes patient well-being above all else. This department exemplifies the impact that a unified, expert pharmacy team can have on patient outcomes now and in the future.  The Masters of Medication Spanning three hospitals plus ambulatory locations across the health system, Renown’s growing pharmacy team – full of dedicated pharmacists, pharmacy technicians and even medical assistants – manages medications in a wide variety of patient settings, touching nearly every aspect of the healthcare continuum: Outpatient Retail Pharmacies Renown Regional Medical Center – 75 Pringle Way The Healthcare Center – 21 Locust Street Renown South Meadows Medical Center – 10101 Double R Blvd  Inpatient Pharmacies Renown Rehabilitation Hospital Renown Regional Medical Center (including Renown Children’s Hospital) Renown South Meadows Medical Center COMING SOON: Conrad Breast Center Pharmacy (in honor of Kristina Ferrari) in the Specialty Care Center at Renown South Meadows Ambulatory Pharmacies Anticoagulation Services – Institute for Heart & Vascular Health (IHVH) Pharmacotherapy Program – IHVH and Renown Medical Group Locations Congestive Heart Failure Pharmacotherapy Program – Center for Advanced Medicine B at Renown Regional Chronic Obstructive Pulmonary Disease (COPD) Pharmacotherapy Program – Renown South Meadows Endocrinology Pharmacotherapy Program – Renown South Meadows Additional Pharmacy Programs Medical Reconciliation Pharmacy Residency Clinical pharmacists at Renown bridge the gap between medicine and compassionate support, making sure each patient receives personalized care one prescription at a time.  “There are various roles pharmacists play within Renown,” said Clarissa Munoz, Clinical Pharmacist in the Renown Regional Inpatient Pharmacy. “Staff pharmacists work diligently to ensure correct medications are dispensed, and if compounded, make sure they were prepared properly. They also work hard to answer medication messages and phone calls, help verify orders and make sure ode trays/RSI kits are appropriately stocked and ready when needed. Clinical pharmacists work from satellite pharmacies on the floor and focus on reviewing patient charts and aim to provide additional interventions to the providers to optimize treatment strategies. We also serve as a resource for nursing staff and help answer medication questions.”  “My role in the pharmacy is pretty expansive,” added Chanelle Ajimura, Clinical Pharmacist in the Renown Regional Outpatient Pharmacy. “I maintain inventory to confirm patients can receive their medications in a timely manner both for our discharge and retail patients while balancing the Meds to Beds program, which offers medication delivery to the bedside and bedside medication counseling; collaborating with an interdisciplinary team to find the most affordable price for patients; and verifying that the dose, strength, indication, etc. is appropriate for the patient from start to finish.”  “In the pharmacy, I make sure patients are receiving appropriate drug therapy by checking for major drug interactions and ensuring appropriate dosing,” added Courtney Church, Clinical Pharmacist in the Renown Regional Outpatient Pharmacy. “I also make recommendations to providers so patients can get cost-effective therapy.”  Our pharmacy technicians work behind-the-scenes ensuring efficient medication management, making a difference in the lives of patients every day.  “A pharmacy technician is responsible for making sure the patient gets their medications on time and at the lowest price possible,” said Nate Graham, Pharmacy Technician in the Renown Regional Outpatient Pharmacy. “This is done by working with patients, insurance companies and case workers. We fill prescriptions, enter prescriptions into our system, receive and send orders for medications and maintain a clean pharmacy with an accurate inventory.”  “We do a variety of things; the task people probably know the most is counting out the medications and putting them in the amber vials,” added Rachel Vallin, Pharmacy Technician in the Renown Regional Outpatient Pharmacy. “We also help patients at the front of the pharmacy, ring out their prescriptions, answer some basic questions (deferring to a pharmacist as necessary) and billing insurance. Meds to Beds is my favorite part because I feel the most involved. I take medications to patients who are discharging up to their hospital rooms so they have it with them when they leave.”  “As a technician, I confirm that all medications of new admissions are available in our machines prior to admitting and then maintain stock during each patient’s stay,” added Tammara Axtman, Pharmacy Technician at Renown Rehabilitation Hospital. "I also assist our nurses when needed in regard to any of their questions with both EPIC and Omnicell.”  Our pharmacy team is also on the move all across our health system, thanks to our Ambulatory Pharmacy programs. For patients experiencing a serious heart, lung, or endocrine condition that requires ongoing drug therapy maintenance and guidance, our ambulatory pharmacies step in to carefully monitor how their medications impact their health and well-being.  “Our role as pharmacists in this department is non-traditional because we actually see patients in the exam rooms face-to-face,” said Cory Lankford, Ambulatory Care Clinical Pharmacist for Renown’s Anticoagulation Services. “We modify their medication regimens and drug recommendations under collaborative practice agreements.”  “Because our role is so unique, we have a lot of opportunities to make a positive impact on patients,” added Janeen Abe, Ambulatory Care Clinical Pharmacist for Renown’s Anticoagulation Services. “We do a lot of direct patient interaction, including counseling patients on their medications and helping them navigate through their disease state.”  “As a medical assistant in this department, we’re called the patient ‘liaisons’ to orchestrate who they should go to whether it’s a nurse, a provider or a pharmacist,” added Kiara Scruggs, Medical Assistant for Renown’s Anticoagulation Services. “We look at each patient’s medications and help with the Warfarin blood thinner monitor. We get to do a lot with patients." A key resource within the Pharmacy department and the emergency admission process, our Medical Reconciliation ("Med Rec") team stays on top of each patient's medication records. By ensuring each medication regimen is accurately reflected in each patient's chart and that patients continue to take their at-home medications while admitted to the hospital, this team provides vital insight into medications that could be a contributing factor to each patient's symptoms, including drug interactions. “Our medication reconciliation pharmacy technician team are true detectives,” said Heather Townsend, Clinical Pharmacy Supervisor. “When a patient arrives to the hospital, Med Rec works with patients, families, caregivers and outpatient pharmacies to compile a list of medications the patient has been taking a home. This list is used to make sure medications are not contributing to the patient’s symptoms and to assure medications are continued throughout the hospital stay. The addition of the medication reconciliation team has been one of the greatest advancements in medication safety.” “As a Med Rec Tech, we interview patients and family members and call pharmacies, skilled nursing facilities, etc. to obtain an accurate and complete medication list/history to outline what the patient is currently taking on a daily basis,” added Kara McGee, Medical Reconciliation Pharmacy Technician. “We make sure that we document the correct medication, dose, route, frequency and directions. This information is crucial because the nurses, pharmacists and physicians look at our work to figure out if any medications are contributing to the patient's health condition, and for the continuation of home medications on admission.” “Even though the Med Rec Tech might seem small in the hospital realm, it is very vital for patient information and beneficial to the patient's health,” added Brizza Villafan, Medical Reconciliation Pharmacy Technician. “There is never a dull moment in this work.” No matter the diagnosis, having Renown Pharmacy as an integral part of your healthcare team is a win-win situation for both you and them: you receive access to medication to help you heal, delivered to you with precision and care, and the pharmacy team has the opportunity to care for you and make a positive impact, a role they take seriously.

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Most prescriptions meds are available in generic form. Find out the similarities and differences between the two and how to determine whether a generic is right for you. Approximately 80 percent of prescriptions sold today are generics. If you’re taking a prescription medication, chances are it’s a generic form of the brand-name drug. But are you getting the same quality in a generic medication? Do generics measure up? The answer in most cases is yes — generics, just like branded products, are regulated by the Food and Drug Administration. “To have a generic product approved by the FDA, the generic manufacturer must prove that its product is bioequivalent to the branded product,” explains Adam Porath, PharmD, BCPS AQ-Cardiology, BCACP and Vice President of Pharmacy Services. Basically, it has to function the same. “Generic products are extremely well tolerated and will provide the same results as using a branded product,” Porath says. Here’s how generics are the same as name-brand prescriptions: Generic products contain the same active ingredients. They produce the same desired clinical effect and accompanying side effects. Generics come in the same form as their branded counterparts: pill, liquid or inhaler, for example. Release into the bloodstream matches the name brand in timing and strength. Here’s how they differ: Generics generally cost less. Federal law requires generics have different names and look different: shape, size, markings and color. Generics contain different inactive ingredients, like binders, fillers and artificial colors. Different side effects with generics can usually be attributed to these additions. Why do generics cost less? When pharmaceutical companies develop a new drug, they are paying for research, development, clinical studies, marketing — in some cases it can cost more than $800 million and take 10 to 15 years to develop a new drug. “The manufacturers of branded medication products have to recoup their research and development costs,” Porath says. So companies are granted a limited patent to sell their drug without the competition of generic counterparts. “When patent exclusivity ends, the market is open for any generic manufacturer to make a competing product with FDA approval.” Without the same startup costs, companies can sell generics at 80 to 85 percent less. And because more than one company can produce the same generics, competition drives prices even lower.

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Alzheimer’s disease is not normal forgetfulness as we age. Instead, it is a specific form of mental decline. And according to the Alzheimer’s Association it accounts for nearly 80 percent all dementia cases. Natasa Dragicevic, MD, PhD., behavioral neurologist and Alzheimer’s disease specialist with Renown Institute for Neurosciences, weighs in on diagnosing it and the importance of early medical action. How to Diagnose Alzheimer’s Disease In general, the signs of Alzheimer’s disease occur slowly, getting worse over time. For example, forgetfulness is a daily search – for shoes, keys and other misplaced items. Not only is memory affected, but also speech patterns and behavior. There is no single test for Alzheimer’s disease. “Specifically, a neurologist should be the one to diagnose Alzheimer’s disease given differences in presentation,” clarifies Dr. Dragicevic. “And ideally a behavioral neurologist (Alzheimer’s sub-specialist) will be managing the treatment,” she adds. Brain Imaging Diagnosing Alzheimer’s disease involves multiple approaches and medical providers. In short, medical history is reviewed along with a physical exam, lab tests and other diagnostic testing. “A medical workup includes a variety of tests. These include MRI and other brain imaging, as well as neurological and psychological testing. Furthermore, a lumbar puncture is performed to look for markers of the disease,” she states. What Causes Alzheimer’s disease? Although no one knows the cause, researchers think many factors play a role. Uncontrollable risk factors include your genetics and having a family member with the disease. However, the controllable risk factors include: reducing the risk of head injury and keeping your heart healthy. It’s important to realize that high blood pressure, high cholesterol, stroke and diabetes play a role in brain health. Blood loss to the brain causes vascular dementia, leading to long-term blood vessel damage. Symptoms of Alzheimer’s disease Generally speaking, the signs of this disease differ in each person. Yet noticeable behaviors include: • Losing the way to familiar places • Forgetting to pay bills • Trouble finding the right words when talking • Repeating questions • General confusion • Social withdrawal Alzheimer’s Disease – Benefits of Early Diagnosis Equally important, spotting Alzheimer’s disease early allows more time to benefit from medications and possible clinical trials. Likewise, nutrition and exercise changes can be made, increasing blood flow to the body, and perhaps delaying symptoms. Early diagnosis also allows for personal health decisions and quality-of-life conversations to take place.   According to the Alzheimer’s Association, these benefits include: 1. Medical advantage 2. Emotional and social comfort 3. Time to plan ahead 4. Cost savings A Brain Supporting Lifestyle “At the present time, treatment is limited,” explains Dr. Dragicevic. “Usually Alzheimer’s is a progressive ongoing disease – any management at this time is purely symptomatic.” However, she states the following lifestyle changes can help support brain health: • New hobbies such as painting, pottery, music classes or learning a new language • Crosswords, puzzles and playing games, such as Scrabble • Brain challenging mobile apps, such as Luminosity • 30-45 minutes of mild to moderate physical activity per day, such as walking • Eating a Mediterranean diet (primarily plant based foods)

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November is National Alzheimer’s Disease Awareness Month. At Renown Health, we know that Alzheimer's safety for your loved one is a priority, as the symptoms can sometimes lead to unsafe situations. We asked Dr. Jonathan Artz – a neurology physician with Renown Health and an assistant professor of clinical neurology at the University of Nevada, Reno School of Medicine – for tips on keeping loved ones safe and secure.  According to the Alzheimer’s Association, Alzheimer’s disease affects safety in various ways, specifically due to body and brain adjustments. These changes can include: Judgment, including forgetfulness  Sense of place – getting lost on the way home  Behavior – being suspicious or fearful  Body difficulty – losing balance Sensing ability – noticeable sensitivity in hearing, seeing or temperature  Dr. Artz gives us four major tips to ensure your loved one’s safety as you both navigate this disease together.  Watch for Wandering  Those experiencing Alzheimer’s disease tend to wander and get lost. Try the following tips to reduce the risk of wandering:  Get your loved one an ID bracelet and have them wear it at all times. You can also enroll your loved one in “Wandering Support.”  Install door chimes so you know when exterior doors are open.  Ask neighbors to call you if they see your loved one out alone. Go with your loved one when they insist on leaving the house. Don’t argue or yell. Instead, use distraction or gentle hints to get them to return home.  Discourage Driving  Driving can be unsafe for someone with this disease. With this in mind, ask a doctor whether it’s safe for your loved one to drive. For example, on a case-by-case basis, there are certain situations where doctors are required to report individuals with particular cognitive impairments, wherein a form of a driving assessment will be recommended.  Limit access to the car. Keep the keys with you or lock them away.  Ask an authority figure, such as an insurance agent or a doctor, to tell them not to drive.  Adult-Proof Your Abode  A simple living space is a safe living space. This means reducing clutter and removing any issues that may pose a safety concern. You may also want to get advice from an occupational therapist (home safety expert). Keep in mind that some changes may not be needed right away. Focus on major safety concerns first.  Try the following tips:  Add lighting (or glow-in-the-dark tape) to brighten dark areas, including stairways and halls.  Use color contrast or texture indicators for dials, knobs and appliance controls.  Remind your loved one not to carry items while walking to avoid a fall.  Remove sharp objects from drawers and countertops.  Avoid using small throw rugs or doormats, as they are easy to trip on.  Move frequently used items so that they are easy to reach.  Lock away alcohol and tobacco products, as they are not recommended for dementia patients.  Install handrails in the shower, tub and near the toilet. Bathroom falls are especially common.  Adjust the setting on your hot water heater so water does not scald. Those with Alzheimer’s can lose their sensitivity to temperature.  Move and lock up hazardous chemicals and cleaning supplies, such as bleach and insecticides.  Disable and remove guns or any weapons. Supervise any medication taken by your loved one.  Promote a Positive & Healthy Lifestyle  Continually emphasize the strengths of your loved one by promoting participation in meaningful activities, wellness visits and healthy habits to help them improve their well-being. Here are some ways to keep them physically and mentally active:   Maintain regular vision and hearing screenings and make necessary adaptations.  Establish a routine for daily activities.  Encourage participation in self-care and leisure activities.  Work with your loved one’s doctor to establish a healthy diet.  Ensure proper hydration. It may help to set reminders for your loved one to drink fluids.  Encourage regular exercise. Exercise delivers oxygen to the brain, improving brain health. Promote good sleep habits. Good quality sleep can increase overall brain health and has been associated with improving memory, attention and concentration.  Resources and support are available with the Renown Memory Disorders Program. Providers within this program are specifically dedicated to treating several different memory-related disorders. Memory Disorders Resources & Support.

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When you’re too sick to go to work but not sick enough for a doctor’s visit, over-the-counter medicines are a welcome relief to help alleviate that fever, runny nose or allergies. But because those medicines aren’t signed off on or managed by your doctor and pharmacist, you must be especially mindful of what you put into your body. Whenever you pop a pill, you want to ensure you’re taking the correct dosage, waiting the right amount of time before taking another dose and not mixing certain medicines. Too Much Tylenol/Acetaminophen Tylenol — or acetaminophen — is a popular pain reliever for many, but too much can be bad for your liver. “Our bodies have a finite ability to metabolize Tylenol,” says Andy Wright, clinical pharmacist at Renown Rehabilitation Hospital. “When too much builds up in the liver, it becomes toxic. In patients with medical conditions like cirrhosis of the liver or hepatitis, this could be disastrous.” Remember, acetaminophen is in more than just Tylenol and generic pain relievers. You may also see acetaminophen in flu, cold and cough medicines, like Nyquil, and some prescription medications including Norco and Percocet. Keep a list of the medications you take, and limit daily acetaminophen use to 3,000 mg per day. When you’re scanning medicine bottle contents, remember acetaminophen is also referred to as APAP, AC, acetam or paracetamol. Mixing Painkillers When you’re dealing with pain and not getting any relief, taking a different medication may seem like the easy solution. Maybe you take some Aleve — a form of naproxen — for a headache, but it isn’t working, so you switch to Motrin, an over-the-counter form of ibuprofen. Not a smart idea. Ibuprofen and naproxen along with aspirin are known as nonsteroidal anti-inflammatory drugs (NSAIDS). Because these medicines work in similar ways, they should never be combined or used in larger doses or more frequently than directed. Otherwise your risk of side effects can increase, which range from mild nausea to severe gastrointestinal bleeding.  It’s also important to consider your family history when taking NSAIDs because, “recent studies have shown NSAIDs may have greater cardiovascular risks for people taking blood thinners or those with hypertension,” explains Andy. “A good example is ibuprofen: It has a relatively low gastrointestinal bleed risk while it has a moderate to high cardiovascular risk. The opposite is true for naproxen.” Rather than experimenting with multiple medicines, figure out which drug works best for you. You may find muscle soreness improves with aspirin, whereas when a headache hits, naproxen is best. Keep in mind that these medications aren’t always best for everyone in the family. “Aspirin in children and teens is not recommended unless under the supervision of a doctor,” Andy says. And pregnant and lactating women should generally avoid NSAIDS due to risk of birth defects and bleeding. “In both of these cases, acetaminophen or Tylenol are preferred but only if approved by an OB/GYN.” Fighting Allergies Over-the-counter antihistamines like Claritin, Zyrtec and Allegra have made fighting itchy eyes and runny noses a little easier. But these daily medicines — when taken inappropriately or in the wrong combinations — can also have an adverse effect. Similar to acetaminophen, you need to watch for antihistamines in other products. Sleep aids — like Tylenol PM and Unisom — commonly use an antihistamine known as diphenhydramine, which may increase your risk of overdose. “Combining antihistamines, or overdosing, can cause many adverse effects including dry mouth, blurred vision — even arrhythmias,” Andy says. “Only take these medications on their own.” If you’re still struggling with symptoms, you can talk to your doctor about adding an over-the-counter nasal steroid.  Andy confirms the importance of closely following the directions listed on antihistamine (and all medicine) bottles. He has seen extended release nasal decongestants cause significant arrhythmias requiring medical care after a patient took the medicine with warm fluids. “The decongestant in question is designed to slowly release, but it can dissolve suddenly in the presence of warm liquids like coffee,” Andy explains. “This can cause the pill to deliver 12 to 24 hours of medication all at once.” Taking an Antidiarrheal with Calcium Calcium supplements and antidiarrheal medicines are another harmful combination. Calcium firms up your stool, but if taken with an antidiarrheal, can cause severe constipation. If you need to take an antidiarrheal, take a break from your calcium for a few days until you’re back to normal. Another consideration when taking calcium supplements or calcium-based antacids is gas. “I’ve had several patients report cases of excessive gas using Tums or calcium carbonate-based supplements.” Andy suggests instead “trying Maalox or Mylanta for indigestion and Citracal as a supplement.” Talk with Your Doctor or Pharmacist About Your Medications If over-the-counter drugs aren’t providing the relief you need, it’s time to see your doctor. And remember, for your safety it is important to keep your doctor and pharmacist up-to-date with any medications — prescribed or over-the-counter — that you are taking.

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