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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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If you’re having surgery on your shoulder, why does it matter what’s in your stomach? We asked Dr. Matthew Hoberg to explain more about pre-surgery directives, including fasting. If you have an upcoming surgery, your care team likely gave you instructions to fast before your procedure. But why? We asked Matthew Hoberg, M.D., medical director of Renown Surgical Services, to explain why it’s important to forgo food and drinks before surgery. Why are patients instructed to fast before surgery? Regardless of surgery type or site, we want the stomach to be empty before having anesthesia, because anesthesia can reduce your body’s ability to protect and prevent food or acids from the stomach from entering the lungs. Normally, your body is able to prevent this, but anesthesia medicines make it harder for your body to do so. When food or liquids from the stomach get into the lungs, doctors call it “aspiration.” This is rare, but can be dangerous if it does happen. Solid foods and liquids leave the stomach at different rates too. Solid food takes longer to empty from the stomach than liquids, so the time to stop eating solids (eight hours) is longer than that for clear liquids (two hours). The body has energy reserves to produce needed nutrients and fuel during fasting. Recently, studies have shown it is important to stay hydrated and have some carbohydrates in clear liquids up to two hours before surgery, so clear liquids are allowed until two hours before surgery. There are also special rules for babies and young children who need surgery. For example, you may give breast milk up to four hours before surgery. If your baby drinks formula, you should stop six hours before surgery, and all solid foods you should stop eight hours before. Your child’s doctor or nurse will give you exact instructions. What if you show up for surgery and have broken the no-eating rule? Will surgery be re-scheduled? If patients have not followed the fasting guidelines, surgery will be postponed or rescheduled due to the possible increased risk associated with not having an empty stomach. The exception would be emergency surgery that cannot be delayed in which case special precautions are taken to help prevent anything from getting into the lungs. What other pre-operative rules should be followed to the letter? All instructions given to patients before their surgery or procedure should be followed. There are specific medical reasons behind all the instructions and they are designed for safety — to minimize risks, lower complications like infections and enhance the recovery process to help patients get back to normal as quickly as possible. Also, many patients ask if they should continue taking medications before surgery. The answer is: It depends. Your doctor or nurse will tell you which medicines you should take and when. Some medicines need to be stopped before surgery. But for others, it’s important you keep taking them as usual. You may also get new medicines to take before surgery. You may be asked to take some medications before surgery as part of advanced pain management protocols. If you need to take medicine right before your surgery, you can take it with a sip of water.

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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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Being diagnosed with a chronic heart condition like atrial fibrillation (A-fib) can shift the course of your entire life. Embracing heart medications and lifestyle changes become your norm, and thanks to advancements in medicine and medical technology, managing the condition can bring you to a new sense of normalcy.  But what if a different option was possible – one that would make medications and activity limits a thing of the past?  This became the reality for Renown Health patient Richard Preyer after receiving a hybrid catheter ablation. Thanks to the vigilant surgical care of Shining Sun, MD, a cardiologist at the Renown Institute for Heart & Vascular Health, and his compassionate team, Richard has a new lease on life.  Minimally Invasive with Maximal Results  An A-fib patient since 2010 who had been living with an unfinished ablation, the 59-year-old Carson City resident turned to the internet to look for alternate solutions. He had heard that the Renown Institute for Heart & Vascular Health was a top-tier location for cardiovascular care. “I changed health insurance plans through Nevada Health Link to ensure I could see a Renown cardiologist,” said Richard.   Choosing a cardiologist was an even easier decision for Richard. Dr. Sun’s introductory Find a Doctor video on Renown’s YouTube channel, where he displayed his expertise and determination, was more than enough for Richard to choose him as his cardiac care leader.  At his first visit, Dr. Sun reviewed Richard’s records, and noted his prior unfinished ablation. The nine-hour procedure had been performed several years ago. With the enhanced technologies at Dr. Sun's disposal, Richard was excited at the thought of his life potentially being changed for good – with a minimally-invasive solution.  Dr. Sun collaborated closely with Richard’s previous and current care teams – including a surgeon who performed a maze operation on him right before his surgery at Renown, to ensure his hybrid ablation was tailored uniquely to him. “Dr. Sun is clearly a very powerful cardiologist with many connections, and the coordination between his team and my other doctors was great,” said Richard.   After working on the exterior of the heart in the first phase of the surgery and the interior of the heart during the second phase, Richard’s hybrid ablation was successful, completing the unfinished portion of his previous ablation.   “Fixing A-fib can take one to three ablations, and sometimes it never holds,” said Richard. “That is one of the largest reasons why I am so thankful for this procedure and how it ended up.”  Life After A-fib  Now comes the long, arduous healing process, right? Not for Richard. With only eight incisions (four on each side of his chest), he was able to remove his bandages after two days, and he healed completely in one week.  “I was even back to taking three-mile walks within a week of my operation,” said Richard.  No more blood thinners.  No more activity limits. And most importantly for Richard, no more heart-stabilizing medications that came with side effects he didn’t enjoy. He attributes his enhanced life to Dr. Sun and his team.   “I highly recommend Dr. Sun and everyone that works with him,” he said. “Everyone in the group, from the nurses and anesthesiologists going above-and-beyond to the schedulers who helped me navigate the appointment process, made me have a lot of confidence. Their calm demeanors made so much difference.”  Today, Richard now enjoys elongated walks in the northern Nevada outdoors, exotic vacations with his wife and, as he describes, “feeling like I’m in my 40’s again.” Learn more about the region's leader in cardiac health, heart and vascular care here.

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