DIS News - Welcome - College of Health and Prac/DIS...Volume 19, Issue 4 Page 2 Currently, 3 sodium...
Transcript of DIS News - Welcome - College of Health and Prac/DIS...Volume 19, Issue 4 Page 2 Currently, 3 sodium...
PATIENT INFORMATION:
RSV (Respiratory Syncytial Virus)—An Overview
What is RSV?
A respiratory virus which affects every-
one
Can cause upper and lower respiratory
tract infections
Usually most severe in children under 2
years old
Symptoms occur within 4-6 days of infec-
tion with the virus
Diagnosed with a mucus sample swab and
antigen detection test
How is RSV transmitted?
Direct or indirect contact with nasal or
oral secretions of infected patients
Patients can spread the virus to other peo-
ple for 3-8 days after infection
The virus can live on hard surfaces for
many hours
What are the symptoms of RSV?
Runny nose, sneezing
Cough, possibly wheezing
Fever
Decreased appetite
Very young children may also have
Irritability
Decreased activity
Breathing difficulties
What is the treatment for RSV?
Fluids like water and electrolyte-replacing
fluids
Tylenol® (acetaminophen) or Advil®
(ibuprofen) for fever
Blowing nose and using a bulb syringe to
remove nasal secretions
Rest
Medications to open the lungs
(bronchodilators) may help
Supplemental oxygen is necessary in se-
vere cases
Prevention is used in high-risk infants
with Synagis® (palivizumab)
What are some RSV statistics?
By 2 years of age, it is believed all chil-
dren will have been infected by the virus
Volume 19, Issue 4
April 2015
We welcome any comments
and suggestions for future
newsletter topics.
Editors in Chief:
Sherrill Brown, DVM, Pharm.D, BCPS
Christina Buchman, PharmD
SGLT2 Inhibitors 2
Viekira Pak® for Hepatitis C
3
Avycaz® (ceftazidime/avibactam)
4
Patient Information: Chronic Fatigue Syndrome
6
Patient Information: Ticks
7
Inside this issue:
DIS News Col lege of Heal th Professions and Biomedica l Sc iences
Drug Informa tion Service
25-40 out of 100 patients infected with RSV
will get bronchiolitis or pneumonia
5-20 out of 1000 patients infected with RSV
will need hospitalization
By Amy Eliason, PharmD Candidate
REFERENCES:
1. Respiratory syncytial virus infection (RSV)
(12/4/14). CDC Web site. Available at: http://
www.cdc.gov/rsv/. Accessed February 17,
2015.
2. Respiratory syncytial virus (RSV) (2/26/14).
Medline Plus Web site. Available at: http://
www.nlm.nih.gov/medlineplus/ency/
article/001564.htm. Accessed February 17,
2015.
3. Understanding RSV disease (2013). RSV
Protection Web site. Available at: https://
www.rsvprotection.com/what-is-rsv-
disease.html. Accessed February 20, 2015.
From: http://www.cdc.gov/rsv/index.html
Volume 19, Issue 4 Page 2
Currently, 3 sodium glucose co-transporter 2
(SGLT2) inhibitors are approved for the
treatment of type 2 diabetes as adjunct thera-
py to diet and exercise—canagliflozin
(Invokana™), dapagliflozin (Farxiga®), and
empagliflozin (Jardiance®).1-3 Inhibition of
SGLT2 in the proximal tubules of the kid-
neys reduces the renal reabsorption of glu-
cose, increases the urinary excretion of fil-
tered glucose, and therefore, decreases plas-
ma glucose concentrations.1-4 The Table
below compares the SGLT2 inhibitors.
The American Association of Clinical Endo-
crinologists (AACE) considers SGLT2 in-
hibitors as fourth-line monotherapy agents.
AACE recommends using metformin plus
GLP-1 receptor agonists, DPP4 inhibitors,
or thiazolidinedione first, then trying an
SGLT2 inhibitor with metformin.5 The
American Diabetes Association (ADA) also
recommends using SGLT2 inhibitors after
lifestyle medication and metformin.6 The
ADA does not specify which order agents
should used in beyond metformin as first-
line.6
Advantages of SGLT2 Inhibitors1-10
Novel mechanism of action
0.4-1.0% ↓ in HbA1c
Once daily, oral administration
Low incidence of hypoglycemia
↓ in body weight
Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors
Disadvantages of SGLT2 Inhibitors1-10
Cannot use in patients with renal
insufficiency
Cannot use in patients who are
hypovolemic
Cannot use in type 1 diabetes
Hypoglycemia is more common
when used as add-on therapy
Use with caution in patients with
hypotension
More expensive than other options
Canagliflozin
Canagliflozin is effective as monothera-
py or in combination with metformin,
sulfonylurea, insulin, or pioglitazone.1,7
Canagliflozin significantly decreased
HbA1c and body weight (-1.8 to -4.7 kg)
when used alone or in combination with
other anti-diabetic agents.1,7 However,
mean LDL-C increased in the canagli-
flozin groups. The most common ad-
verse events included UTI, genital my-
cotic infection, and increased urination.7
Dapagliflozin
Dapagliflozin is effective as monothera-
py and in combination with other anti-
diabetic agents.2,8 Dapagliflozin reduced
mean HbA1c and body weight from
baseline. The most common adverse
events were UTI, genital mycotic infec-
tion, and nasopharyngitis.2,8
A possible increase in bladder cancer
risk has been noted with dapagli-
flozin.2,8 Ten patients in 22 clinical
trials (n=6045) were diagnosed with
bladder cancer after treatment with
dapagliflozin; only one patient in the
placebo groups (n=3512) had bladder
cancer. Therefore, dapagliflozin should
not be used in patients with active blad-
der cancer.2,8
Empagliflozin
Empagliflozin is effective as monother-
apy and in combination with other anti-
diabetic agents.3,9 Empagliflozin re-
duced both HbA1c and body weight.9
Patients on empagliflozin also experi-
enced a decrease in blood pressure.
Nasopharyngitis, UTI, genital mycotic
infections, and dyslipidemia were the
most common. One patient taking 10
mg of empagliflozin had a cerebrovas-
cular accident that was deemed related
to the drug.9
By Liz Wolsfelt, PharmD Candidate
Efficacy Dosing Adverse Events Comments
Canagliflozin
(Invokana™)1,7 ↓ HbA1c 0.6-1.0% Initiate at 100 mg once
daily; may increase to
300 mg once daily
UTI, genital mycotic infections,
URTI, increased urination, consti-
pation, nausea, dyslipidemia
Do not use in patients
with CrCl < 45 mL/min
Dapagliflozin
(Farxiga®)2,8 ↓ HbA1c 0.5-0.9% Initiate at 5 mg once
daily; may increase to
10 mg once daily
UTI, genital mycotic infections,
nasopharyngitis, increased urina-
tion, nausea, dyslipidemia, back
pain, constipation
May be associated with
increased risk of bladder
cancer
Do not use in patients
with CrCl < 60 mL/min
Empagliflozin
(Jardiance®)3,9 ↓ HbA1c 0.4-0.8% Initiate at 10 mg once
daily; may increase to
25 mg once daily
UTI, genital mycotic infections,
URTI, increased urination, arthral-
gia, nausea, dyslipidemia
Possible increased risk of
stroke
Do not use in patients
with CrCl < 45 mL/min
Comparison of the SGLT2 Inhibitors
HbA1c=hemoglobin A1c; CrCl=creatinine clearance; URTI=upper respiratory tract infection; UTI=urinary tract infection
References on Page 5
Viekira Pak® is a new drug combination
package (ombitasvir/paritaprevir/
ritonavir 12.5/75/50 mg + dasabuvir 250
mg) for the treatment of chronic hepatitis
C genotype 1.1 It can be given with or
without ribavirin and is used for patients
with and without cirrhosis. Viekira Pak®
offers an advantage over interferon-
containing regimens because it has fewer
reported side effects. Also, compliance
should be increased with the packaging
of Viekira Pak® (see picture below).1
A sustained virologic response (SVR)
occurred in over 90% of genotype 1a
(GT1a) patients treated with Viekira
Pak® plus ribavirin (RBV) for 12 weeks
in four clinical trials.1 The patient popu-
lations of these trials included treatment
naïve groups as well as patients who had
previously been treated with peg-
interferon and RBV. SVR in all studies
of Viekira Pak® was defined as HCV
level below the lower limit of quantifica-
tion 12 weeks after the end of treatment.
Viekira Pak® treatment was effective in
patients with GT1a or genotype 1b
(GT1b) HCV with or without compen-
sated cirrhosis. In some patient popula-
tions, Viekira Pak® does not have to be
given with RBV, which further decreas-
es the pill burden and improves compli-
ance.1
Each daily dose pack of Viekira Pak®
contains two 12.5/75/50 mg ombitasvir,
paritaprevir, ritonavir tablets and two
250 mg dasabuvir tablets. Both om-
bitasvir/paritaprevir/ritonavir tablets are
taken in the morning, while one da-
sabuvir tablet is taken in the morning
and the other tablet is taken in the even-
ing.1 All of the Viekira Pak® tablets
should be taken with a meal; however,
the fat and calorie content of the meal
will not affect the absorption of the med-
ications. The recommended treatment
duration is 12 weeks for all populations,
with the exception of patients with GT1a
and cirrhosis which requires 24 weeks of
treatment.1
Due to increased ALT elevations in
women taking ethinyl estradiol-
containing medications, other forms of
contraception should be used when tak-
ing Viekira Pak®.1 Ethinyl estradiol-
containing medications may be resumed
two weeks after completion of therapy
with Viekira Pak®. ALT elevations were
similar in subjects taking other estrogens
concomitantly with Viekira Pak® and
patients who were not taking any estro-
gens; however, caution is recommended
when using these medications together.
Viekira Pak® interacts with other medi-
cations, so a thorough medication review
Page 3 DIS News
should be completed prior to starting
this therapy.1
Viekira Pak®, like other medications in
for hepatitis C, is expensive (~$83,000
for 12 weeks of treatment).2 AbbVie’s
assistance program ―proCeed – Cus-
tomer Solutions‖ helps with patient
copays for people with insurance, as
well as offering financial assistance for
eligible patients.3
By Casey Lauver, PharmD Candidate
REFERENCES:
1. Viekira Pak® [package insert].
North Chicago, IL: AbbVie Inc.;
2015 February.
2. Porter LK. AbbVie's Viekira Pak:
what you need to know about the
newest hepatitis C treatment
(12/22/2014). Hep Web site.
Available at: http://
blogs.hepmag.com/
lucindakporter/2014/12/
abbvies_viekira_pak.html. Ac-
cessed February 28, 2015.
3. proCeed Resources (n.d.). Viekira
Pak® Web site. Available at:
http://www.viekirahcp.com/
proCeed/proCeed-resources/. Ac-
cessed February 28,2015.
Viekira Pak® for Hepatitis C
From: https://www.viekirahcp.com/dosing/packaging/
Avycaz® (ceftazidime/avibactam) is a
new cephalosporin/beta-lactamase inhib-
itor combination product that was ap-
proved in February 2015 for the treat-
ment of complicated urinary tract infec-
tions, pyelonephritis, and complicated
intra-abdominal infections in combina-
tion with metronidazole.1,2 Ceftazidime/
avibactam has activity against extended
beta-lactamase producing organisms and
provides another avenue for treatment of
these resistant organisms.2
Ceftazidime/avibactam has the same
mechanism of action as other beta-
lactam/beta-lactamase combination
products – inhibition of peptidoglycan
cross linking in bacterial cell walls.2
Avibactam alone does not have antimi-
crobial activity. Avibactam prevents
degradation of ceftazidime by beta-
lactamases, which prolongs
ceftazidime’s duration of action and ex-
pands its activity to beta-lactamase-
producing organisms. Although
ceftazidime/avibactam has activity
against resistant organisms, it is not ef-
fective against bacteria that are resistant
due to overexpression of efflux pumps or
decreased membrane permeability.2
Ceftazidime-avibactam has demonstrat-
ed efficacy against the following organ-
isms (check package insert for complete
list):2,6
Escherichia coli (including cephalo-
sporin-resistant organisms)
Klebsiella species (including cephalo-
sporin-resistant organisms)
Enterobacter species
Haemophilus influenzae
Moraxella catarrhalis
Pseudomonas aeruginosa (including
ceftazidime- and meropenum-resistant
strains)
Extended spectrum beta-lactamase-
producing organisms
In a phase II, randomized, double-blind,
controlled trial, clinical response was
similar with ceftazidime/avibactam +
metronidazole and meropenem mono-
therapy for patients with complicated
intra-abdominal infections.4 The study
included 203 participants who were
treated for an average of 6 days. Clinical
response rates for the ceftazidime/
avibactam + metronidazole and mero-
penem monotherapy groups were 97.1 %
and 97.4%, respectively.4
A large number of patients in each group
had polymicrobial infections, and the
most commonly isolated organism was
E. coli.4 Overall rates of adverse reac-
tions were similar between groups. Nau-
sea, vomiting, and abdominal pain were
more common in the ceftazidime/
avibactam + metronidazole group while
increased liver enzymes were more com-
mon in the meropenem group. This study
was limited by the small number of pa-
tients, the large number of E. coli iso-
lates, the large number of appendicitis
cases, and the patients’ low acute physi-
ological assessment and chronic health
evaluation (APACHE II) scores.4
Response rates were also similar be-
tween ceftazidime/avibactam and
imipenem/cilastatin in a phase II, ran-
domized, single-blind study in 135 pa-
tients with complicated urinary tract
infections ± pyelonephritis.5 Response
rates in patients with urinary tract infec-
tions in the ceftazidime/avibactam and
imipenem/cilastatin groups were 70.4%
and 71.4%, respectively.5 There was also
no difference in response rates for pa-
tients with pyelonephritis between the
groups (72.2% vs. 73.7%, respectively).
The median duration of intravenous ther-
apy for both treatment groups was simi-
lar (5 days for ceftazidime/avibactam
and 6 days for imipenem/cilastatin).5
The ceftazidime/avibactam group had
slightly lower adverse event rates than
the imipenem/cilastatin group (67.6% vs.
76.1%, respectively).5 While headache
and infusion site reactions were the most
commonly reported adverse reactions,
the ceftazidime/avibactam patients expe-
rienced far fewer infusion site reactions
than the imipenem/cilastatin patients
Page 4 DIS News
(5.9% vs. 22.4%). The most common
organism isolated was E. coli while
Klebsiella species were not well repre-
sented. This study had several limita-
tions. Only a small number of patients
had a positive blood culture which
limits extrapolation to patients with
urosepsis. All patients with positive
blood cultures were infected with E.
coli and this was a small study so the
results may not be generalizable. The
doses of ceftazidime/avibactam used in
this study were less than those current-
ly recommended by the package insert
(500/125 mg every 8 hours vs.
2000/500 mg every 8 hours), which
may explain the low response rates
reported for some study subgroups.5
In clinical trials, ceftazidime/
avibactam has generally been well
tolerated.4,5 Reported adverse reactions
include those expected with a broad
spectrum beta-lactam antibiotic. Hy-
persensitivity reactions have been re-
ported, do not use ceftazidime-
avibactam in patients with a history of
cephalosporin allergies and use with
caution in patient with other bet-lactam
allergies.2 There is a risk of Clostridi-
um dificile-associated diarrhea and
allergic reaction.2 Ceftazidime/
avibactam also carries a risk of sei-
zures due to the ceftazidime compo-
nent. The risk of seizures is higher in
patients with renal failure due to the
antibiotic’s extensive renal elimina-
tion.2
Due to its broad spectrum, ceftazidime/
avibactam may be an appropriate
choice for patients with suspected or
confirmed extended spectrum beta-
lactamase-producing organisms or
ceftazidime-resistant organisms. Phase
III trials with ceftazidime-avibactam
have not yet been published and will
provide more data about this new anti-
biotic.
By Emily Kobos, PharmD Candidate
Avycaz® (ceftazidime/avibactam)
References on Page 5
Page 5 DIS News
Avycaz® References
(from page 4)
1. FDA approves new antibacterial
drug Avycaz (2/27/2015). FDA
Web site. Available at: http://
www.fda.gov/NewsEvents/
Newsroom/PressAnnouncements/
ucm435629.htm. Accessed March
16, 2015.
2. Avycaz [package insert]. Cincin-
nati, OH: Forest Pharmaceuticals,
Inc.;2015 February.
3. Zhanel GG, Lawson CD, Adam H,
et al. Ceftazidime-avibactam: a nov-
el cephalosporin/β-lactamase inhibi-
tor combination. Drugs 2013;73
(2):159-177.
4. Lucasti C, Popescu I, Ramesh MK,
Lipka J, Sable C. Comparative study
of the efficacy and safety of
ceftazidime/avibactam plus metroni-
dazole versus meropenem in the
treatment of complicated intra-
abdominal infections in hospitalized
adults: results of a randomized, dou-
ble-blind, phase II trial. J Antimi-
crob Chemother 2013;68(5):1183-
1192.
1. Invokana® (canagliflozin)
[package insert]. Titusville, NJ:
Janssen Pharmaceuticals; 2014
May.
2. Farxiga® (dapagliflozin) [package
insert]. Wilmington, DE: Astra-
Zeneca Pharmaceuticals; 2014
August.
3. Jardiance® (empagliflozin)
[package insert]. Ridgefield, CT:
Boehringer Ingelheim Pharmaceu-
ticals, Inc.; 2014 August.
4. Hasan FM, Alsahli M, Gerich JE.
SGLT2 inhibitors in the treatment
of type 2 diabetes. Diabetes Res
Clin Pract 2014;104(3):297-322.
5. Abrahamson MJ, Barzilay JI,
Blonde L, et al. AACE compre-
hensive diabetes management al-
gorithm. Endocr Pract 2013;19
(2):327-335.
6. Diabetes Association standards of
medical care in diabetes. Diabetes
Care 2015;38(1):1-94.
7. Stenlof K, Cefalu WT, Kim KA, et
al. Efficacy and safety of canagli-
flozin monotherapy in subjects
with type 2 diabetes mellitus inad-
equately controlled with diet and
exercise. Diabetes Obes Metab
2013;15(4):372-382.
8. Ferrannini E, Ramos SJ, Salsali A,
Tang W, List JF. Dapagliflozin
monotherapy in type 2 diabetic
patients with inadequate glycemic
control by diet and exercise: a
randomized, double-blind, placebo
-controlled, phase 3 trial. Diabetes
Care 2010;33(10):2217-2224.
9. Roden M, Weng J, Eilbracht J, et
al. Empagliflozin monotherapy
with sitagliptin as an active com-
parator in patients with type 2 dia-
betes: a randomised double-blind,
placebo-controlled, phase 3 trial.
Lancet Diabetes Endocrinol
2013;1(3):208-219.
10. Lexi-Comp, Inc. (Lexi-Drugs® ).
Lexi-Comp, Inc.; January 29,
2015.
SGLT2 Inhibitors References (from page 2)
Chronic fatigue syndrome (CFS) is a
debilitating disorder that can cause se-
vere, unexplained mental and physical
exhaustion. People with CFS do not get
better with rest, and often the fatigue
gets worse with physical or mental ex-
haustion or stress.
Usually the fatigue happens suddenly,
and sometimes it occurs after an illness,
like a respiratory infection (bronchitis)
or mononucleosis (mono) infection.
CFS is more common in women, Cauca-
sian populations, and young and middle-
age adults. It is not very common in
children or the elderly.
Causes of CFS
There is very little knowledge about why
people get chronic fatigue syndrome.
Although scientists don’t know exactly
what causes CFS, some possibilities are:
Infections (i.e. Lyme disease)
Immune system dysfunction
Low blood pressure (hypotension)
Stress
Nutritional deficiency
Symptoms & Diagnosis of CFS
CFS is characterized by severe fatigue
that lasts longer than 6 months. Although
fatigue is the main symptom, other
symptoms may be present, including:
Muscle pain
Joint pain
Memory loss
Problems concentrating
Sore throat
Headaches
Difficulty sleeping (insomnia)
Tender lymph nodes
Diagnosis of CFS can be complicated
since there are no tests to determine if
the disease is present. Diagnosis is based
solely on symptoms and a medical histo-
ry taken by your healthcare provider.
Treating CFS
Managing CFS can be very difficult and
complex. Unfortunately, there is no cure
for CFS, and treatment consists of symp-
tom management and teaching patients
how to cope with the disease. Some
treatments that may be effective include:
Cognitive behavioral therapy (CBT)—
appointments with a counselor to dis-
cuss chronic fatigue syndrome and
ways to cope with the disease.
Maintaining a healthy lifestyle—this
means eating a healthy, well-balanced
diet and exercising regularly. Exercise
can sometimes make CFS worse, but
an overall lack of physical activity will
also worsen the symptoms. It is im-
portant to maintain an active
lifestyle with low-intensity
exercises.
Other potential treatments:
Antibiotics—may be used
if the patient has an infection,
but antibiotics are not effec-
tive for the treatment of CFS.
Sleep-aid medications—
often people are unable to
sleep due to CFS. This can
sometimes be helped with
medications.
Antidepressants—
depression is common in peo-
ple with CFS. There are several effec-
tive treatments for depression, and
your healthcare provider may start you
on something to help you cope better
Fibromyalgia treatments—
fibromyalgia is very similar to CFS
and can also cause pain with no known
cause. Your healthcare provider may
give you a medication commonly used
Page 6 DIS News
to treat fibromyalgia.
More Information on CFS
Always ask your doctor, pharma-
cist, or other healthcare provider
for information on CFS
www.cdc.gov/cfs
www.nlm.nih.gov/medlineplus/
chronicfatiguesyndrome.html
By Liz Wolsfelt, PharmD Candidate
REFERENCESz :
1. Gluckman SJ. Patient Information:
Chronic fatigue syndrome (beyond
the basics). In: UpToDate, Weller
PF (Ed), UpToDate, Waltham,
MA. Accessed on January 12,
2015.
2. General information- chronic fa-
tigue syndrome (CFS). CDC Web
site. Available at: www.cdc.gov/
cfs/general/index.html. Accessed
January 12, 2015.
3. Prins JB, van der Meer JW,
Bleijenberg G. Chronic fatigue
syndrome. Lancet 2006;367
(9507):346-355.
4. Whiting P, Bagnall, Sowden AJ, et
al. Interventions for the treatment
and management of chronic fa-
tigue syndrome: a systematic re-
view. JAMA 2001;286(11):1360-
1368.
5. Monitoring the use of all medi-
cines and supplements. CDC Web
site. Available at: http://
www.cdc.gov/cfs/management/
medicines.html. Accessed January
13, 2015.
6. Straus SE. Pharmacotherapy of
chronic fatigue syndrome: another
gallant attempt. JAMA 2004;292
(10):1234-1235.
PATIENT INFORMATION:
Chronic Fatigue Syndrome
From: http://www.medicinenet.com/chronic_fatigue_syndro me_pictures_slideshow/article.htm
The University of Montana
Skaggs School of Pharmacy
32 Campus Drive
Missoula, MT 59812-1522
College of Health Professions and Biomedical Sciences
Drug Information Service
Phone: 406-243-5254
Fax: 406-243-5256
Email: [email protected]
www.health.umt.edu/DIS
PATIENT INFORMATION:
TICKS!!
Ticks are external parasites which live
off the blood of other species including
mammals, birds, reptiles, and amphibi-
ans. In Montana, ticks are most com-
mon in the months of March through
July and are usually found in thick
brushy country with lots of sun expo-
sure. Ticks are associated with the
spread of diseases such as Rocky
Mountain spotted fever and Lyme dis-
ease.
Avoiding Ticks
Reducing exposure to ticks is the pri-
mary way to prevent tick-borne illness.
The best ways to avoid ticks is to stay
on designated trails and avoid brushy
areas. Bbug repellent containing at
least 20% DEET will prevent ticks,
although protection only lasts for a few
hours after the initial application.
Permethrin 0.5% can be used to treat
clothes and gear and will repel ticks for
up to four days after application. Tucking
your shirt into your pants and your pants
into your socks will make it hard for ticks
to get onto your skin. Wearing light color
clothing will make it easier to spot ticks.
Tick Check
At the end of every day spent in tick
country, you need to perform a tick check.
Clothes and gear should be inspected
thoroughly for ticks. A shower and a full
body tick check with the use of a mirror is
recommended. Children should be in-
spected by an adult. Pets in tick-infested
areas should also be checked under their
front legs as well as on their neck and
ears. Tick checks should be performed
daily for 2-3 days after exposure to ticks
to make sure nothing goes unnoticed.
How to Remove a Tick
Unfortunately, even with proper precau-
tions, ticks may still find a way to bite.
Ticks have an anesthetic in their saliva
which numbs the area they bite and lets
them attach undetected. The most im-
portant thing to remember when removing
a tick is to make sure the entire tick is
removed. Use a fine-point pair of twee-
zers, grab the tick as close to the skin
where attached as possible, and pull
straight out. Squeezing or scratching at the
tick is not recommended because part of
the tick may break off and still be at-
tached. Once a tick is removed, clean the
area with rubbing alcohol or soap and
water and allow it to heal.
Signs of Tick-Borne Illness
Symptoms from a tick-borne illness can
start while the tick is still attached or up to
30 days after removal. Common symp-
toms include fever or chills, headache,
muscle ache, joint pain, and rash. If you
have any of these symptoms during or
after a tick bite, you should see a
healthcare professional for a full evalua-
tion.
By Hugh Daniels, PharmD Candidate
REFERENCES:
1. Ticks (5/5/2014). CDC Web site.
Available at: http://www.cdc.gov/
ticks/. Accessed April 3, 2015.
2. Tips to prevent tick bites
(11/12/2014). EPA Web site. Availa-
ble at: http://www2.epa.gov/insect-
repellents/tips-prevent-tick-bites. Ac-
cessed April 3, 2015.
From: http://www.cdc.gov/ticks/resources/
Hunterfactsheet.pdf
From: http://www.cdc.gov/lyme/removal/index.html