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Managing glaucoma requires a commitment to a daily routine. Because glaucoma is often “silent” (meaning you won't feel your eye pressure rising), the medications are your primary defense against permanent vision loss.

Here are five essential things every patient should know about glaucoma medications:

1. Consistency is Your Most Powerful Tool

Glaucoma eye drops only work for a specific window of time (usually 12 to 24 hours). If you skip a dose, your eye pressure can spike, causing “silent” damage to the optic nerve.

• The Goal: Maintain a steady level of medication in your eye around the clock.
• Pro-Tip: Tie your drop schedule to a daily habit, like brushing your teeth or having your morning coffee, to ensure you never miss a dose.

2. Proper Technique Prevents “Body-Wide” Side Effects

Many patients don't realize that eye drops can enter the bloodstream through the tear ducts, potentially affecting your heart or lungs. You can minimize this using a technique called Punctal Occlusion:

• After putting in a drop, close your eyes gently (do not squeeze or blink rapidly).
• Use your finger to press firmly on the inner corner of your eye (near the bridge of your nose) for 1 to 2 minutes.
• This keeps the medicine in your eye and prevents it from draining into your throat and bloodstream.

3. The “Five-Minute Rule” for Multiple Drops

If your doctor prescribes more than one type of eye drop, wait at least 5 minutes between them.

• Why? Your eye can only hold about one-sixth of a single drop at a time. If you put the second drop in too quickly, it will simply wash out the first one before it has a chance to be absorbed, making your treatment less effective.

4. Side Effects Are Common — and Manageable

Don't be alarmed if your eyes sting, turn red, or feel “gritty” when you first start a new medication.

• Expect Local Changes: Some drops (Prostaglandins) can cause your eyelashes to grow longer or even permanently darken the color of your iris (the colored part of your eye).
• Monitor Systemic Effects: Beta-blocker drops can sometimes slow your heart rate or worsen asthma. Always tell your eye doctor about your full medical history, especially heart or lung conditions.
• Refrigeration Trick: If you have trouble feeling if the drop actually landed in your eye, try keeping the bottle in the fridge. The cold sensation makes it much easier to tell if you’ve “hit the target.”

5. They Don't Make Your Vision Better (But They Keep It)

One of the hardest parts of glaucoma treatment is that the medication doesn't improve your sight or make your eyes feel better — it simply preserves the vision you still have.

• Stay the Course: You may feel like the drops aren't “doing anything” because you don't see a difference, but they are working behind the scenes to prevent blindness.
• Never Stop Suddenly: Abruptly stopping glaucoma medication can cause a dangerous “rebound” spike in eye pressure.

Prosper and be in health

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William Garst is a consultant pharmacist who lives in Alachua, Florida. He is semi-retired and works part time at Lake Butler Hospital in Lake Butler, Florida. William received his pharmacy degree at Auburn University and a Doctor of Pharmacy from Colorado University. The Pharmacy Newsletter is a blog where you can find other informative columns. He may be contacted at garstcph@gmail.com.

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The history of vitamin K is a story of a single discovery that later expanded to include a family of related compounds, each with distinct roles in the body. The journey from initial observation to a detailed understanding of vitamin K1 and K2 spans several decades and involves multiple scientists.

The Initial Discovery of Vitamin K

The story begins in the late 1920s with Danish biochemist Henrik Dam.

• 1929: Dam was conducting experiments on chickens, feeding them a diet that was deficient in cholesterol and fat. After a few weeks, he noticed that the chickens developed a mysterious bleeding disorder, where their blood was slow to clot.
• 1935: Dam concluded that a new, fat-soluble vitamin was missing from the chickens' diet. He named this substance “Koagulations-Vitamin,” which is German and Danish for “coagulation vitamin.” This is where the letter “K” comes from.
• 1939: American biochemist Edward Doisy and his team at St. Louis University isolated and determined the chemical structure of the primary plant-based form of the vitamin, which they named phylloquinone. This substance would later be officially named Vitamin K1.

For their work on the discovery and chemical nature of vitamin K, Dam and Doisy were jointly awarded the Nobel Prize in Physiology or Medicine in 1943.

Vitamin K1 (Phylloquinone)

• Source: From the very beginning, it was clear that the "anti-hemorrhagic" factor came from plant sources, particularly green, leafy vegetables like spinach and kale.
• Function: Early research, and the Nobel Prize, focused on its essential role in blood coagulation. Vitamin K1 acts as a crucial cofactor for an enzyme that "activates" several clotting factors in the liver, including prothrombin (Factor II), Factor VII, Factor IX, and Factor X. Without this activation, these proteins cannot function properly, leading to uncontrolled bleeding.
• Modern Understanding: Vitamin K1's role in blood clotting remains its most well-known and clinically important function. It is used medically to treat bleeding disorders, and is routinely given to newborns to prevent a condition called Vitamin K Deficiency Bleeding (VKDB).

Vitamin K2 (Menaquinones)

The story of vitamin K2 is more recent and has led to a re-evaluation of the entire vitamin K family.

• Discovery of a Second Form: Soon after the discovery of vitamin K1, scientists realized that there was another form of vitamin K. This second form, found in animal products and produced by bacteria, was chemically different. It was named menaquinone and collectively referred to as Vitamin K2. Unlike K1, which has a single chemical structure, K2 is a family of related compounds, designated as MK-4, MK-7, MK-9, etc., based on the length of their side chain.
• Japanese Fermented Foods: A major breakthrough in the understanding of K2 came from research into the traditional Japanese food natto, a dish of fermented soybeans. Scientists discovered that natto was an incredibly rich source of a long-chain menaquinone, specifically MK-7. This led to a boom in research on K2's health benefits.
• Beyond Blood Clotting: While K1 is primarily used by the liver for blood coagulation, researchers found that K2 has a different fate in the body. It is preferentially used by other tissues, especially bone and arterial tissues.
• The “Calcium Paradox”: A key aspect of modern K2 research is its role in “calcium trafficking.” Scientists have discovered that K2 activates proteins like osteocalcin in bones, which helps bind calcium and integrate it into the bone matrix. At the same time, K2 activates Matrix Gla Protein (MGP), a protein that prevents calcium from building up in soft tissues like arteries. This led to the theory that K2 may play a significant role in both bone health (preventing osteoporosis) and cardiovascular health (preventing arterial calcification).

Summary of Key Differences and Modern Research

The history of vitamin K is a testament to how scientific understanding evolves. What began as a single discovery of a “coagulation vitamin” has expanded to encompass a complex family of nutrients with far-reaching effects on human health.

Prosper and be in health.

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William Garst is a consultant pharmacist who lives in Alachua, Florida. He is semi-retired and works part time at Lake Butler Hospital in Lake Butler, Florida. William received his pharmacy degree at Auburn University and a Doctor of Pharmacy from Colorado University. The Pharmacy Newsletter is a blog where you can find other informative columns. He may be contacted at garstcph@gmail.com.

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Everyone taking prescription medications should be aware of essential safety practices. Here are six tips to help ensure you are taking your medicine correctly and safely:

1. Maintain a Comprehensive Medication List

Keep an up-to-date list of everything you take, and share it with every healthcare provider you see (doctors, specialists, dentists, and pharmacists).

• Include: All prescription drugs, over-the-counter (OTC) medications, vitamins, herbs, and dietary supplements.
• Detail: The name, dosage, how often you take it, and the reason it was prescribed.
• Why it matters: This is the most crucial step to prevent dangerous drug-to-drug interactions, to ensure you don't accidentally overdose on two products with the same active ingredient, and to help your doctor avoid prescribing medicine you shouldn't take.

2. Know the "Five W's" of Each New Drug

Before you leave the doctor's office or the pharmacy, make sure you know the following for every new prescription:

• What is the name of the drug and what is it for?
• When should I take it (e.g., morning, night, with food, on an empty stomach)?
• What are the most common side effects, and when should I call the doctor?
• What foods, drinks (like alcohol or grapefruit juice), or other medications should I avoid?
• Why am I taking this (What is the goal of the therapy)?

3. Take Your Medication Exactly as Prescribed

Consistency is key to the drug's effectiveness and your safety.

• Follow Directions: Take the exact dose at the exact time(s) specified. Do not skip doses, and never take a larger dose because you think it will work faster.
• Do Not Stop Early: Finish the full course of a prescription (especially antibiotics), even if you start to feel better. Never stop taking a maintenance drug on your own; always consult your doctor first.
• Ask Before Modifying: Do not crush, cut, or chew tablets unless your pharmacist or doctor specifically says it is safe, as this can affect how the drug is absorbed or release the medicine too quickly.

4. Use a Single Pharmacy

Whenever possible, fill all your prescriptions at the same pharmacy.

• Interaction Check: This allows your pharmacist—who is a medication expert—to have a complete and centralized record of your profile and automatically check for potential drug interactions or dosage conflicts.
• Ask Questions: Your pharmacist is your best resource for practical advice on when and how to take a medication and what common side effects to expect.

5. Store and Dispose of Medication Safely

Improper storage can ruin the drug's effectiveness, and improper disposal can lead to danger.

• Storage: Keep most medications in a cool, dry place, away from heat and direct sunlight. The bathroom medicine cabinet is often too humid for proper storage.
• Security: Always store medications, especially controlled substances and pain relievers, in a secure place out of reach and out of sight of children, pets, and visitors.
• Disposal: Never flush medicine down the toilet or throw it in the trash unless the label specifically instructs you to. Find a drug take-back program or a community disposal site (often at local police departments or pharmacies) for safe disposal of unused or expired drugs.

6. Never Share or Borrow Prescription Medication

Medications are prescribed based on an individual's specific medical condition, weight, allergies, and other concurrent medications.

• For You Only: Never take medicine prescribed to another person, even if you have the same symptoms. What is helpful for one person could be dangerous or deadly for another.
• Do Not Share: Never give your prescription to a family member or friend. If you have unused medication, dispose of it safely.

Prosper and be in health.

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William Garst is a consultant pharmacist who lives in Alachua, Florida. He is semi-retired and works part time at Lake Butler Hospital in Lake Butler, Florida. William received his pharmacy degree at Auburn University and a Doctor of Pharmacy from Colorado University. The Pharmacy Newsletter is a blog where you can find other informative columns. He may be contacted at garstcph@gmail.com.

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~ The First Recorded Clinical Trial in 1747 ~

The history of Vitamin C is closely linked to the understanding and eventual conquest of scurvy, a debilitating and often fatal disease that plagued sailors on long voyages for centuries.

Early Observations

As early as the 15th century, it was noted that certain foods, particularly citrus fruits, had a curative effect on scurvy. Vasco da Gama's voyages, for instance, observed this link.

In 1747, James Lind, a British naval surgeon, conducted a controlled experiment demonstrating that citrus fruits effectively prevented scurvy. He compared various treatments among sailors with scurvy and found that only those receiving oranges and lemons recovered. This is perhaps, the first recorded clinical trial.

Despite Lind's groundbreaking work, it took several decades for the British Navy to mandate citrus fruit or juice as a regular provision for sailors, earning them the nickname “limeys.”

The Dawn of Vitamin Research:

In 1912, Casimir Funk introduced the concept of “vitamins” as essential dietary components. The anti-scorbutic factor was soon recognized as a water-soluble substance, initially called “water-soluble C.”

Isolation and Identification:

In 1928, Hungarian scientist Albert Szent-Györgyi isolated a substance from animal adrenal glands, naming it “hexuronic acid.” He suspected it might be the anti-scorbutic factor.

Around the same time, in 1932, American biochemist Charles Glen King also isolated vitamin C in his laboratory and concluded it was the same as Szent-Györgyi's hexuronic acid. There was some dispute over who made the definitive connection first, possibly due to communication delays.

Working independently, Szent-Györgyi and his colleague Joseph Svirbely conducted experiments on guinea pigs (which, like humans, cannot synthesize vitamin C) and proved that hexuronic acid was indeed the anti-scorbutic factor. They renamed it “ascorbic acid,” meaning “anti-scurvy.”

Structural Determination and Synthesis:

In 1933, British chemist Norman Haworth determined the chemical structure of vitamin C. Haworth and Szent-Györgyi jointly proposed the name “ascorbic acid”

Both Szent-Györgyi and Haworth were awarded Nobel Prizes in 1937 for their work on vitamin C. Szent-Györgyi received the Nobel Prize in Physiology or Medicine for his discoveries concerning biological combustion, with specific reference to vitamin C, and Haworth received the Nobel Prize in Chemistry for his work on the constitution of carbohydrates and vitamin C.

Further Discoveries and Applications:

Szent-Györgyi continued his research, famously identifying paprika as an exceptionally rich and easily accessible source of vitamin C, allowing for its production in larger quantities.

Since its discovery, vitamin C has been extensively studied for its various roles in human health, including its function as an antioxidant, its involvement in collagen synthesis, immune function, and iron absorption.

Today, vitamin C is recognized as an essential nutrient, and its deficiency is known to cause scurvy, characterized by symptoms like weakness, bleeding gums, and poor wound healing.

Research continues to explore the potential benefits of vitamin C in preventing and treating various diseases.

The history of vitamin C is a compelling story of scientific investigation driven by the need to combat a devastating disease. From empirical observations to isolation, structural determination, and synthesis, the journey to understanding and utilizing this essential nutrient has significantly impacted human health

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William Garst is a consultant pharmacist who lives in Alachua, Florida. He is semi-retired and works part time at Lake Butler Hospital in Lake Butler, Florida. William received his pharmacy degree at Auburn University and a Doctor of Pharmacy from Colorado University. The Pharmacy Newsletter is a blog where you can find other informative columns. He may be contacted at garstcph@gmail.com.

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