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: druginfo@umontana.edu

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