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					Central Rexall Drugs,Inc.
125 East Thomas Street
P. O. Box 1318
Hammond, LA 70404
985-345-5120       Fax 985-345-5178                         Donald K. Fellows, PD
www.centraldrugs.net
Email: centraldrugs@i-55.com                                Compounding Specialists

     What is compounding?
        o Compounding is the process in which the Pharmacist uses pure ingredient
           chemicals to make your medications.
     Why would I want/need to have a prescription compounded?
        o If you need a specific medication, medication strength, or dosage form that is not
           available, then your medication must be compounded (for example, you may want
           a specific flavor, need a discontinued medication, or need a unique formulation of
           a medication).
     Why can’t my regular pharmacy compound my prescription?
        o A compounding only pharmacy uses state-of-the-art equipment, chemicals, and
           advanced techniques to compound and ensure quality products. Other pharmacies
           do not have the time, equipment, chemicals, or education to “custom-make” your
           medications.
     What types of things do you compound?
        o A compounding only pharmacy compounds: topical creams and ointments,
           flavored suspensions (any flavor), ophthalmic preparations, suppositories, sprays,
           lozenges, capsules, powders, enemas, veterinary formulations and many, many,
           more!
     Why don’t you accept my insurance?
        o There are so many insurance plans available that we have decided to focus our
           expertise on solving your medication problems and let insurance companies utilize
           their expertise in solving insurance needs.

                   Central Rexall Drugs, Inc. is devoted to working with you to solve your medication problems.
                               Our goal is to make the medication fit you in the best possible way.
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                                          Symptoms List
                                       These lists are not all inclusive.
  Lack Of Progesterone                             Lack Of Estrogen
   Headache.                                       Hot Flashes
   Low Libido                                      Shortness of Breath
   Anxiety                                         Night Sweats
   Swollen Breasts                                 Sleep Disorders
   Moodiness                                       Vaginal Dryness
   Fuzzy Thinking                                  Dry Skin
   Depression                                      Anxiety
   Food Cravings                                   Mood Swings
   Irritability                                    Headache
   Insomnia                                        Depression
   Cramps                                          Memory Loss
   Emotional Swings                                Heart Palpitations
   Painful Breasts                                 Yeast Infections
   Weight Gain                                     Vaginal Shrinkage
   Bloating                                        Painful Intercourse
   Inability to concentrate                        Inability to Reach Orgasm
   Early Menstruation                              Lack of Menstruation
   Painful Joints                                  _____________________
   Asthma                                          _____________________
   Acne                                            _____________________
   ______________________                          _____________________
  Abundance of Progesterone                        Abundance of Estrogen
   Depression                                      Water Retention
   Somnolence                                      Fatigue
                                                    Breast Swelling
                                                    Fibro-cystic Breasts
                                                    Premenstrual-like Mood Swings
                                                    Loss of Sex Drive
                                                    Heavy or Irregular Menses
                                                    Uterine Fibroids
                                                    Craving for sweets
                                                    Weight Gain




Central Rexall Drugs   875dadee-126b-4d87-accf-2211ecfd4816.doc             Page 2 of 11
                                  Bio-Identical Hormones
                 Human Estrogen                                          Premarin®
Estrone           10-20%                                       Estrone            75-80%
Estradiol         10-20%                                       Estradiol & Others 5-19%
Estriol           60-80%                                       Equillin            6-15%

          Tri-Est (Original) 2.5 mg                             Bi-Est (Original) 2.5mg
Estrone            0.25mg (10%)                                Estradiol      0.5mg (20%)
Estradiol          0.25mg (10%)                                Estriol        2.0mg (80%)
Estriol            2.0mg (80%)
                   Estrogen: Types and Kinds, Transport and Metabolism
 17ß-estradiol is the primary estrogen of ovarian origin and the major estrogenic hormone in the pre-menopausal
  woman. If is formed by the aromatization of testosterone.
 Estrone, the primary estrogenic hormone in the post-menopausal woman, is made from peripheral conversion
  of androstenedione (e.g., in adipose cells, liver and skin).
 Estriol is a biologically weak estrogen, created by metabolism of estrone. It is highest during pregnancy, and has
  functions related to fetal development.
 Estrogen circulates throughout the body bound to the protein SHBG (Sex-Hormone Binding Globulin),
  resulting in a circulating reservoir of hormone, and acting as a buffer against sudden changes in plasma levels. It
  is believed that the unbound (free) hormone has biological activity.
 Free estrogen binds to estrogen receptors on breast cells, female sex organs, skin, brand and liver, and changes
  the rate of transcription of specific genes in these cells.
 Following metabolism in the liver, estrogenic compounds are excreted.
                                         Dosage Comparison Chart*
Conjugated         Estriol      Tri-Est       Estradiol      Estradiol     Estropipate      Esterified
Estrogens                      or Bi-Est                    Transdermal                     Estrogens
 0.625 mg              5 mg     2.5 mg          1 mg        0.05 mg/24       0.75 mg        0.625 mg
                                                                hrs
Medroxyprogesterone                                              Progesterone
    2.5-5 mg                                                         100mg
       10 mg                                                         200mg
NOTE: The above information is to be used as reference only it in no way is indication a recommendation for any
product, for any patient or for any clinical situation.
*Chart compiled by Jim Paoletti, R Ph. PCCA, Pharmacy Consulting Department.




Central Rexall Drugs          875dadee-126b-4d87-accf-2211ecfd4816.doc            Page 3 of 11
                                               Central Rexall Drugs, Inc.
                                         Patient Information and Update
____________________ _________________                                                    ___    _____       ________
      (Last Name)                                        (First Name)                     (MI)    (Sex)      (Today’s date)

__________________________                               ________________                        ___________
   (Patient's Address)                                             (City)                          (Zip Code)

______-______-______                           _______________                     ______        ____________________
  (Date of Birth)                              Social Security Number              (Height)               (Weight)

__________ ________                   __________ _____                      __________ ___________
(Telephone Number)                        (Fax Number)                      May we contact you by email? (Email address)

_________________________,                               ________________________________________
(Head of Household) Last Name                                     (Head of Household) First Name
Drug Allergies:                 Medical Conditions:                               Current Medications,
                                                                                  Herbs or Over-the-
                                                                                  Counter Products
     None                             None                    Heart
                                                              Condition
     Aspirin                          Arthritis               High Blood
                                                              Pressure
     Codeine                          Cancer                  Seizures
                                      (Type)                  (Epilepsy)
     Penicillin                        Asthma                 Diabetes
     Sulfa                            Thyroid                 Glaucoma
     Other                            Other


Do you have any medical conditions other than those listed above? If so, which ones?
________________________________________________________________________
May we use generic medication on your prescriptions? _____Do you prefer safety caps? _____
Do you smoke? ____ Do you use alcohol? ____
If these prescriptions are being billed to a lawyer or other 3rd party:
________________________________________________________________
Name of Lawyer or Insurance Company ________________________________________

Claim # and Injury Date (Workman’s comp or Suits) _________________________________________
Where did you hear of our pharmacy?
____________________________________________________________________________



Central Rexall Drugs             875dadee-126b-4d87-accf-2211ecfd4816.doc                     Page 4 of 11
                                      Central Rexall Drugs, Inc.
                                             125 East Thomas Street
                                              Hammond, LA 70401
                                     Phone: 985-345-5120 Fax: 985-345-5178
                                              www.centraldrugs.net
                                              Donald K. Fellows, PD


                 Natural Hormone Replacement Confidential Evaluation
From a clinical management point of view, it is very useful to gain a detailed history of possible hormone
deficiencies. The answers provided in the questions below will allow the pharmacist to maintain your medical
history and will help in advising about current medical therapies. All information provided is confidential.

GENERAL INFORMATION                                                             Date: ____________________
Name: ____________________________________________ Age: _____________ Birth Date: _____________
Address: ___________________________________________________________________________________
Home Phone No: _______________________________Work Phone No: _______________________________
Occupation: ___________________________________Full-Time ___Part-Time____ Retired____ Unemployed
____Other _____
Living Situation: Spouse ____ Alone ____ Partner ____ Friend(s) ____ Parents____ Children _____ Other
_____
Status: Married ____ Single ____ Divorced ____ Widowed ____
Pets: ______________________________________________________________________________________
How did you hear about Natural Hormone Replacement Therapy: Ad _____ Another Patient ____ Courses/Seminars ____
Physician/Healthcare practitioner ____ Books/Articles ____ Other ____________________________
Do you understand what Natural Hormone Replacement is: ____________________________________________
What are your goals for Natural Hormone Replacement: ______________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
MEDICAL STATUS
General Health: Excellent ______Good _____Fair ____ Poor ____ Height: ___________ Weight: _____________
Current diagnosis or medical conditions: __________________________________________________________
___________________________________________________________________________________________
Drug Allergies: ______________________________________________________________________________
___________________________________________________________________________________________
Allergies to food, pollens, etc.: __________________________________________________________________
___________________________________________________________________________________________




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Current Medications: __________________________________________________________________________
___________________________________________________________________________________________
Current Vitamins or OTC products: ______________________________________________________________
___________________________________________________________________________________________
Current Herbs/etc.: ___________________________________________________________________________
___________________________________________________________________________________________
Have you ever had your cholesterol level checked: _____________ Date: ___________ Results:

Have you ever had a mammogram: _____________________ Date: ___________ Results:

Have you ever had a bone density scan: __________________ Date: ___________ Results:

Current/Recent Health Care Providers: ____________________________________________________________




PAST MEDICAL CONDITIONS
Childhood diseases: __________________________________________________________________________
Heart Trouble: ______ High Blood Pressure: ______ Stroke: ______ Varicose Veins: ______
Clotting Defects: ______ Diabetes: ______ Kidney Trouble: ______ Epilepsy: ______ Fractures:
Arthritis: ______ Colitis: ______ Gallbladder Trouble: ______ Asthma: ______ Chronic Fatigue:
Fibromyalgia: ______ Eating Disorder: ______ Cancer: ______
HABITS
Dietary Restrictions: __________________________________________________________________________
Meal Choices: Breakfast: _____________________________________________________________________
Lunch: ________________________________________________________________________
Dinner: _______________________________________________________________________
Do you get routine physical exercise: ______ What type: _____________________________________________
Do you use tobacco products: ______ How much: ______ Previously: ______ How long: _____
Do you use alcohol products: ______ How much: ______ Previously: ______ How long: _____
Do you use caffeine products: ______ How much: ______
FAMILY HISTORY
Please list family members and their age which are still living that may have important diseases such
Pressure, Heart Disease, Cancer, Diabetes, Osteoporosis, etc.: _____________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________




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___________________________________________________________________________________________
___________________________________________________________________________________________
Please list family members who died of important diseases (see above question) and their age at the time of death:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
GYNECOLOGICAL HISTORY
Age at first period: __________ Date of last period: __________
Date of last pelvic exam: __________ and Pap smear: __________ Results: __________
Have you ever had an abnormal pap? __________ Treatment: ___________
Are you sexually active: ___________________________Are you trying to get pregnant: ___________________
Current birth control method: _______________________ How long: ______________________________
Problem with it: __________________________ How long: ______________________________
Past birth control and any related problems: ________________________________________________________
How many days from start of one period to the start of the next: ________________________________________
Number of days of flow: _______________________ Amount of bleeding: _______________________________
Amount of cramps: ___________________________________________________________________________
Premenstrual symptoms: _______________________________________________________________________
Starting and ending when: ______________________________________________________________________
Any current changes in your normal cycle: _________________________________________________________
Any bleeding between periods: ______________________________ When: ______________________________
Any pelvic pain, pressure or fullness: _______________ Describe: _____________________________________
Any unusual vaginal discharge or itching: ____________Describe: _____________________________________
Treatment: _________________________________________________________________________________
Age at first pregnancy: ________________________________________________________________________
How many full-term pregnancies: _________________ Problems: _____________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Any interrupted pregnancies (miscarriages or abortions) ______________________________________________
___________________________________________________________________________________________
Have you had a tubal ligation: _______________________When: ______________________________________
Have you had any part or whole ovary removed: _________When_______________________________________
Have you had a hysterectomy: _______________________When: ______________________________________
Do your ovaries remain: _______________________________________________________________________




Central Rexall Drugs        875dadee-126b-4d87-accf-2211ecfd4816.doc                  Page 7 of 11
SYMPTOMS I
Rate your current status for each symptom by checking the appropriate modifier. Please feel free to use additional
space to describe any symptom. This section may be repeated upon subsequent visits.




                                           Absent              Mild            Moderate              Severe

 1 Headaches

 2 Low Libido

 3 Anxiety

 4 Swollen Breasts

 5 Moodiness

 6 Fuzzy Thinking

 7 Depression

 8 Food Cravings

 9 Irritability

 10 Insomnia

 11 Cramps

 12 Emotional Swings

 13 Painful Breasts

 14 Weight Gain

 15 Bloating

 16 Inability to Concentrate




Central Rexall Drugs           875dadee-126b-4d87-accf-2211ecfd4816.doc               Page 8 of 11
-5-
SYMPTOMS II
Rate your current status for each symptom by checking the appropriate modifier. Please feel free to use additional
space to describe any symptom. This section may be repeated upon subsequent visits.


                                            Absent               Mild             Moderate              Severe

 1 Hot Flashes

 2 Shortness of Breath

 3 Night Sweats

 4 Sleep Disorders, Insomnia

 5 Vaginal Dryness

 6 Dry Hair/Skin

 7 Hair Loss

 8 Anxiety

 9 Mood Swings

 10 Headaches

 11 Depression

 12 Short Term Memory Loss

 13 Frequent Urinary Tract
 Infections

 14 Heart Palpitations

 15 Frequent Yeast Infections

 16 Vaginal Shrinkage

 17 Loss of Pubic Hair

 18 Painful Intercourse

 19 Inability to Reach Orgasm




Central Rexall Drugs         875dadee-126b-4d87-accf-2211ecfd4816.doc                 Page 9 of 11
SYMPTOMS III

Rate your current status for each symptom by checking the appropriate modifier. Please feel free to use additional
space to describe any symptom. This section may be repeated upon subsequent visits.

                                      Absent                  Mild               Moderate             Severe
 1 Water Retention, Edema

 2 Fatigue, Lack of Energy

 3 Breast Swelling

 4 Fibrocystic Breasts

 5 Premenstrual Mood Swings

 6 Loss of Sex Drive

 7 Heavy or Irregular Menses

 8 Uterine Fibroids

 9 Cravings for Sweets

 10 Weight Gain
 (Hips & Thighs)
 11 Symptoms of Low Thyroid


CONSULTATION NOTES
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________________




Central Rexall Drugs         875dadee-126b-4d87-accf-2211ecfd4816.doc                Page 10 of 11
                                           Central Rexall Drugs, Inc.
                                             125 East Thomas Street, Suite B
                                                  Hammond, LA 70401
                                         Phone: 985-345-5135 Fax: 985-345-5178
                                                  www.centraldrugs.net
                                                   Donald K. Fellows, PD

                                        PATIENT ADVISORY LEAFLET

                       Directions for the Use of Natural (Bio-ldentical) Estrogens

Medication: Your medication may contain one or a combination of the following natural Estrogen: Estriol,
Estradiol, and Estrone. These are identical to the hormones, which are produced in significant quantities in the
human body, primarily by the ovaries. Estrogen s are responsible for the development and maintenance c the
female reproductive system, secondary sex characteristics, favorable effects on blood cholesterol and lipid
profiles, and slowing the progression of osteoporosis, as well as causing proliferation of the endometrium.

Use: Natural Estrogens are used for replacement therapy in pert-menopausal, menopausal, and postmenopausal
women for the treatment of symptoms of low estrogen levels. These symptoms include vasomotor symptoms
(hot flashes, night sweats), irregular menses, mood swings, and vaginal dryness, burning, and itching. Estrogens
are also used in the treatment of a variety of other conditions associated with a deficiency of estrogen hormones,
including female hypogonadism, ovarian failure, or ovariectomy (removal of ovary). Other uses include
preventing osteoporosis, ischemic heart disease, and Alzheimer's disease; improving blood lipid profile, and
maintaining bladder and urinary tract function. Estrogens can also be used for breast cancer treatment in
selected postmenopausal women and in men, prostate cancer in males, and in combination with progesterone
for ovulation control in prevention of conception. Topical Estrogen therapy has been used for reduction of
wrinkles and skin softening effects.

Side Effects: Side effects of Estrogen therapy include nausea, stomach upset, bloating, headache, dizziness, and
lightheadedness. These effects may be temporary and self-limiting. Other adverse reactions may include
breakthrough bleeding, breast-swelling, breast pain, fluid retention, weight gain, mood swings, depression,
decreased libido, increased risk of gallbladder disease, increased risk of thromboembolic disorder, and increased
risk of breast or uterine cancer. Do not use Natural Estrogens during pregnancy. Adverse reactions to natural
hormones may be related to dose or composition of your prescription. The increased risk of cancer may be
reduced or eliminated by the use of Estriol alone or in combination with Progesterone therapy. Please consult
your Physician or Pharmacist if you experience any of these symptoms or have any questions.

Directions: Natural Estrogens are available in many dosage forms, including oral capsules, troches, injections,
and topical preparations. Storage requirements depend on dosage form used, please follow instructions from the
Pharmacist for your prescription. Oral preparations may be taken with food. Follow dosage directions exactly.
Be sure to consult with your Physician or Pharmacist for adjusting dosage or if you have any questions.

If you miss a dose, take as soon as remembered. Do not take if it is almost time for your next dose, instead, skip
the missed dose and resume your usual dosing schedule. Do not double the dose.
           This Patient Advisory Leaflet is #0015 and was reviewed by the International Academy of Compounding Pharmacists.




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