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Know your medicine (part three): What to ask and why
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Do you know what your drugs are, what they are for or why you are taking them?
As part of American Pharmacists Month we have looked at just what your pharmacist actually knows--which is a lot--and the many places a pharmacist can be found and what he or she does there. Today we are going to journey into the “know your medicine” part of the American Pharmacists Month slogan.
Why is important to know your medicine? Why would someone not want to? The question that always dogs your Intrepid Pharmacist is why would anyone with any amount of intelligence take something that is going to alter the way their body functions—potentially fatally—put it in their (or their children’s) mouths and swallow it (or inject it or snort it) without having some knowledge of what it is they are ingesting. Yet time and again patients call in requesting a refill of “the round white pill” on their profile. They do not know what the medication’s name or even what it is supposed to do, just that they are supposed to take it.
So, you may be thinking, not everyone can get their tongues around complicated chemical/generic names. Why is this problem? Because there are patients who at least know what the medication is supposed to do or they will spell out the first couple of letters from their current bottle or they will know the drug’s brand name so it can be done. Let’s face it, Maxzide is far easier to say than triamterene/hydrochlorothiazide, though interestingly people have no trouble with supercalifragilisticexpialidocious. And again, why would anyone blindly pay money for and take something just because someone told them to and not know what it is? Your Intrepid Pharmacist says such a premise should remain reserved for street drugs.
So, next time you are prescribed a new medication, take the time to ask your physician or pharmacist these questions:
What does it do? A patient should know what a medication they are taking should do for them physically. Will it better control cholesterol, or blood pressure, or heart rate, or inflammation? What does the drug actually do? If you do not know this, why are even spending the money to take it?
What are the Adverse (side) Effects? Along with the desired medicinal effects, there are adverse (or side) effects; those unwanted events that may or may not happen while taking a medication. Patients are always surprised when they ask about a drug and they are shown a list of all the possible reported adverse effects. Many of these only occur in less than 5% of all users, but the 95% chance it won’t happen does not matter if a) you did not know that it could happen and it did and b) you are in the 5% it did happen to.
Some adverse effects are especially important to know, such as NSAID’s (Motrin, Advil, Aleve, Voltaren, Mobic, Celebrex, and others) needing to be taken after food to minimize gastric irritation, which in long term use can lead to gastrointestinal bleeding. Likewise, Rifampin turning your sweat, urine and tears a reddish-orange is going to be an unnerving surprise to anyone who did not at least read the patient leaflet. Ditto for the 4,000 milligram per day limit on Tylenol (acetaminophen) dose, which physicians routinely overlook when they write prescriptions for combination pain medications. (Biggest frequent offender: Darvocet 100 prescriptions written for 1 or 2 tablets by mouth every four to six hours. Each pill contains 650 milligrams of Tylenol giving it a six tablet a day limit, though the prescriber has just given the patient direction that would allow them to take 7,800 milligrams of Tylenol in a single day; nearly double the safe dose).
What other medications, herbs or foods does this medication interact with? Many medications interact with each other and this is a common problem with emergency room prescriptions where the prescriber was not told of other medications the patient was taking, often because the patient did not know what these were or have a written list of the medications for reference (hint hint). Some interactions are rare, but dangerous enough that patient needs to be aware of signs and symptoms so he or she knows what to do if it happens to them. Mixing two Central Nervous System (CNS) affecting drugs such as tramadol and an SSRI antidepressant (fluoxetine, paroxetine, citalopram, sertraline, etc) can potentially lead to serotonin syndrome. Granted this is so rare it happens in less than 1% of all users.The rare person it does happen to should probably buy a lottery ticket that day, too; it's that rare. But again, as with adverse effects, if you are that one person and have no idea what is happening to you, will you know what to do? Will you know the signs and symptoms? Other interactions are more common but can easily be controlled by temporarily stopping or altering the dose of one of the medications or monitoring the patient.
Will this medication affect other health conditions? Many medications may help one problem but cause problems with another. A patient who has both asthma and hypertension has to walk a fine line in some cases since the albuterol inhaler’s action (a beta-agonist) works in direct conflict with some blood pressure medications called beta-blockers (or beta-antagonists). This does not mean these medications cannot be used together (some beta-blockers are more selective away from the lungs than others) but such issues must be taken into account when prescribing takes place. The same may be said for diabetic patients who also have heart failure. Certain oral diabetic drugs (pretty much all of them) will help the diabetes, but pose a danger to the heart failure. And ladies, do not forget about pregnancy and breast feeding issues when taking prescribed or over-the-counter medication.
How should I take this medication? Will food affect the action of the drug? Does it matter when I take it? In cases such a proton pump inhibitors (Prevacid, Nexium, Prilosec, etc.), which decrease the amount of stomach acid produced, the answer is yes, timing with food does matter. Your Intrepid Pharmacist is amazed at the number of physicians who prescribe one of these for patients who have reflux/GERD at night and tell them to take it at bedtime. By then the offending acid has already been made and it’s too late. Studies experimenting with dose timing of these drugs (recapped here) have found 30 to 60 minutes before breakfast (or breakfast and dinner if twice daily dosing) to yield the most effective results. Patients who have been corrected on the dosing time have reported improvement in effective to your Intrepid Pharmacist on a number of occasions. But again, if you do not ask this question you may never know this information!
Should my prescriber monitor anything? Many medications state in the manufacturer’s FDA approved drug information that certain things should be monitored and they almost always provide a time frame for such. For instance, patients taking “statin” drugs for cholesterol (Zocor, Lipitor, Crestor, etc.) should have their liver enzyme levels checked at specific intervals.
Hopefully, this column has given you some tips on what to ask and why to ask it when you receive a new medication. Know Your Medication should be more than part of a slogan, it should be a rule.
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