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Medication Management

Why Medication Management is important

Safe Medication Management  

     Knowing what drugs you take and managing those drugs safely can save your life.  As a caregiver, one of your most important jobs is Medication Management. Understanding that role is what this page is all about.

 

Read Drug Labels

Most of the time, when you go to the doctor for an illness, you come home with a prescription. The label on the bottle tells you the name of the drug, how often to take it, and any special warnings you might need to know.  Attached to the pharmacy bag is a handout that goes into a lot of detail about side effects, but that usually goes directly into the trash once you get home, doesn’t it? Do you ever read that information?

We Trust Our HCP to Know What Meds We’re Taking

     We trust our doctor and pharmacist to know what medications we take and to warn us if we are already taking something that might interact poorly with the new drug. We expect them to protect us from harm by not giving us any medication that might cause us more damage than good; that includes giving us a medication that we might have listed as an allergy on our record.

Once We Start a Med, We Don’t Stop.

     We also trust our doctors to know if we need to continue to take a medication if we start one. Once given medication,  we tend to continue to take it forever unless our doctor does not approve refills.  After a while, we may even forget why we are taking the medication. 

“Just in Case We Need Them” Drugs  

 Even the drugs we took for just a short while for injuries seem never to leave our medicine cabinets.  We keep them around in case we need them again sometime.  You never know when someone might get a GI bug and need some Zofran, right?  I bet if you checked the issue date on some of the pills in your cabinets, you might find that some of the dates are quite old.

Warning: Drugs Can Be Bad for Your Health

     My point is that we take the drugs in our homes for granted and don’t realize just how dangerous they can be when used other than how prescribed or outside of the time frame initially intended. Many drugs have long-term side effects, interact with the foods we eat, and are detrimental to our internal organs after long term use.

Drugs lose potency after a while and may interact with other drugs having an accumulative effect boosting the strength of the medicine to a level unintended by the doctor.

Food and Drug Interactions

     Sometimes foods counteract or enhance the effectiveness of a drug.  People who use heparin or other blood thinners need to be careful about eating greens.  Some of those greens make the blood thinner not work. Many people use herbs and spices as medicines.  If you use them in cooking, they may have an impact on your medications. In general, if you use an excessive amount of any food, perfume, dietary additive, or other chemicals, check out what the long-term side effects might be in deciding if you want to stay on them for a long time. 

Know the Generic Name of your Drugs

Medications

     Most of us talk about our medications using the name of the drug the doctor used the first time we received it. Often that is the brand name we hear advertised on television. However, medications have many names. Tylenol with codeine, for instance. Tylenol #3 is a brand name. The generic name is Acetaminophen/Codeine. The drug classification is an analgesic meaning it provides pain relief, and because it has codeine, it is also an opioid. Therefore, when your doctor talks to you about this medication, he may say that you are receiving Acetaminophen with codeine instead of Tylenol #3 because in medical speak in the hospital, they almost always refer to medications by their generic names.

 

Why Use Generic Names for Medications Instead of Brand Names

   Once patents no longer protect a new medicine, other drug companies can reproduce their formula and distribute “copycat” drugs. At that point, the marketplace has multiple versions of the same drug, but all have different names and slightly different effectiveness depending on the formula used.

 

     Since the drug companies do not share information, it is natural that the outcomes of their research are different. Separate and unique drug reactions might occur from the alternate formats of Acetaminophen based on how the manufacturer completed the formula. Each pharmacy and hospital have suppliers from whom they buy generic products. During hospital admissions, your medications come from this stockpile of generic medicines. Therefore, the common denominator between your list and their supply chain is the generic brand of the drugs you currently take. Creating a table showing the generic and brand name of all your medication helps you to follow conversations in the hospital where they use both names routinely. You can find the generic name on the literature the pharmacy gives you.

 

Do Not Take Extra Medicine While in the Hospital

     By the way, in case anyone has never told you this before, the reason why they ask you not to take additional medication while you are in the hospital is that they are tracking how you react to what you are taking while you are there. If the doctor is unaware that another medication influenced a clinical reaction, then he might make an inappropriate medical decision based on misinformation and cause you harm. 

An Example of How Secretly Taking Medicine In the Hospital Can Hurt You

     Let me demonstrate: You take pain medication for chronic back pain. Earlier today, you took two Tylenol #3 tablets. An hour later, you still had pain and decided to get two Valium out of your suitcase. You were really hurting. You know the Valium is not going to hurt you, and the nurse says you can’t have anything else for another two hours, so you have your friend hand you your suitcase and take the Valium.  It works. The pain is relieved.

 

     You solved your problem, but what you do not know is that the nurse makes her rounds later and asks how your pain is doing. You tell her it finally has gone away because it has. She makes a note of that in her charting. The doctor sees that the two Tylenol #3 he ordered has been useful and does NOT increase your medication dose when you ask him more later because from what he sees, you do not need it.

Who Can Prescribe Medications?

     Only someone licensed by their state of residence is authorized to prescribe medication based on the laws of that state legally.  In Virginia, only doctors (including dentists, psychiatrists, etc.), nurse practitioners, and physician assistants are licensed to prescribe. Registered nurses cannot prescribe.  Not all nurse practitioners can prescribe unless they have a separate license to do so.

 

Know Your Allergies

Allergy, Sensitivity, or Intolerance?

     Many people often use the terms allergy to describe everything that happens to them that includes reactions that are sensitivities, intolerance, and actual allergic reactions. Is there a real difference? Yes, there is.

 
Allergic Reactions May Become Life-Threatening

     Allergic reactions are life-threatening situations characterized by an immune system response to a substance. Symptoms start immediately or within a few hours of exposure and range from mild wheezing to difficulty breathing, a rapid, weak pulse, and anaphylaxis shock. Individuals who have anaphylaxis must always carry an epinephrine injection with them. 

 
Allergic to one Drug in a Family; Probably Allergic to Rest

     Something to keep in mind when doctors are talking about new medications with you is that they often talk about them using their generic name. The generic name is the name used by the manufacturer and not the one you often see in the store.  It usually is one that has a similar sound to other family names of drugs that act just like it does, and that comes from the same base products. Therefore, if you are allergic to penicillin, you can not take other antibiotics from the same family.

 
Generic Drugs

     If you have a sensitivity to a substance, your immune system doesn’t get involved; however, you have an exaggerated response to the medication you take that far beyond the usual.  While there is no immune response, you still have lots of symptoms and get very sick. Some of the issues can even become life-threatening, especially if the person is exposed to the substance repeatedly. 

What is Food Intolerance?

     Intolerance means that the person’s body cannot tolerate certain foods due to not producing certain enzymes in enough amounts to allow easy digestion of foods eaten.  The result is very unpleasant and uncomfortable side effects, such as nausea, bloating, vomiting, and diarrhea.  

Manage Side Effects

Looking up prescription information on the internet
What are Side Effects?

     Let me clarify what I mean by “know side effects.”  First, in case you didn’t know, by law, companies must list every symptom that research subjects experienced while they participate in trials even if the symptom happened once.  That rule also applies to events that are also likely to occur due to something else. Therefore, many of those side effects are bogus and may never happen. 

Frequency of Occurrence  Matters  

It’s essential to look at the fine print and check out the percentage of times the events occurred due to that fact.  If it’s one of those 1 in 10,0000 events, you can cross it off your risk list. The ones to watch are the side effects that usually are either highlighted or underlined.  Those are the ones that happen the most.

 

Every Symptom Counts   

 You need to be somewhat familiar with side effects in case symptoms start to develop that are new and unexplainable.  The doctor will ask what new medications have started, and if he doesn’t, then you should think about whether there could be a connection.

 

Accumulative Effect      

     The other impact regarding side effects has to do with the accumulation of multiple drugs with the same side effect.  If you have many drugs, all are causing dehydration or nausea or heart irregularities, the more medications with that side effect, the more likely you are to experience it.

Explanation of Medication Terminology

When the doctor asks you what you take, include the following:

  • Any current prescription– list dose, frequency, (once a month, or once a day) reason for use, or who prescribed it.
  • Any vitamins, minerals, herbal supplements, protein powders, dietary supplements, or health food pills, powders, or drinks are now considered medications.
  • Drugs come as pills, tablets, capsules, caplets, injection in muscle, fat or under the skin, creams, ointments, eye drops, nose drops, oral suspensions, drinks, sprays, rubs, patches, inhalers, intravenous, suppository, held under the tongue, and inside the cheek. I’ve probably forgotten a way or two.
  • Herbs, spices, vitamins, and other nutrients impact the body’s fluid and electrolyte balance, which has a direct impact on how well or how poorly the body functions.

     Many times, healthcare providers ask questions about what a patient is currently taking, but they forget to ask about home remedies, supplements or foods that the patients take regularly for medicinal remedies. These items are very important for the doctor to include in the patient’s health history because they can significantly influence the patient’s health. 

 

If there are foods that the patient eats EVERY day, that food may have the potential to impact the patient’s response to medications if the food contains ingredients that interact with the chemical in the medication; therefore, bring them up, just in case.

 

A lot of people add supplements and vitamins to their diets based on news articles of TV programs and then forget the reason why.  However, they continue to take the supplement for years afterward.  Periodically, inventory what you take.  If you can’t find a reason for something you’re taking, stop using it.

     You might wonder how the doctor decides how much medication to prescribe? Research.  The amount is predetermined based on research that shows how much it took to treat the type of condition you have successfully.

 

     Each drug is approved by the Federal Drug Administration (FDA) based on research.  The drug is approved to treat specific conditions only and prescribed as approved by the FDA. They also specify the dose, route, frequency of use.  If prescribed in any other way, insurance will not pay for it, and the doctor is subject to charges of inappropriate practice if he cannot explain his reasons for his actions.  That is why you get the stern lectures on following the instructions given to you about doing things a particular way in the hospital. The must do it that way by law.

 

     At home, most of you probably have a medicine chest full of drugs that are expired, and you may be saving to see if you might need them again one day. There is no law against that. However, you need to be cautious in keeping medicines like that around and in using them for yourself or sharing them with others in your family. 

 

     You should never share drugs since pills for one may be incompatible for someone else and could do great harm. You also may mix medications that work against one another to produce harmful side effects or which work together to make the side effects much stronger and cause someone to overdose. On the flip side, the drugs may be old and have lost all their potency and, therefore, no longer be active.  It’s best to take them to the pharmacy to ask them to dispose of them.

The dosage is the amount of medication you need to take.

  • Most of the dosing is written in ml volume though some of what comes in bottles may be stated in teaspoons.
  • Always measure by the bottom of the bubble against the line on the side of the measuring device if you have a liquid to measure.
  • If you need to convert measurements from one type of measure to another, contact your pharmacist for assistance.
  • Always give the exact amount of medication. It’s determined based on age and weight usually and if you give a different amount, you might have a bad reaction.
 

     The route is the way in which you give the medication. Medications are given by mouth, intramuscularly, subcutaneously, rectally, through a tube into the stomach, under the tongue, held in the cheek, given as eye drops, nose drops, inhaled, swallowed, injected, and a few other ways.

     If you need to change the route of administration, call the doctor to find out if the dose needs to change.  Often the dosage is based on how the medication is absorbed.  If the route is changed, the amount may need to be increased or decreased accordingly.

     Try to evenly space multi-dose drugs apart when you take them throughout the day so that the effects of the drug have the opportunity to keep a consistent blood level as they work within the body.

 

     Don’t take medication if you no longer need it.  You will build a tolerance to it and begin to need more to produce the same effect as you received previously. Your goal should always be to decrease the number of drugs you are taking so that your body continues to create its natural supply of chemicals rather than relying on external sources for supplements.