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VOL. 5 • NO. 1

MEDICATION SAFETY: The dos and don’ts of prescription drugs Timothy Velasquez, 67, is like a lot of people — rarely, prescription drug, almost 90 percent of those 65 years if ever, did he extensively question the details of his and older reported the same. prescription drugs. Multiply the drugs and the gap further widens: 63 If questions were few to his doctor, they were even percent of elderly people versus 11 percent of those 18 less to his pharmacist. “I trusted those guys,” he said. to 44 use three or more prescription drugs. “They put [the drugs] in a bag and I walked out.” Fortunately, Velasquez didn’t become another Velasquez can only shake his head at his past irmajor statistic for a medication mishap. But Velasquez responsible attitude. Especially in light of the fact that he did receive a recent wake-up call. He was prescribed a is on 10 different drugs for heart disease, diabetes, high liquid medication to reduce the potassium levels in his blood pressure and other medical complications. He blood and was given two bottles at his pharmacy. considers himself fortunate. There was only one problem. The plastic cup to Fortunate is right. According to a study published help measure exact dosages was missing. Reading the in the Journal of the American Medical Association in label was of little help. And measurements like “CCs” 2006, more than 700,000 visits to the emergency departfor cubic centimeters merely added to the confusion. ment occur every year due to medication mishaps. And He had no idea what that meant, let alone how to 120,000 of these visits result in hospitalization. Part of calculate it, and that led to the next problem. Velasquez the reason is attributable to the virtual explosion in drug developed his own regimen. usage across America. In fairness, Velasquez was right that he needed to Prescription drugs alone constitute the third hightake the medicine twice a day. But without knowing est national health expenditure in this country, trailing the exact amount, he drank half of the first bottle after only costs for hospital and physician services. The Nabreakfast and the remainder before bed. tional Council on Patient Information and Education, He repeated this regimen the following day. “The a Rockville, Maryland-based nonprofit organization, medicine tasted pleasant,” he explained, “so I did not estimates that more than 3.5 billion prescriptions were make a big deal of it.” written in 2007. But it was a big deal. He wound up taking more Timothy Velasquez took four times the amount of his prescribed medication Some medications in particular have escalated in than four times the recommended dosage — a mishap — fortunately, with no side effects. Velasquez says he now asks questions demand. For instance, the use of antidepressants and about his medication before he leaves the pharmacy. (Ernesto Arroyo photo) that could have resulted in kidney damage, according to antiasthmatic drugs has doubled in the past nine years, Dr. Donney John, the clinical pharmacist at South End while certain medications for high blood pressure and high preceding month, while roughly one-fourth used three or Community Health Center. cholesterol have experienced a five-fold increase. more prescription drugs. Velasquez realized his error when he spoke to his It’s no wonder then that almost half the population The elderly are particularly vulnerable. While only 38 pharmacist. Alarmed, the pharmacist immediately called his reported using at least one prescription drug during the percent of those between the ages of 18 and 44 used one Velasquez, continued to page 4

Easy access belies over-the-counter drugs’ health risks

Over-the-counter (OTC) drugs can interact with prescription medications, food, alcohol and other OTC drugs. Read the drug labels carefully before using.

Stephanie Andrews learned her lesson the hard way. Like most people, the 36-year-old mother of two, who asked that her real name not be used, underestimated the potency and impact of the over-the-counter (OTC) drugs she was taking to relieve her abdominal cramps. Instead of reducing the pain, the extra doses of pain relievers actually added to her misery. Her story starts a few years ago when she suffered a miscarriage. Her doctor offered her two treatment options. One was a surgical procedure; the other allowed nature to take its course

and dispel the tissue. She chose the latter, but that meant a few days of discomfort. Andrews’ doctor recommended 800 milligrams (mg) of ibuprofen every four hours. But Andrews had another idea after her cramps subsided with the help of the first round of ibuprofen pills. She decided to get a head start on her next bout of pain by taking more pills. “I tried to head it off at the pass,” she said. “I was trying to beat the pain.” She decided not to wait for four hours as instructed; she took another 800 mg in two hours — double the recommended dose. She continued her “treatment” for two days. Though she said “it felt good to be without pain,” the plan backfired. What she didn’t know is that stomach and kidney problems are the two main side effects associated with excessive use of ibuprofen. She knows now. “My stomach was cramping even more,” she said. Her doctor was a tad furious and had a few choice words after Andrews confessed. “You’re taking way too much,” her doctor warned. “Stop taking it immediately.” The doctor instead advised her to take acetaminophen, another pain reducer. “But take it as prescribed,” she said. Andrews says she has learned her lesson. “I still take ibuprofen as needed,” she said. “But I definitely watch how I take it.” Misuse of OTC drugs has not received the amount of at-

tention as prescription drugs but they are far from harmless. Part of the problem is that doctors are taken out of the process. Consumers instead diagnose their own problems, and then selfmedicate — all without the benefit of any medical education. Indeed, OTC drugs are readily available for all to use, but that does not mean that all should readily use them. It is a common misperception that OTC drugs are not powerful and do not require the same attention to detail as prescription medications. Not so. Many OTC drugs were at one time available only through a provider’s orders. The Food and Drug Administration (FDA) regularly evaluates the safety of prescription drugs and their ability to transition from prescription-only to OTC status. Between 2001 and 2009 the FDA approved that transition for almost 30 medications. Some drugs that have made the switch are well known: the antihistamines Claritin-D and Zyrtec and the acid reducer Prevacid 24 HR. Ibuprofen, a common pain killer, got its walking papers about 20 years ago. There’s one catch though. That switch and the resultant ease of access did not reduce their potency. A practical way of viewing all OTC drugs, including vitamins and herbal supplements, is that any product that changes the way your body works or treats a condition is a drug. But how can an untrained person make such an important OTC drugs, continued to page 4

Medicine: A lifeline — when used correctly Whether you have a chronic health issue like diabetes, asthma, high blood pressure or a curable illness like the flu or pneumonia, medicine prescribed by your doctor can be a lifeline. When taken properly, medications can help you live a longer, healthier life. The tips below will help you gain the greatest benefit from the medicines you need, while helping to stretch your health care dollars.

the drug information sheets that come with your medicine, in case you need to refer to them. • Take as directed. Not more often, not less often, and on time. If you miss a dose, ask your doctor or pharmacist what to do. • Set up reminders. Let a daily habit, meals or bedtime for example, be your reminder to take your medication. Or set an alarm on your cell phone. You can also use a pill box with compartments to help with times of day, or check off daily doses on a simple checklist. • Expiration dates. Always check expiration dates listed on the bottle before taking medication. Taking medicine after it has expired may cause negative side effects. Throw out any drugs that have expired to prevent medication mix-ups. • Keep a little list. Tuck a list of medications into your wallet or purse to show to all health care providers (and pharmacists, too, if you use more than one drug store). Keep a copy of the list in your home too, on the refrigerator, so others can access it. In emergencies, this list helps ensure faster, more effective care. Include drug name, doctor, reason for taking, and dosing information. If medications change, make a new list and throw out the old one.

Taking medications safely A national health survey shows that the use of prescription drugs continues to spiral upward. During the past month, 42 percent of African American adults were taking at least one prescription drug, according to the Centers for Disease Control and Prevention (CDC). And nearly 40 percent of all Americans over age 60 reported taking five or more medications. When used properly, these medications can enhance and extend life. To take your medicine safely, follow these tips: • Tell all. Avoid worrisome drug interactions and side effects by telling your doctor and pharmacist about all the medicines (over-the-counter and prescription), vitamins or other supplements and herbal remedies you use. Also mention allergies and past problems with medications like rashes or dizziness. Using one drug store is also beneficial, because the pharmacist can track the prescription medications you take. • Go over the basics. Anytime medicine is prescribed, write down the drug name, why you need it, the amount to take, and when to take it and stop. Find out if you need to take the medicine with food and any other important instructions. Remember to save

pharmaceutical companies are permitted to copy brand name drugs by creating chemical counterparts called generic medications. These are often quite inexpensive, can be just as effective and help save you money. Just like brand name drugs, generic drugs must be approved by the Food and Drug Administration (FDA). This approval ensures that generics are equally safe and effective and have the same active ingredients, strength and form (whether they’re pills or liquid, for example) as brand name drugs.

You can stretch your health care dollars by: • Asking your doctor or pharmacist about generic options. • Checking whether your health plan or local pharmacies offer generic drugs at low cost. • Buying a 90-day supply of drugs you take regularly through a mail order pharmacy can also help save money. Check with your health plan to see if this option is available to you. Taking your medication properly is a vital part of managing your own health. By being a more informed patient you can keep yourself healthy and help bring down your health care costs. Remember to always use antibiotics and medication as directed by a pharmacist, physician, nurse, or according to the bottle. Some medications may be counteracted with the use of alcohol, drugs or other medications like antibiotics, so read the drug label before use. And, work with your doctor to manage your prescriptions, or if you have any questions about your health.

Flu facts and tips Flu season is just around the bend. Staying healthy = keeping your health care expenses down.

Generic drugs versus brand name drugs Patents on new drugs can last for up to 20 years to allow manufacturers to recoup their investment in researching, developing and marketing medications. Once patents expire, other

Get vaccinated Call your health plan today to find out when and where you can be vaccinated. Some pharmacy or retail locations may not participate with your health plan — so be sure to ask what providers, pharmacies or retail locations participate in order to save money.

This year’s flu facts • The CDC and vaccine experts recommend that everyone 6 months of age and older get a flu vaccination unless they have a severe allergy to chicken eggs, or have had a severe reaction to a flu vaccine in the past. Members should always check with their doctor first if they have questions or concerns about getting vaccinated. • Unlike 2009, there will be no need for two separate flu shots. This year’s shot will protect against the 2009 H1N1 pandemic virus and against two other seasonal flu strains (the H3N2 virus and an influenza B virus). • Children 6 months to 8 years of age who have never received a flu vaccination may need two shots. Parents should check with their pediatrician first.

Quick tips for staying healthy this flu season You’ve heard it before — the best prevention against the flu is good hygiene. Below are some quick tips to help you and your family fight off the flu: • Frequently wash your hands with soap and water. When hand washing is not possible, use antiseptic hand gels that contain alcohol. • Cover your mouth and nose with a tissue when coughing or sneezing. Throw out the tissue in the nearest waste basket and immediately wash your hands with soap and water. • Don’t sneeze into your hand if you don’t have a tissue. Instead, use the crook of your arm. • Stay at least three feet away from people who are coughing or sneezing. • Immediately wash your hands after contact with an ill person. • Stay at home when you are sick. • Keep your children at home when they are sick. • Teach your children good hygiene habits. • Ask for a mask when in the doctor’s office or hospital.

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Questions & Answers

October is Talk About Prescriptions Month

1. Since overthe-counter drugs, such as aspirin, are inexpensive and readily available, does that mean that they are always safe to take? Over-the-counter (OTC) medications can be considered safe if taken for the reason Pablo Hernandez Itriago, M.D., F.A.A.F.P. intended and at the Medical Director dose recommended South End Community Health Center on the label. However, it is important to be aware of one’s medical condition. For example, allergies, diabetes and high blood pressure are conditions that could become worse in patients who take OTC medications without first consulting his or her primary care physician. Also, OTC drugs can interact with each other as well as prescription medications. 2. If a person forgets to take a medication on time, is it best to double the dose the next scheduled time? That is generally the rule of thumb, but it differs by medication. If you missed one dose, you may be advised to take it as soon as you noticed or with the next dose. If you missed two or more, then it is better to continue taking the regular dose and not to catch up. The risk of overdose is the primary reason for this. Ask your doctor’s recommendations for each medicine you take. 3. Why is exceeding the recommended daily maximum amount of acetaminophen, an active ingredient in Tylenol, dangerous to a person’s health? Acetaminophen, a common pain reliever, is one of the safest drugs on the market. However, like most medications, acetaminophen is metabolized by the liver, and taking more than the recommended dose can cause liver problems.

A closer look

BEFORE YOU LEAVE THE DRUG STORE, GET THE FACTS. Read the drug label to make sure the prescription is yours and matches the one written by your provider. Name and address of the pharmacy

My name and address

How and when to take the medicine

The amount of medicine in each pill

Name of the medicine

The number of pills in the bottle

The number of refills allowed

ASK QUESTIONS. YOU’RE THE ONE WHO SUFFERS THE CONSEQUENCES IF YOU DON’T. 1.

What is the name (brand and generic) of the medicine? What is it for?

What’s the dose?

How do I take it and how often?

What food, drinks or other medicines should I avoid while taking this medicine?

What are the possible side effects? What should I do if I have side effects?

What should I do if I miss a dose or accidentally take more than the recommended dose?

When will the medicine start working?

Is there any written information I can take home with me?

4. Should a person stop taking a drug if he or she begins to feel better before completing the prescribed amount? NO. You should always consult with your doctor before discontinuing the medication. Antibiotics, for example, should be taken for the duration prescribed. Doing the contrary could lead to bacterial resistance and the surge of “super bugs.” In addition, there are chronic conditions, such as diabetes, hypertension and high cholesterol that require treatment for life — regardless of how good you feel. That’s why it is important to call your doctor’s office to request a refill and an appointment before you run out of the medication. 5. If you have bad side effects from a drug prescribed by a doctor, should you stop taking them? Most medications have side effects, and you should always inquire what they are before starting a new medicine. However, if the side effects are severe and not what you expected, you should call your doctor’s office right away. He or she will know what to do next. 6. Since herbal medications are considered “natural,” are they safe to mix with other medications? Not always. Even when most herbal supplements have a “natural origin,” they are still drugs with potential interaction with other medications, as well as side effects. One such herbal medication is St. John’s Wort, which is often taken for depression. It has been found, however, that St. John’s Wort interferes with medication for the treatment of HIV and other chronic illnesses. 7. Will doubling up on a medication make you feel better more quickly? NO. Some people think that if one pill is good, two are better. But taking more than prescribed can result in adverse drug reactions. Always take medications as your doctor prescribed. 8. When keeping a list of current medications, should a person include vitamins and herbal supplements as well? YES. Any drug — including OTC, herbal supplements and vitamins — may have potential interactions with each other, food and beverages and prescription medications. Always carry a medication list with you. The following link shows what a medication list should include: http://www.safemedication.com/safemed/MyMedi cineList.aspx. 9. Why is it recommended to have all your prescriptions filled at the same pharmacy or pharmacy chain? When you have all your prescriptions filled at one pharmacy, the pharmacist can check for potential drug interactions and side effects. It also helps alert your primary care physician of all the medications prescribed by other doctors.

The information presented in BE HEALTHY is for educational purposes only, and is not intended to take the place of consultation with your private physician. We recommend that you take advantage of screenings appropriate to your age, sex, and risk factors and make timely visits to your primary care physician.

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Velasquez, continued from page 1

and purpose of the drug. doctor who quickly ordered a blood test. “She She says she also knows now to actually dropped a dime on me,” he said. The good look at the individual tablets. news is that Velasquez suffered no ill effect. “I Link is on five different types of drugs got my potassium down all right,” he laughed. that she takes daily for high blood pressure, high cholesterol and a few other ailments. “Thank God nothing serious happened. Fortunately, it was OK.” The volume of drugs is just part of the problem. Another significant part is that people are just not paying attention. “It can be overwhelming particularly if they are on several different drugs. “It’s hard to keep track,” said John. “Some people double up doses and take more than prescribed. Others split the pill to make them last longer. Some just Donney John, Pharm.D. (right), the clinical pharmacist at completely forget. Others just don’t want to take pills South End Community Health Center (SECHC), counsels and never follow through.” Zenaida Del Valle on proper use of medication for her diaComplicating the issue is betes. SECHC participates in Collaborative Drug Therapy Management, which delegates drug therapy management to that each and every medicine a pharmacist. (Ernesto Arroyo photo) has its own characteristics. Medication for diabetes is one example. She also takes pain medication as needed for a Insulin and other medications are prescribed complicated orthopedic procedure performed according to a person’s lifestyle — what on her spine. they eat and their level of physical activity. The mishap occurred with her pain mediModifications in a diet may require adjustcation. The directions were to take one to two ments in the prescription, John explained, and pills every six hours. “I take two,” Link said. those should be made by the health provider. “That’s my dose.” “But some people make adjustments on their But after taking the pills one recent day, own,” he said. she lay down but did not feel any better. Six hours later she took two more. Taking too much insulin can cause The next morning she knew something blood sugar levels to drop. “People can get was wrong. “I felt funny in the stomach and very shaky or pass out,” said John. Drowsitired,” she said. “I usually don’t wake up tired. ness, fatigue and rapid heartbeat are other Something told me to look at the medicine.” potential consequences. Another example is blood thinners. PreShe was surprised at what she discovscribed to prevent clots from forming in the ered. “One pill in the bottle looked different blood, blood thinners pose their own set of from the others,” she explained. “I counted up problems: too much can cause a major bleed; the pills in the bottle. Five of them were the too little can result in a heart attack or stroke. wrong pills; the rest were mine.” And like many other medicines, blood But they looked very similar. Both were thinners are also food sensitive. “A lot of things the same color and shape, according to Link, can affect it,” said John. “Like green leafy but the “wrong” medication was smaller. vegetables.” Green leafy vegetables are high in She informed the pharmacy and was told vitamin K, which reduces the effectiveness of by a nurse at her clinic to go to the emergency blood thinners. Other foods, such as grapefruit room. Fortunately for Link the effects were juice, can also impede the success of medishort-lived and left no permanent damage — at least physically. “It caused me a lot of mental agony,” she said. What she found out was that the pharmacy inadvertently mixed the drugs and gave Link — in addition to her painkillers — medicine for migraines that were also antidepressants. The medicine caused diarrhea, excessive fatigue and a headache. Link vows to pay closer attention. “Before I leave that window I check very carefully now,” she said. “I put a few pills in my hand and take a look.” She hopes other patients check as well. “I was fortunate,” she remarked. “The next person might not be.” For his part, Velasquez is making sure that he doesn’t make a mistake either. Because Since the wrong drugs were accidentally he’s not as familiar with his drugs as he should mixed in with her pain medication, Patricia be, he relies heavily on the medicine list that Link now looks at the pills she picks up his doctor gives him during each visit. from the pharmacy. (Tony Irving photo) As a result, Velasquez said, he knows when to take his drugs. He knows which ones cines. As do alcohol and illicit drugs. Even if a person knows his or her medihave to be taken with food. He also knows cation and takes it correctly, there is a chance which foods to avoid in order to insure the of multiple drug interactions that diminish or medication’s effectiveness. More importantly, he fills all his preincrease the effect of the medication. Patients are not always to blame for medication scriptions at the same pharmacy, a practice recommended by health practitioners. That mishaps; sometimes the medical community allows the pharmacy to have an accurate does its fair share. A 2003 study published record of what drugs he is now taking or has in the New England Journal of Medicine found that of the patients interviewed at four taken in the past. The pharmacist can then primary care practices, a notable percentmore easily check for potentially harmful age of adverse drug events was attributed to drug interactions, or interactions that may physicians’ failure to respond to symptoms decrease the effectiveness of his medications. caused by the medications. Velasquez says he’s learned his lesson and vows to change his behavior the next And there’s always the chance that a time he picks up his meds. “I’ll check to see problem may occur at the pharmacy. if everything is there,” he insisted. “I will Patricia Link, 59, now knows that take the time to ask a few questions,” he checking a prescription before leaving the said. “I can’t leave everything up to the docdrug store is a two-step process. She says she tor and pharmacist. They’re busy enough.” checks the label for the correct name, dose

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A DOUBLE TAKE There are checks and balances to prevent prescription errors, but slip ups can occur. Take a second look to make sure you get the right medicine.

THE

LOOK-ALIKES

Your doctor prescribed this Although the packaging is similar, these drugs are very different. The medicine on the left treats seizures and nerve pain, while the medicine on the right is for high cholesterol.

Is that what you got?

Photo courtesy of Institute for Safe Medication Practices

ILLEGIBLE

HANDWRITING

The doctor ordered medicine for attention deficit disorder, but because of illegible handwriting, the prescription was filled for methadone, a medication for the treatment of narcotic withdrawal and dependence. That is why you should always ask the pharmacist what the medicine is for.

Your doctor prescribed this

Is that what you got? Photo courtesy of the Food and Drug Administration

CAN’T

JUDGE A BOOK BY ITS COVER

All of these are OK

These three medicines are actually the same — they all are prescribed for manic-depression and seizure disorders. However, the looks of drugs can differ by the company that manufactures them. If you’re used to getting the pink pill but get salmon instead, just confirm the identity of the pill with the pharmacist.

TAKE ALL OF THIS … Antibiotics are prescribed for bacterial infections, such as pneumonia and strep throat, but are not effective against viruses, like the common cold or the flu. It is important to finish your medicine even if you feel better. If an antibiotic is stopped prematurely, the bacteria may not be completely killed, which can increase their resistance to the antibiotic. This can result in a re-infection of now resistant bacteria.

… BUT NOT TOO MUCH OF THIS. Acetaminophen is a common and effective pain reliever and fever reducer. Many people are unaware, however, that acetaminophen is found in many prescription pain relievers as well as numerous over-the-counter products to treat cold and allergy symptoms and menstrual cramps. The maximum daily dose — from all sources — is 4,000 milligrams. Use caution when taking two or more drugs that contain acetaminophen. Excessive use can result in liver damage. For a detailed list of products that contain acetaminophen, visit http://www.nlm.nih.gov/medlineplus/druginfo/meds/a681004.html.

OTC drugs, continued from page 1 medical decision? The FDA weighed in when it mandated in 2002 that all OTC drugs carry a universal “drug facts label” that clearly lists each drug’s active ingredient, uses, warnings, directions for taking, inactive ingredients and other information. That means a consumer should be able to determine what the drug contains, if it treats the complaint, how to take it, what to watch out for and even how to store it. That answers the question for one drug and one illness. Multiple OTC drugs or combining OTC with prescription drugs is another issue. Take acetaminophen for example. Acetaminophen, a pain and fever reducer, is the active ingredient of several medications, both prescription and OTC. But the current maximum daily dose is 4,000 mg and prolonged excessive use can result in liver damage. Tylenol especially is tricky because of its many products with varying potencies of acetaminophen. For instance, each pill of Tylenol for arthritis contains 650 mg versus 325 mg for regular strength. If a person does not keep an

eye on how much he or she is taking, it is easy to surpass the recommended daily maximum. Cough syrups present another sort of problem. When taken in excess, cough syrup can cause hallucinations and partially explains why teenagers are using it for cheap highs. Herbal supplements are not without consequences either. Researchers found that St. John’s Wort — used for depression — interacts with drugs that treat HIV and other serious illnesses. Black cohosh, which women take for hot flashes, causes some drugs to stay in the system too long or move out too quickly, which reduces their effectiveness. Dr. Donney John, the clinical pharmacist at South End Community Health Center, cautions against taking too many pain killers. “People often think ‘one pill is not cutting it’ and double the dose,” he said. But John cautions against doing this: “You should not take a higher strength than what you need.” Self-medicating with pain killers can be dangerous. It’s best not to take pain killers too long without seeing a doctor. “It could be masking the symptom of something more serious,” John said.

Comments on Be Healthy? Contact Health Editor Karen Miller at kmiller@bannerpub.com.