A closer look
Before you leave the
Read the drug label to make sure the prescription is
drug store, get the facts.
yours and matches the one written by your provider.
The dos and don’ts of prescription drugs
Timothy Velasquez took four times the amount of his prescribed medication — fortunately, with no side effects. Velasquez says he now asks questions about his medication before he leaves the pharmacy. (Ernesto Arroyo photo)
If questions were few to his doctor, they were even less to his pharmacist. “I trusted those guys,” he said. “They put [the drugs] in a bag and I walked out.”
Velasquez can only shake his head at his past irresponsible attitude. Especially in light of the fact that he is on 10 different drugs for heart disease, diabetes, high blood pressure and other medical complications. He considers himself fortunate.
Fortunate is right. According to a study published in the Journal of the American Medical Association in 2006, more than 700,000 visits to the emergency department occur every year due to medication mishaps. And 120,000 of these visits result in hospitalization. Part of the reason is attributable to the virtual explosion in drug usage across America.
Prescription drugs alone constitute the third highest national health expenditure in this country, trailing only costs for hospital and physician services. The National Council on Patient Information and Education, a Rockville, Maryland-based nonprofit organization, estimates that more than 3.5 billion prescriptions were written in 2007.
Some medications in particular have escalated in demand. For instance, the use of antidepressants and antiasthmatic drugs has doubled in the past nine years, while certain medications for high blood pressure and high cholesterol have experienced a five-fold increase.
It’s no wonder then that almost half the population reported using at least one prescription drug during the preceding month, while roughly one-fourth used three or more prescription drugs.
The elderly are particularly vulnerable. While only 38 percent of those between the ages of 18 and 44 used one prescription drug, almost 90 percent of those 65 years and older reported the same.
Multiply the drugs and the gap further widens: 63 percent of elderly people versus 11 percent of those 18 to 44 use three or more prescription drugs.
Fortunately, Velasquez didn’t become another major statistic for a medication mishap. But Velasquez did receive a recent wake-up call. He was prescribed a liquid medication to reduce the potassium levels in his blood and was given two bottles at his pharmacy.
There was only one problem. The plastic cup to help measure exact dosages was missing. Reading the label was of little help. And measurements like “CCs” for cubic centimeters merely added to the confusion.
He had no idea what that meant, let alone how to calculate it, and that led to the next problem. Velasquez developed his own regimen.
In fairness, Velasquez was right that he needed to take the medicine twice a day. But without knowing the exact amount, he drank half of the first bottle after breakfast and the remainder before bed.
He repeated this regimen the following day. “The medicine tasted pleasant,” he explained, “so I did not make a big deal of it.”
Donney John, Pharm.D. (right), the clinical pharmacist at South End Community Health Center (SECHC), counsels Zenaida Del Valle on proper use of medication for her diabetes. SECHC participates in Collaborative Drug Therapy Management, which delegates drug therapy management to a pharmacist. (Ernesto Arroyo photo)
Velasquez realized his error when he spoke to his pharmacist. Alarmed, the pharmacist immediately called his doctor who quickly ordered a blood test. “She dropped a dime on me,” he said. The good news is that Velasquez suffered no ill effect. “I got my potassium down all right,” he laughed. “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 completely forget. Others just don’t want to take pills and never follow through.”
Complicating the issue is that each and every medicine has its own characteristics. Medication for diabetes is one example. Insulin and other medications are prescribed according to a person’s lifestyle — what they eat and their level of physical activity. Modifications in a diet may require adjustments in the prescription, John explained, and those should be made by the health provider. “But some people make adjustments on their own,” he said.
Taking too much insulin can cause blood sugar levels to drop. “People can get very shaky or pass out,” said John. Drowsiness, fatigue and rapid heartbeat are other potential consequences.
Another example is blood thinners. Prescribed to prevent clots from forming in the blood, blood thinners pose their own set of problems: too much can cause a major bleed; too little can result in a heart attack or stroke.
And like many other medicines, blood thinners are also food sensitive. “A lot of things can affect it,” said John. “Like green leafy vegetables.” Green leafy vegetables are high in vitamin K, which reduces the effectiveness of blood thinners. Other foods, such as grapefruit juice, can also impede the success of medicines. As do alcohol and illicit drugs.
Even if a person knows his or her medication and takes it correctly, there is a chance of multiple drug interactions that diminish or increase the effect of the medication. Patients are not always to blame for medication mishaps; sometimes the medical community does its fair share. A 2003 study published in the New England Journal of Medicine found that of the patients interviewed at four primary care practices, a notable percentage of adverse drug events was attributed to physicians’ failure to respond to symptoms caused by the medications.
And there’s always the chance that a problem may occur at the pharmacy.
Patricia Link, 59, now knows that checking a prescription before leaving the drug store is a two-step process. She says she checks the label for the correct name, dose and purpose of the drug.
She says she also knows now to actually look at the individual tablets.
Since the wrong drugs were accidentally mixed in with her pain medication, Patricia Link now looks at the pills she picks up from the pharmacy. (Tony Irving photo)
Link is on five different types of drugs that she takes daily for high blood pressure, high cholesterol and a few other ailments. She also takes pain medication as needed for a complicated orthopedic procedure performed on her spine.
The mishap occurred with her pain medication. The directions were to take one to two pills every six hours. “I take two,” Link said. “That’s my dose.”
But after taking the pills one recent day, she lay down but did not feel any better. Six hours later she took two more.
The next morning she knew something was wrong. “I felt funny in the stomach and tired,” she said. “I usually don’t wake up tired. Something told me to look at the medicine.”
She was surprised at what she discovered. “One pill in the bottle looked different from the others,” she explained. “I counted up the pills in the bottle. Five of them were the wrong pills; the rest were mine.”
But they looked very similar. Both were the same color and shape, according to Link, but the “wrong” medication was smaller.
She informed the pharmacy and was told by a nurse at her clinic to go to the emergency room. Fortunately for Link the effects were short-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 he’s not as familiar with his drugs as he should be, he relies heavily on the medicine list that his doctor gives him during each visit.
As a result, Velasquez said, he knows when to take his drugs. He knows which ones have to be taken with food. He also knows which foods to avoid in order to insure the medication’s effectiveness.
More importantly, he fills all his prescriptions at the same pharmacy, a practice recommended by health practitioners. That allows the pharmacy to have an accurate record of what drugs he is now taking or has taken in the past. The pharmacist can then more easily check for potentially harmful drug interactions, or interactions that may decrease the effectiveness of his medications.
Velasquez says he’s learned his lesson and vows to change his behavior the next time he picks up his meds. “I’ll check to see if everything is there,” he insisted. “I will take the time to ask a few questions,” he said. “I can’t leave everything up to the doctor and pharmacist. They’re busy enough.”
For more information:
National Council on Patient Information and Education
Institute for Safe Medication Practices