Chances are, you've had, are taking or will be prescribed medicine by a doctor at some point. There are lots of things you should know about pharmaceuticals to increase their ability to make you better and reduce any chance of negative side effects, according to Dr. Tamara Dean, clinical pharmacist and pharmacy coordinator at Doctors Hospital Pharmacy.
Do you understand the difference between generic medications and name brand medications?
Do you know why you should always finish the medicine that has been prescribed unless otherwise instructed by your doctor?
What about why you should never share prescription medications with other people?
And do you know how to safely dispose of expired medications?
Dr. Dean addressed the proper handling of medications during the recent Doctors Hospital Distinguished Lecture Series.
She said people should ensure that they are educated on medication's adverse events and drug interactions; expiration dates; medication storage; proper drug disposal; the difference between brand and generic medications; over-the-counter medications and safely administering medications at home.
Adverse drug event
An adverse drug event (ADE) is an injury resulting from medications and includes medication errors, allergic reactions, adverse drug reactions or an overdose. She said ADEs could happen anywhere -- a doctor's office, at a hospital, during a visit to an emergency room as well as in the home.
"According to the Centers for Disease Control, adverse drug events is considered a public health problem. Eighty-two percent of adults take at least one medication; 29 percent take five or more medications. As the number of medications you're taking increases, this also increases your risk of an adverse drug event."
The clinical pharmacist said $3.5 billion is spent on extra medical costs incurred by ADEs annually. And at least 40 percent of the ambulatory (non-hospital settings) adverse drug events are preventable.
According to the National Center for Healthcare Statistics and Centers for Disease Control (CDC), statistics show that drugs now kill more people than cars and guns. The overdoses can be intentional or unintentional.
To help avoid ADE events Dr. Dean encourages patients to ensure that their physician and pharmacist have a complete list of their medications.
"This is important because when making decisions about your drug therapy, if your physician has a detailed drug history, he or she can prescribe the necessary or safe regimen, or the options that are safe for you," she said.
She encourages people to use one pharmacy to fill all medications and take advantage of pharmacist consultations. She advised against leaving the pharmacy with unanswered questions.
To avoid ADE events, she said people should limit how often they use over-the-counter (OTC) medications, which can cause harm just like prescribed medications. If you are taking any prescription medications, she suggested asking your doctor or pharmacist before you add an OTC medication to your drug regimen.
"Read the drug fact label on the medication very carefully, whether it's an over-the-counter medication, or whether it's a prescribed drug. Most times when you're dispensed a medication from a pharmacy, there's a label that's placed on that medication along with auxiliary labels. These are all instructions to you to keep you safe. Ask your doctor or pharmacist if the information about your medication is unclear. According to the American Society of Health Systems Pharmacists, studies have shown that patients that are empowered about their medications, that have received adequate information about their medications, their outcomes tend to be much better than patients who have no idea why they're taking their medications," she said.
Dr. Dean said medications should be taken exactly as directed; the instructions on the label are not only to ensure patients complete the entire regimen, but also to ensure that they are safe while taking medications.
A person should not take medications that have not been prescribed for them.
"A lot of times your friends or family members may present with the same symptoms or signs, and you'll be like, 'OK, I have some antibiotics here you can use this', or 'I have some pain medications you can use'. Never share your prescribed medications with family members or anyone for that matter."
The Doctors Hospital pharmacy coordinator also said you should not take vitamin pills and minerals along with medications unless you have authorization from your physician or pharmacist. She said a lot of times the OTC multi-vitamins can interact with the drugs.
Drug interactions
Drug interactions (when a patient is taking two or more medications at the same time) may make medication less effective, cause an unexpected side effect or increase the action of a particular drug. In some instances, a drug interaction can also decrease the effect of certain drugs, and even be harmful. Drug-food or drug-beverage interactions are common.
"Alcohol is a common beverage that interacts with a lot of medications. On the label of your prescribed medication or your over-the-counter medication, you will always see 'Do not drink alcohol'. There is a reason for that. If you're taking antihistamines, that causes drowsiness, and you consume alcohol, that drowsy effect is potentiated and sometimes can harm you.
"Or, if you're taking a certain medication and consume alcohol, you can damage the liver. So all food-drug interactions are not good. Then sometimes you would see on the labe 'Take after a meal'. Some food interactions are beneficial, and others can be detrimental to you."
She said it's important people know what they're taking and the possibilities of a drug interaction.
Drug-condition interaction, which is described in the pharmacy as drug disease interaction, is an interaction that occurs when a person with a known medical condition like hypertension takes a drug like a cold and cough preparation that has a decongestant in it which can elevate the blood pressure. For reasons like this Dr. Dean said people should consult their pharmacist or physician before adding any drug to their regimen.
To avoid interactions, you are encouraged to always know the active ingredients of your medication -- whether they are OTC medications or prescribed.
Expiration date and how it affects your medications
Admitting that some medications are expensive, the pharmacist said some patients, to avoid an expensive doctor visit or to avoid refilling an expensive drug, tend to take medications after the expiration dates have passed, which is not good at all.
"Pretty much once a drug has reached its expiration date, what happens is that drug gradually decreases in potency. So you start off at 100 percent, but over time a drug diminishes in its effectiveness. And once that drug has passed the expiration date, that drug is not as effective as a drug that has not expired yet."
In 1979, United States law mandated that the manufacturers indicate the expiration date on their products. This is the date at which the manufacturers can guarantee that the drug is still effective, or still has potency to exert its pharmacological effect. Drug expiration dates exist on prescription medications as well as OTC medications and dietary and herbal supplements.
"While there are some drugs that you can take after the expiration date has passed, I want to note to you, do not take any drug that has expired, unless you've gained authorization by your physician, or you've spoken to your pharmacist, because some drugs when taken after the expiration date can harm you, or they can be ineffective," she said.
Drugs that should never be used past their expiration dates include anticonvulsants, nitroglycerin, Warfarin, Theophylline, Digoxin, thyroid preparations, oral contraceptives, insulin and eye drops.
Proper drug storage
While oxygen, light and water are among the substances that humans need to survive, they are the elements you want to avoid coming into contact with your medications. According to the Food and Drug Administration (FDA), they can degrade your medications.
"Exposure of medications to inappropriate conditions may render them ineffective or even harmful if ingested," said Dr. Dean. "Every medication has its own specific instructions as it relates to storage. The manufacturer would set this parameter. Certain medications would require refrigeration, certain medications and some vaccines require freezing, some medications require that they be stored at room temperature, and if these medications are stored outside of the recommended environment, they can be ineffective.
"And contrary to popular belief, it is not advised that you store medications in your bathroom's medicine cabinet, because of the extremes in temperatures and humidity. Medications also come in specific containers -- clear, opaque and in foiled packages -- all for reasons based on maintaining the stability of the product.
"When a product or medication is dispensed to you, always keep that medication in that container, or if possible, the original container."
Dr. Dean said you should separate pediatric medications from adult medications to eliminate the possibility of administering an adult medication to a pediatric patient.
Disposal of unused or expired medications
Flushing medications down the toilet, or pouring them down the drain is a no-no, according to the FDA and the World Health Organization (WHO).
Dr. Dean encourages people to refrain from crushing their medications and to keep them in the original containers when disposing of htem.
"Remove or blacken out, de-identify the personal information on your medication container, but leave the name of the drug as well as the dose of the drug on the container. Add a safe and unpalatable substance, such as dirt, kitty litter, or coffee grounds to the medications in a sealed bag before disposing of the medications in the trash. The reason you're doing this is to ensure that if the medication gets into the wrong hands -- child or pet, the unpalatable substance would cause a diversion, and those persons or the pet would not consume the medication. If you can, dispose of the medication as close to trash day as possible."
The difference between generic and branded products
According to Dr. Dean, generic drugs should be safe, they should be effective and in most cases they should all have the same active ingredients as the brand product.
"Generic drugs are required to have the same dosage strength, dosage form, as well as active ingredients. The generic manufacturer must prove to the regulatory bodies such as the FDA as well as the WHO that its product is bio-equivalent to the brand product. It should have the exact active ingredient. It should have the same safety and efficacy profile as the brand product. It should also have the same pharmacokinetic profile -- that basically means if you take a generic drug and you take a brand drug, if you test the person's blood level, there should be the same amount of drug levels in the blood when you compare both of them. A drug is not deemed bio-equivalent unless it meets these standards. And there are regulatory bodies that ensure that the generic drugs that are manufactured meet these standards."
A lot of times she said there is a significant difference, sometimes as much as 80 to 85 percent, in the cost of generic drugs compared to branded products, with the manufacturers of the brand products sometimes the same manufacturer of the generic product. It's all economics.
"When a drug is manufactured, a product has a patent that's set on that drug. Once that patent has expired, companies can now manufacture that same drug
but there are some regulations that they do not manufacture the drug during the patent of the branded product.
The difference in price between brand and generics is the brand company spends an excessive amount of money on marketing the drug, clinical studies, and clinical trials, so the cost of the branded product is significantly higher than the generic product."
Dr. Dean said the FDA and the WHO monitor adverse events associated with generic drugs, so the drugs, once they've been approved to be manufactured, are also monitored for safety and efficacy as well.
Over-the-counter medications
Over-the-counter medications or non-prescription medicines can be purchased without a doctor's prescription. The clinical pharmacist said they are safe and effective if used exactly as directed, and if you minimize the usage of them. She said normally patients that are healthy and that are not on multiple drug therapies, tend to do very well on OTC medications. But she said these drugs can still pose a problem or can still create a significant increase in the amount of adverse drug events if they are not handled appropriately.
She said there are certain patient profiles -- children, older adults and persons taking more than one medication at a time -- that are at a greater risk for experiencing an adverse drug event from OTC medications. The same, she said, applies to OTC and prescribed medications. And that the larger amount of medications a person consumes, this increases their chances of an adverse drug reaction, an adverse drug event and even a drug interaction.
When it comes to OTC's Dr. Dean says to always read the direction labels, and to measure the dose appropriately.
"If you look at an OTC label, on the back of the label is information about the active ingredients. This tells you exactly what is in your product. It also gives you information to avoid certain adverse drug events as well. It helps you to avoid taking two or more of the same drugs within the same drug class. Then you have the inactive ingredients that are very important. While they do no exert a pharmacological effect, the inactive ingredients can cause an adverse drug reaction or they can cause an allergic reaction. This information is very important. Patients who have allergies to certain drugs or inactive ingredients, it's very important that they know the types of dyes, the stabilizers that are in their medication, and on the label, it tells you exactly what is in your medication."
Safety tips when administering medications at home
Never use a household teaspoon or tablespoon when measuring medications. Dr. Dean says these do not deliver the accurate volume of medications that are required.
"Always use the devices that are provided to you by the manufacturer or your pharmacist. If you are dispensed a syrup or suspension in the pharmacy, never leave the pharmacy unless you have some measuring device so that you can measure your medications accurately. When measuring the medications, always look at the medications at eye level on a flat surface so you get the right volume. Do not look down into a cup. A lot of dosing errors occur when we measure medications incorrectly. There is a patient population, the elderly as well as pediatric patients, it's very important that we measure medications accurately for these populations," said the clinical pharmacist.
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