- [Announcer] Living longer, living healthier, living better than ever before.
Welcome to Mountain-Pacific's Healthy Living for Life, a weekly series that gives you the
information, education, and expert insight you need to become an active participant in
today's ever-changing health care climate.
Here now is today's program host.
- When it comes to making sure you understand your medications, who would you say is on
your pharmacy team?
Your doctor, your pharmacist?
They certainly are, but you may be surprised to learn the most important member of your
pharmacy team is you.
Welcome to Healthy Living for Life, a show dedicated to helping you do just that.
I'm your host, Beth Brown.
Today's show is about what you need to know about your medications.
Stay with us, we'll be right back.
- Welcome back.
Part of being a member of your pharmacy team means knowing about the medications you're
taking.
Joining us this morning is Lisa Sather to talk to us about how to do that.
Lisa, thanks for being with us this morning.
- You bet, Beth, thank you.
- Can we start out by just explaining what is medication reconciliation?
- Sure, that's a great question.
So medication reconciliation is when you make a complete list of all of your prescription
and over-the-counter medications, and that includes the name of them, the dosage, how
they're taken, the frequency, how many times per day, and you want to compare that with
the medication list that your hospital, your provider, your pharmacy has.
So it's really important to have a complete list of those things, and typically that's
done when you transfer care from one healthcare setting to another, like say you're leaving
a hospital, going home, leaving a hospital, going to a nursing home, home to a nursing
home, et cetera, et cetera, so that's what we're talking about when we're talking about
transition of care.
- [Beth] Okay, and so who does a medication reconciliation?
Does your doctor do that for you, can you do that for yourself?
- Sure, really anyone can do that.
Certainly you can do that for yourself.
Typically you're going to see a pharmacist doing that, a physician doing that, a nurse
can even do that.
You can even ask a caregiver to help you do something like that.
It's just really important that you get a complete list and also it does somewhat help
if you have someone that's skilled in medications and knowledge about those because names can
be confusing and in order to understand that you're not having a duplication of a medicine
and things like that, that's really where it does come in helpful to have someone that's
trained in medications.
The whole basis of this is you really want to make sure your list is complete so that
you don't miss a medicine when you're transitioning, you don't have a duplication of a medicine,
things like that, that's the important pieces we're looking for.
- So you mentioned that medication reconciliation happens at a care transition.
- [Lisa] Yes.
- Does it happen automatically?
Is there a time when you should be requesting this to happen?
- Sure, it really does depend upon the healthcare system.
So typically upon discharge from a hospital that's something that in most cases is going
to happen at some level.
The situation is that sometimes there can be gaps and it is different from different
healthcare system to healthcare system.
So, definitely if it's not something that has happened for you it is something that
you should definitely ask for.
The importance of that is it will also help you understand your medications, help you
be in tune with that.
You are your, you know, one of your biggest advocates of course, and so if it is not something
that you have had offered to you, it is definitely important to ask and get that done.
- Okay, great.
And why would you say you should perform a medication reconciliation, why do it?
- That's a great question.
So medication errors is really the biggie here.
Nearly half of all medication errors happen at some transition of care, and so that's
important.
We know that if a person is missing at least one or more of their medications upon a transfer
of care, they're more than 50% likely to have some type of an adverse drug event.
And they're also more likely to get hospitalized even within that first month after they leave
the hospital.
That's why it's really imperative that we understand our medicines, and it will help
you not to make mistakes.
- Okay, perfect.
So a medication reconciliation you said is basically putting together a list of your
medicines that you're taking.
It seems pretty straightforward just creating a list, but it can actually be really complicated,
right?
Can you talk about that a little bit?
- Sure that's right, I kind of mentioned earlier, I mean, this process can vary from healthcare
system to a doctor to a pharmacist.
There's not one national type list that's available in order to perform a medication
reconciliation.
So, since the documentation differs, there can be sometimes inconsistencies in information,
that's why it's just really important to work with those you're comfortable with, your providers,
in order to put together that complete list.
- [Beth] And you mentioned the inconsistencies, but the one constant there obviously is the
patient.
And the problem or the difficulty there is the patient isn't necessarily an expert on
his or her medications, and so for those folks out there who maybe feel a little bit overwhelmed,
maybe they take a lot of medications, any advice on how to kind of put this together,
make sure that everything is accurate, how do you go about doing it if you don't have
that knowledge like you said.
- Absolutely, so I think the biggie is ask for help.
Whether that means seeking out your family member to sit down with you, help you sort
through that.
I think even more importantly is to talk with your doctor and your pharmacist.
Your pharmacist, if you're using one pharmacy, which we highly recommend, they're going to
have that complete list, and share with them your over-the-counter medications.
So I think that's really imperative.
The other thing you can do is you can take all of your medicines in a bag to your doctor's
office when you have a visit so that they're able to reconcile with the medicines that
are on their list that they have on record there as well, and I think also another key
point is that if you're in a hospital situation or a nursing home, and you're transitioning,
to ask questions.
Make sure you understand, and it's important also, I remind people, take notes, if you
don't have something that's printed out for you, even if you do, oftentimes it's very
helpful to jot down notes to help you keep things straight, so make sure to do that.
- Okay, good advice.
So what if you're working with your doctor or your pharmacist to do a medication reconciliation,
is that also a time when you can check for maybe medications that might interact with
one another?
- You know, that's possible, it depends upon the skill obviously of the person doing the
reconciliation.
At some level, obviously on your new prescriptions, and refill prescriptions and those kinds of
things, if you're seeing one pharmacy, that should kind of be done at that point in time,
but if you have any questions at all, you definitely should ask your pharmacist, especially
if you have a new prescription that's being added.
- Okay, we have about a minute left here.
There are some websites online, they're called interaction trackers.
- [Lisa] Yes.
- You can go in and sometimes they have lists of medications, sometimes you type them in,
but you can put your medications in and find out if there are interactions.
Would you recommend these kinds of sites?
- You know, certainly there are some trustworthy ones out there, drugs.com has one, I was just
online this morning, CVS has one, some of the national chains have those, they even
link, you can pull up the drugs you take through those companies.
So yes, I mean, that is a good valuable tool, the important thing to remember about this
is if you do go online and you do do that, it's kind of sometimes difficult to evaluate
whether or not the level of interactions are extremely severe and those kinds of things,
so I always recommend that you talk to your pharmacist about those if you do come up with
something that's flagged to ascertain whether or not it's really clinically significant.
Also to follow up on that, another important thing is you want to make sure you don't just
stop things cold turkey.
You need to talk with someone first.
- Perfect, thanks Lisa.
We do need to take a quick break, but coming up next, there are several medications that
patients must take with caution because they are notorious for causing drug-to-drug interactions
not only with other prescriptions but with over-the-counter medications too.
We'll talk about that right after this.
Stay with us.
- Welcome back.
With so many people over the age of 65 taking multiple medications in this country, it's
a good idea to know when the wrong combination can make it so your medicines are no longer
helping you, can harm you, or can even be deadly.
Lisa Sather is still with us to talk about this.
Are there certain prescription medications that doctors and pharmacists automatically
know they're red flags because they just don't play well with others?
- Sure, that's a great question, Beth.
I think it's important to firstly mention that medications can be life-saving and necessary
in the treatment of medical conditions.
- [Beth] Sure.
- But always there's a risk/benefit when we look at that.
And so yeah, there's kind of a group of medicines that we're always vigilant about and we'll
just mention those, anticoagulants, or medicines that people know as blood thinners.
Warfarin, is kind of the old standard that we're used to, there are newer ones out there,
Eliquis, Xarelto, Savaysa, Pradaxa the new agents, and then moving on, nonsteroidal anti-inflammatory
drugs, those medicines like Ibuprofen, Naproxen, that are used to treat pain and inflammation
are a biggie.
Medicines with anticholinergic side effects, that's kind of a big word, it kind of refers
to the mechanism of action and how they work, but they definitely are things that can cause
issues.
And then we have benzodiazepines, used for the treatment of anxiety, sometimes sleep,
those kinds of things, sometimes seizures, they have a red flag for us, and then last
but not least, opioids, which are pain medicines used for the treatment of moderate to severe
pain, and so those are kind of the five big classes.
- Let's dig into some of those and talk about some of the more common interactions.
Can you talk a little bit more about Warfarin?
- Sure, so you know, as a pharmacist, one of the big things, there's a lot of things
with Warfarin, but one of the things just that folks might commonly get prescribed are
an antibiotic, and there are certain classes of antibiotics that can interact with Warfarin
and cause increase in bleeding.
Nonsteroidal anti-inflammatory drugs as well, those drugs can increase bleeding, and so
we're always vigilant about that.
Herbal supplements can sometimes even interact with Warfarin, garlic comes to mind as well.
Another one that I recently came across, I wasn't familiar that this was an interact
is glucosamine and chondroitin, folks sometimes take that for the relief of inflammation and
pain in their joints, it's an over-the-counter medication, so think it's important to just
mention that any time you're on an anticoagulant, either the older Warfarin or the newer ones,
it's important to talk with your doctor, make sure your doctor or pharmacist understands
all of the prescription medicines and over-the-counter medicines you're currently taking.
- Okay, and another type of medication that you mentioned in the big five there was NSAIDs,
can you talk a bit more about NSAIDs?
- Yeah, so, nonsteroidal anti-inflammatory drugs, some of the biggies with those, a couple
of them, were blood pressure.
They can actually make your blood pressure medications less effective, so that's something
to watch out for.
Also, water pills, diuretics, that's kind of along those same lines.
Also, you know, as a sidebar, folks that have stomach issues, if they're taking medicines
for ulcers or those kinds of things, not necessarily interaction, but those medicines can make
your stomach have more issues with being upset and things like that, so we want to watch
out with that.
Again back to making sure that your physician and pharmacist are on the same page and they
know all of those medicines you're taking because NSAIDs are even available over-the-counter,
it's not necessarily just a prescription.
- Right, okay.
And then another one you mentioned, and this, like you said, that is a tough one to say,
anticholinergics.
- Yes, good job.
- Okay, thanks.
Can you talk about the common interactions with those?
- Sure, so anticholinergic medications, again, that's kind of referring to the mechanism
of action which is more of a, you know, a pharmaceutical term, that class of medicines
are often used to treat motion sickness, gastrointestinal disorders, overactive bladder, sometimes folks
will deal with that as they age, and just by virtue of how they work, they can decrease
the saliva we make, they can decrease our stomach motility, they can also cause drowsiness
and dizziness and those kinds of things, so some of the medicines that might interact
would be medicines for dementia, Aricept comes to mind, or if you're taking a medication
that also causes drowsiness or dizziness and those kinds of things, that can just compound
that effect.
Antidepressants, some medications that are used as anticonvulsants, and a common one
that's over-the-counter is Benadryl.
It's an antihistamine, it has anticholinergic effects, people use it for sleep, allergies,
that's a biggie.
- Okay, great.
And then you also mentioned benzodiazepine.
- [Lisa] Sure.
- So what are some of the common interactions there?
- Sure, as I mentioned, benzodiazepines are used to treat sleep, sometimes anxiety, sometimes
seizures.
They can cause drowsiness, dizziness, confusion, so again, any other medicines that cause those
same kind of side effects like opioids, seizure medications, sleeping medications like Ambien,
that's really not per se a benzodiazepine, but it's like a benzodiazepine.
Muscle relaxers, sometimes people are taking those in conjunction because they might have
muscular issues, so again those can all compound the effects, important to share with your
physician and pharmacist if you're getting those from a different provider.
- Okay, and last but not least, let's talk about opioids, what should folks be aware
of if they're taking an opioid?
- Sure, opioids of course used to treat pain, mostly moderate to severe pain, typically
following surgery.
Those medications can cause drowsiness, a decrease in your respiratory rate, decrease
in heart rate, so any other medicines, again that can increase the effects of those can
cause more dramatic effects, more dramatic side effects.
Medicines that we use for seizure, muscle relaxers are notorious, benzodiazepines are
notorious.
So it's, again, we're all going back to that same common thread, make sure your physician
and pharmacist know exactly all the medicines that you're taking to minimize those potential
issues.
- Perfect, good advice once again.
And we're running up on our commercial again, so one last question here really quickly,
any other common interactions that folks should be aware of that maybe don't involve those
big five?
- Yeah, insulins is a big one to look out for.
Sometimes medicines that are used to treat blood pressure can cause hypoglycemia, that's
kind of one of the biggest issues we have with insulin and that can be very life-threatening
if not treated appropriately.
Digoxin is a medicine used for heart conditions, there are others medicines that are used for
heart conditions that can make it more pronounced and can cause issues, and then ACE inhibitors
used to treat blood pressure, also used for diabetes, those kinds of things, for prevention,
they have typical interactions with things like excess potassium, or you know, that can
cause them to be, have increased adverse drug events, so there's a whole host of things,
those are just a few.
- [Beth] Okay, so the main advice there, talk to your doctor or your pharmacist.
- Main advice, yes.
- Okay, let's take another quick break here, but when we come back, do you have questions
about your prescription today?
Your pharmacist probably asks you that every time you pick up a medication, but do you
take that opportunity to ask your questions, or are you just not sure what you even should
be asking?
We're gonna give you some questions you should ask your pharmacist right after this.
Stay with us.
- Welcome back.
We are always encouraged to ask questions about our medications, but if we don't know
what questions to ask, we miss out on the opportunity to learn about the medications
we're taking and how they might impact our health.
Lisa is still with us to talk about what questions you should definitely ask your pharmacist.
So before we get into the questions though, Lisa, are there times when we should be asking
these questions, is it when we get a new prescription, even when we're doing a refill, when do we
even ask these questions?
- Yeah, sure, Beth, that's a great question.
So my opinion on that is absolutely every time there's a new prescription, you should
be asking these questions, but also I think it's always good to touch base on refill situations,
you know, especially if any of your medical conditions have changed since the last time
you filled a prescription, or if you have decided you're gonna start a new over-the-counter
medication, I think that's a good time to check in with your pharmacist to make sure
there's not going to be a potential issue with that.
Again, any time you have concerns or questions is a good time, that's what they're there
for.
- [Beth] Great, and what about those folks who say I don't need to ask my pharmacist
any questions, there's tons of information with this bottle they're giving me, I'll just
go home and read it.
- Right, I think that initially that might be all right, but you really should take the
time to understand what the directions are and the things we're gonna get into in a couple
of minutes, and a lot of times if you, you get into that information when you get home,
it can be very overwhelming and maybe not necessarily very patient-friendly.
Also it's difficult sometimes to really discern, what's really clinically important.
You might read information on the printout that's sent with you, and it's a slew of information,
it's a whole page.
Yes, there are opportunities where sometimes those types of side effects may occur, it
may be in less than 1% of the population, but your pharmacist can really point out for
you what situations specifically apply to you, and when you should really be looking
for, you know, issues of concern.
I would always say if you are in a hurry and you can't, or your pharmacist is tied up and
you can't necessarily talk with him right then, don't hesitate to give them a call once
you get home and you've sat down and tried to digest the information.
- Okay, so let's give folks a list of questions that they can ask, what would be first on
that list?
- Sure, I think one of the number one most important things is what's the name of my
medicine and what is it being used for?
For example, I'm taking Lisinopril, and I'm using it for my blood pressure.
Is it a, you know, you should know the generic.
Most medications anymore are available generically.
They work as well as their brand name counterparts, they are as effective, but they are less costly.
So if there's a brand and a generic, those are typically gonna be on the label, but I
think it's kind of important to know that because when you're reconciling, making lists,
you might think they're two different things and they're actually one and the same.
How to take it?
Am I taking it as needed, and what does that mean, are there maximum amounts per day if
I'm doing that, am I taking it scheduled, meaning a set time every single day, if it's
twice a day, what times during the day?
Am I going to need to take it with a lot of water or am I going to need to take it on
an empty stomach, or am I going to need to take it with food?
As a sidebar regarding food, you know there are some foods that do interact with medications
and we didn't get an opportunity to talk about that earlier, but I think it's important,
and your pharmacist should be pointing that out to you, you should have that on the label
of the medicine if there are certain foods to avoid.
A biggie is grapefruit juice.
People don't realize that it can interact with over 85 medications, and really can be
very serious either decreasing their effectiveness or making them more potent and increasing
the risk of adverse drug events, so that's important.
And how long are you taking the medicines for?
Is it just for 10 days, do I take it till I feel better, can I stop it, those kinds
of things.
- Okay.
So those are sort of the top of the list, what are some of the other questions that
folks should take or ask about taking their medications?
- Right, so we've kind of hit on this earlier and a big this is drug interactions.
Are there any things I need to be looking out for in terms of other medicines?
That's usually gonna be done at the point of fill, you know, your pharmacist is going
to be looking at those kinds of things.
Do you have any allergies that are new that need to be discussed, and then whether the
side effects that might occur are serious or not, and we talked about that a little
bit earlier in the patient information.
- [Beth] Okay, so that, have we exhausted the list, or are there any other questions
you would throw out there?
- We could go on and on.
I think another important thing is storage.
Is it refrigerated, can it be stored just on the shelf?
Are there refills on the medicine, do I need to talk to my pharmacy, or excuse me, my physician
before I get a refill?
Can I just refill it myself?
Are there any activities that I need to avoid?
Some medicines of course cause drowsiness, dizziness, we talked about benzodiazepines,
and opioids earlier.
What happens if I miss a dose?
I think that's important.
Some medicines you can resume at the next dose, some you need to take it that same day,
but also again if you forget to ask these questions at the pharmacy, don't hesitate
to call if something comes up and you have a question, your pharmacist will be able to
help you.
- Okay, and we just have a couple minutes left in the show, so let's spend that time
talking about over-the-counter medications.
You did mention earlier that those can cause interactions too, whether it's aspirin or
a supplement.
Is there a specific time when somebody should ask either their pharmacist or their doctor
about an over-the-counter medication before they take it?
- Yes, absolutely.
So it's important to remember, these are as significant in terms of the fact that they
can cause adverse effects or issues as a prescription, you need to take that seriously and be diligent
about that.
I would suggest you read the label and that will give you general information, but any
time you start an over-the-counter medicine and you are taking a prescription medication
it is not a bad idea to check with your pharmacist about that, just to make sure.
- Okay, so going back to asking our pharmacist questions, are there questions that you should
be asking about your over-the-counter medications?
- Sure, I mean I think most importantly is will it interact with something I'm taking?
Are there specific side effects to look out for?
How long should I take it?
A great example of that is medicine used to treat stomach ulcers now that's over the counter,
the proton pump inhibitors, Prilosec, and you know, that's a two week deal normally.
There's reasons why we don't want to take that longer than that, or we can take it as
needed.
So I think it's important to ask at least at minimum those types of questions.
- [Beth] Okay, and what are some of the common side effects that can happen with over-the-counter
medications?
- Sure, I think cough and cold is a biggie because we all always end up with a cough
and cold at some point in time, and it really does depend upon the medication.
So medicines for cold, if they have multiple ingredients can cause drowsiness, dizziness,
dry mouth, those kinds of things.
The antihistamines, Benadryl, I mentioned that earlier, it's a sedating antihistamine,
it can cause drowsiness, and so I think those are kind of the biggies.
- [Beth] Okay, perfect.
Lisa, thanks so much.
- You bet, Beth.
- Great information, appreciate you being here.
And thank you for tuning in this week.
Be sure to join us again next week.
Until then, stay fit, stay well, and stay healthy for life with Healthy Living for Life.
Have a great week.
- [Announcer] Healthy Living for Life is brought to you by Mountain-Pacific Quality Health.
We'd love to hear from you.
If you have suggestions for future programs, visit our website at MPQHF.org or call us
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