By Mary Jane Dittmar
We are living in an age where it is absolutely necessary to be proactive about our health; there is probably no area that mandates our attention more than the medications we take. According to the Food and Drug Administration (FDA), “Harmful reactions to medications cause more deaths annually than all motor vehicle accidents, homicides, and airplane crashes combined!” relates Robert Steven Gold, RPH, MBA, author of Are Your Meds Making You Sick?
Gold, a hospital pharmacist, explains how prescription drugs, over-the-counter remedies, herbal and nutritional supplements, alcohol, and tobacco can singly, or in conjunction with a similar or totally different substance, can cause various medical problems/conditions and even kill us. Being aware of the adverse side effects of the medications we are taking, what to do if we experience them, and knowing how to avoid them the next time can help ensure that we do not become one of the 100,000 people the U.S. FDA reports are killed by drug reactions each year.
The book, a valuable reference, presents guidelines patients can use to prevent drug interactions and adverse side effects. “The optimal therapeutic regimen for individuals should include having a pharmacist or a doctor review their medications and lab tests to make sure their drugs are providing the best results possible,” Gold recommends.
Other potential problem-avoiding actions Gold advocates include the following:
- Hospitalization can pose medication-related problems. When in a hospital, ask the hospitalist (the general physician who only treats patients admitted to the hospital) about any changes made to your drug regimen. Advise your physician about these changes, and ask which medications your doctor wants you to continue or discontinue when you go home.
- Note any problems experienced when starting a new medication, and report these problems to your physician or pharmacist. The FDA must be made aware of these side effects, Gold explains, and the FDA surveillance system relies heavily on outside observation and voluntary reporting to identify rare adverse reactions patients may experience. [As noted in previous To Your Health columns, the FDA may address some of these reactions through a product labeling change or some other warranted action.]
According to Gold, many critics believe the FDA is missing information on numerous serious adverse events because consumers do not report them. Another way to report these side effects is through the FDA’s MedWatch Web site at http://www.fda.gov/medwatch/report/consumer/consumer.htm.
Physicians report only one to 10 percent of adverse drug reactions to MedWatch.
In addition, report also adverse side effects for medical devices (contact lenses and glucose tests, for example); blood, human cell, and tissue products (except vaccines); nutritional supplements (dietary supplements, infant formulas, and nutritional supplements); and cosmetics.
- Being proactive includes discussing the risks of taking a medication with your doctor and pharmacist and knowing the possible and likely side effects (minor and serious) so you can recognize a problem and have it addressed before it is too late. Don’t rely solely on pharmaceutical company advertisements to tell you what the possible side effects are, Gold counsels.
What is needed, Gold says, is “a mandated set of guidelines that would provide medical professionals with information pertaining to inappropriate medications for certain populations. These guidelines, he explains, would include a dosing range appropriate for patients according to their ages, weights, and kidney/liver functions, and they would make lab reports available to pharmacists to review so appropriate dosages could be evaluated.”
The book contains 30 case histories of patients with medical complaints caused by medication. The cases, presented as “a series of mini-mysteries,” encourage the reader to “solve” the case by determining which of several medication(s) in the patient’s regimen is responsible for the complaints. The 30 cases cover dangerous, unintended side effects such as problems in the lungs, heart; kidney, liver, or pancreas; the mind; diabetic complications; bleeding; and “strange and unusual symptoms” such as intestinal blockage, lactic acidosis, low blood sugar, muscle pain, high blood potassium, diarrhea, movement disorder, for example.
The reader also can look up a medication or a medical condition of concern in a special Index (page 232) in the Appendix. There is also a glossary and a list of Web resources for additional information related to this topic.
Especially helpful are the “16 Rules of Safe Medication Use,” presented in Chapter 1. Some are summarized below, preceded by the author’s Rule number:
Rule 1: Learn which medications are causing people to be admitted to emergency rooms. Some of the most troublesome include insulin, digoxin, warfarin, acetaminophen (Tylenol).
Rule 2: Know your kidney lab values. Many medicines are removed from the body through the kidneys. If the kidneys do not function as they should, a drug remains in the body for a longer time, which increases the likelihood of problematic reactions.
Become acquainted with the applicable kidney tests: serum creatinine (SCr) and blood urea nitrogen (BUN). Knowing the critical lab values of these tests can help your doctor determine which drug to select to keep you safe. Some medications should not be prescribed when kidney function is below par. A resource to help with this topic is “Understanding Your Lab Values,” National Kidney Foundation Web site www.kidney.org.
Rule 3: Know your liver lab values. Your liver also removes many drugs from your body. Simple lab tests, including alanine transaminase (ALT), aspartate aminotransferase (AST), albumin, alkaline phosphatase (Alk Phos), and bilirubin, can detect how well your liver is functioning. Drinking alcohol can damage your liver and change the way it clears some drugs from your system. Taking acetaminophen and drinking alcohol at the same time can cause changes in your metabolism and increase the risk of liver toxicity.
Rule 5: Take your medications as your doctor prescribes. Always let your doctor know if you take a different dosage from that prescribed—preferably, talk to your doctor before you make any changes.
Rule 6: Know you lab-test schedule. Missing scheduled lab tests can lead to your receiving the wrong dosage as your health condition changes and can cause additional health problems.
Rule 7: Know your medication’s monitoring parameters. These parameters serve as guidelines that can show if a certain drug is working or not. Patients and caregivers should talk with the physician or pharmacist about how to monitor these medications to help avoid the use of certain drugs when readings are outside of the given parameters.
Rule 9: Be aware of drug interactions. Don’t assume your doctor is checking every medication you are taking for interactions with your kidney and liver function. The physician or pharmacist’s role does not eliminate your need to know about the major interactions among your medications, especially if you use multiple pharmacies. Using a single pharmacy that has a complete record of your medications is one way a pharmacist can determine if you have been prescribed drugs that may cause harmful interactions with your other medications.
Rule 10: Understand that Over-the-Counter Medicines, Herbals, and Alcohol are all drugs. These commonly used substances can react with your prescription drugs.
Rule 11: If your health changes after you add a new drug, think drug-induced disease. If you develop a new symptom after beginning a new medication or adjusting the dosage of an existing one, that new drug may be causing the problem. Do not ignore the symptoms. Contact your doctor to see if the new drug may be causing the new symptoms, especially if the problem arose within a short time after the new drug was added and nothing else has changed.
Rule 13: Insist on medication reconciliation. If you doctor writes information on your new prescriptions in one section of a hospital chart and a nurse records similar information in a different area of the chart, or if you go home from the hospital with conflicting information about your new and existing prescriptions, you can receive a damaging mix of medications. A complete, accurate, and current list of all medications a patient is taking should be compared to the patient’s medical record or medication orders. The medication list should be reconciled every time a patient is moved from one health care setting to another.
Keep an up-to-date list of all the medications, OTC drugs, herbals, or nutritional supplements you take. Include dosages, time of usage, and method of delivery. (The book includes a sample medicine record and provides a form you can use to compile the medication list.) Make sure health professionals refer to it and check for any possible drug interactions that could affect you negatively.
Rule 14: Don’t stop taking a medication without talking to your doctor. It can be harmful to your body to suddenly discontinue taking a drug. Talk to your doctor if you are considering stopping any or all of your medications, even if you are experiencing bad side effects or cannot afford the medications.
The book is available from Hunter House Publishers, Alameda, California; and is distributed by Publishers Group West. It is available in bookstores nationwide or may be ordered by calling (800) 266-5592.
MARY JANE DITTMAR is senior associate editor of Fire Engineering and conference manager of FDIC. Before joining the magazine in January 1991, she served as editor of a trade magazine in the health/nutrition market and held various positions in the educational and medical advertising fields. She has a bachelor’s degree in English/journalism and a master’s degree in communication arts.
