Medication Safety

Women typically are the safekeepers of their families' health. Women purchase their families' medications, take their children and sometimes their older parents to health care providers, and tend to make most of the family health care decisions. If this describes your role, there is much to know about how to keep yourself and your family safe when using medication.
Chances are you have a cabinet full of medications-from over-the-counter (OTC) decongestants to prescription drugs you take for a variety of reasons. You may also have some herbal treatments, vitamins and minerals-even some expired medications, and perhaps some prescription drugs you no longer use.
The U.S. Food and Drug Administration (FDA) has the final say as to whether a medication will be available by prescription only or OTC. The FDA establishes guidelines for use, which are required to appear on all labeling instructions, but the proper use of these drugs depends on you. Herbal products are regulated only as they are considered dietary supplements, but nonetheless, they must be treated as medications. They should be used as you would any other medication: carefully and correctly.
The first and most important step to use medications properly is to educate yourself about the specific drugs you and your family are taking and the conditions they are intended to treat. Here are basic guidelines for keeping your family and yourself safe while using medications safely and effectively.
Always keep an updated list of all the medications (prescription, over-the-counter, herbal, supplements) you (or those you care for) take. Also include medications you are allergic to with an explanation of what happens when you take the medicine. Make this list available to all health care providers.
Take medication only as directed. Read and follow instructions on the label. Make sure the prescription includes specific directions for taking each medication.
Ask questions about your medication if you don't understand how to use it until you fully understand the answer.
Take the correct amount of medication. Do not take more or less than the label indicates. Do not give adult doses to children or guess at the dose you should give them. Instead, ask your pharmacist or health care professional.
Do not take medicine in the dark or without the benefit of glasses, if you wear them, to read the label correctly.
Do not use or share medications prescribed by a health care professional for someone else.
Be aware that medications can interact with each other-even OTC and herbal medications. In addition, certain foods, like grapefruits, and drinks (particularly alcohol) can interact with medications. Discuss all the medications you are taking with your health care professional or pharmacist to determine if any potential problems exist between the medications you are taking, and make sure to check all labels on your medication and read any safety information that comes with it. If you are not sure, take your medication with water.
Do not keep old medications to self-medicate when you think you have the same problem.
Throw away all expired medications and look through your medicine cabinet from time to time to make sure nothing in there has expired.
Discussing Medication With Your Health Care ProfessionalWhen two or more drugs are mixed in the body, they may interact with each other and produce uncomfortable or even dangerous side effects. Your health care professional needs to know what other medications you take so he or she can help you avoid possible adverse drug interactions. This includes any prescription or OTC medications, supplements, herbal remedies, or vitamins and minerals you take, even if it seems as minor as aspirin or sleep aids and even if you only take them occasionally. Make sure you mention, also, if you use birth control pills or other methods of hormonal contraception such as long-acting shots or implants. Even certain foods and drinks can interact with medications.
Some common examples of dangerous drug interactions include:
blood-thinning medications (anticoagulants), such as warfarin, combined with aspirin.
These medications also interact strongly with alcohol.
antacids combined with certain drugs for Parkinson's disease
antacids combined with some heart disease medications
Remember, not all drug combinations are bad; high blood pressure, for example, is often treated with several different drugs. Unless supervised by a health care professional, however, taking a mixture of drugs can be dangerous.
Ages and Stages: Special Medication Considerations for WomenWhen it comes to medication safety, pregnancy and breast-feeding require special consideration. So, too, do other stages of a woman's life and the lives of those she cares for. For example, some women find that hormonal fluctuations may affect how certain medications work or increase their need for medication: headaches experienced premenstrually, for instance, may increase a woman's use of pain relievers. Using medication for children requires careful supervision. Age may also affect how medication works by affecting how it is absorbed. Also, as people age, they tend to use more medication for different conditions; drug interactions may become an issue. All these "life-stage" issues are important to be aware of and discuss with a health care professional.
Women who are considering pregnancy, are pregnant or are nursing should follow the basic guidelines for using medications safely, with a few additional precautions:
If you are pregnant or trying to become pregnant, it's imperative that you let your health care professional know, because some drugs are dangerous to an unborn baby.
If there is a possibility that you could become pregnant, ask about any potential side effects of medications to you or your fetus that you might be prescribed.
If you are nursing, be sure to ask your health care professional if any drug or medication he or she is prescribing or recommending is safe for the nursing baby.
Some drugs, including common antibiotics, as well as certain herbal remedies, can cause birth control pills to become ineffective, requiring that you use a second form of birth control. Be sure to ask your health care professional about this possibility so you won't be surprised by an unplanned pregnancy.
Some drugs affect fertility, so be sure to tell your health care professional if you are trying to become pregnant.
Medication In-HandBefore you leave your health care professional's office, make sure you know what the prescription is for and how it should be taken, and that you can read the label. Then you can double-check these facts at the pharmacy. You may also discuss with a pharmacist any questions or concerns you have when you purchase medications over-the-counter.
If you experience side effects after you begin taking medications, contact your health care professional. Don't try to adjust your dosage yourself, either to minimize side effects or save money; finding just the right dosage is a fine science that requires teamwork between you and your health care professional. It's also important not to stop taking a medication because you feel better without first consulting your health care practitioner.
If you or someone in your care is taking a lot of medication, consider asking your primary health care professional, the specialist who has prescribed the majority of your medications, or your pharmacist to conduct a "brown-bag check up" for you. This is a safety measure to ensure all the medications you are taking won't cause any potential problems and don't need to be adjusted as your health needs have changed. Here's how it works:
Gather any and all prescription medications, over-the-counter drugs, herbal or natural products, and vitamins or minerals you use and take them to both your health care professional and your pharmacist.
Your health care professional will review all of them to ensure they are the same as those listed on your medical record; your pharmacist will double-check against your pharmacy profile.
They will screen them for potential duplication of therapies, side effects or interactions.
They will ask you how you take each one to ensure you fully understand the instructions.
Discussing Medications With Your PharmacistNo other health professionals have as much training in prescription and OTC drugs as pharmacists. A pharmacist can help prevent drug interactions. Be sure to tell him or her about any prescription drugs you are taking whether purchased at the same or a different pharmacy or by mail order. You should also mention any OTC medications or supplements you use.
If you are pregnant, nursing, or plan to become pregnant, tell your pharmacist.
Before you leave the pharmacy, go over the dosing instructions with your pharmacist. Make sure you can read and understand the instructions. For example, if the instructions say, "take 5 mL," make sure you know what 5 mL is and use a special liquid dropper or oral syringe to make sure you take the right amount. Also ask your pharmacist what the concentration of the original prescription was supposed to be. For instance, your doctor should have written: 250 mg per 5 mL. Doublecheck that the concentration is correct.
If the bottle says, "take three times a day," find out if you need to take the medication at meal time, at three equally spaced times during a 24-hour period, or at three equally spaced times during your waking hours. Most medications don't require you to take them in the middle of the night, but you should double-check to make sure.
While you're at the pharmacy, ask the pharmacist to open the bottle to see what the medication looks like. The pharmacist can help make sure the medication looks right. You should look also. If you've taken it before, does it look the same? If not, be sure to ask your pharmacist about it to ensure he or she didn't dispense the wrong drug. Sometimes the same drug may look different if it came from a different manufacturer. Also ask your pharmacist what the medication will do for you; make sure his or her answer makes sense. If you are filling a prescription to treat an infection, for example, but the pharmacist says the drug is for asthma, you'll know a mistake has been made. How could such a situation occur? Many prescription drugs have very similar sounding and looking names within one or two letters of each other.
A side effect is an effect other than that for which a medication is used; side effects are typically known to be associated with a drug and are listed in the labeling and the consumer information sheets. It is important to make sure you receive this information and read it very carefully. An adverse reaction is a harmful, unexpected and unintended response to a drug.
Ask your pharmacist about any potential side effects or adverse reactions to the medication, as well as what you should do in case you experience any of them:
Are there side effects you should simply tolerate while continuing to take the medication? Some side effects only occur when you start the medication, but then go away.
What side effects should make you stop taking the medication?
When should you call your pharmacist or health care professional?
When should you seek treatment immediately?
Ask your pharmacist what foods to eat or not eat with each drug; some drugs shouldn't be taken with some foods. Some foods can make medications more or less powerful or interfere with your body's ability to absorb them. For example, drinking grapefruit juice while taking certain medications may increase blood levels of these drugs. Should you drink a full glass of water when you take the drug? Finally, ask your pharmacist how you should store the medication; some drugs need to be refrigerated.
Ask your pharmacist about OTC medications as well as prescription drugs. Remember, just because a medication is available over the counter doesn't mean it is safe under every circumstance for every person. For example, many decongestants can raise blood pressure and be dangerous for those who already have high blood pressure. Your pharmacist can tell you when and how to take the medication and if it should alleviate the symptoms you are trying to treat. He or she also can look up your prescription drug record to make sure the OTC product won't have adverse interactions with any of the other medications you take. Try to use just one pharmacy for all of your prescriptions so there is one complete drug record in one place.
Medication Safety in a Hospital
It's not uncommon for medication errors to occur in hospitals. Again, women need to be proactive in their health care and in their care of other family members. You can take steps to alleviate the risk of medication errors in the hospital:
Take a specific list of prescription and OTC drugs you take and their dosages with you to the hospital so the health care professionals there can know what you are taking. (It's best to bring the actual medications; you can have a family member or friend take them home after the health care professional has seen them.) Also tell your health care professional about any illegal drugs you use, making sure he or she knows that the information is confidential.
Make sure to tell your health care professionals about any allergies you have, even if the allergy is not to a specific medication but to a food, such as shellfish or peanuts,and the type of reaction you experience. Some tests use dyes or solutions that may have non-medicinal ingredients to which you are allergic, while some medicines may use ingredients to which you are allergic, like eggs. Double-check with hospital personnel before you have any test or procedure that requires dyes or medications.
Ask the person bringing your medication to you the name of each medication and the reasons you are taking them. Then, each time you are given a drug to take, make sure the hospital employee checks your identification, and then ask what the medication is. You can do this in a friendly and non-confrontational way. If you don't remember your health care professional telling you about the specific medication, you need to ask questions to help ensure a mistake isn't being made.
When you or a family member is ready to go home, have the health care professional or hospital pharmacist go over each medication with you, just as you would in a health care professional's office or pharmacy.
Ensuring Medication Safety At HomeWomen need to remember drugs and medications affect people differently. What may work for your partner or friend may not work in the same way for you. Never take another person's prescription medications.
It's easy to make a mistake when you are busy or overseeing medication for more than one family member; make sure instructions for each medication/family member are written down so you don't have to worry about remembering every detail. Ask your health care professional to write out a medications schedule you can sign when you take your medication. If you receive any conflicting or confusing information or instructions, contact your health care professional for clarification.
When you or a family member first starts taking a new medication, watch for any of the side effects or adverse reactions. Some adverse reactions result from being allergic to a drug and can be so dangerous you should stop taking the medication and seek emergency medical treatment immediately. Serious adverse reactions and side effects include:
hives
difficulty breathing or swallowing
convulsions and loss of consciousness
These are all signs of anaphylaxis or anaphylactic shock-a sudden and sometimes deadly drop in blood pressure. Anaphylactic shock can potentially stop the heart or lead to complete closure of air passages, causing death by suffocation. So be ready to call 911 if you experience any of these symptoms.
Other, non-life-threatening side effects are reasons to call your health care professional and your pharmacist. The side effect may be something minor or common. If they don't bother you too much, the positive effects of the drug may outweigh them, in which case your health care professional may have you continue taking the medication. In other cases, your health care professional may want you to stop taking it altogether or try a different dose or different drug. Keep track of any such reactions and make sure your pharmacist enters the information into your file. Be sure to mention it to any health care professionals you see.
If you discontinue your medication because of uncomfortable side effects, be sure to notify your health care professional. Also, don't try to adjust the dose without telling him or her. For example, abruptly stopping certain medications that lower your heart rate could result in a dramatic increase in your heart rate. If you experience minor side effects and are advised to continue taking the medication, be careful in treating the side effect; make sure the medication you take-such as an antacid for minor stomach upset-will not interact or interfere with any of the medications you take.
Keep your medications in their original packaging with the full instructions. With OTCs, be sure to read the label and informational insert carefully to note any warnings or possible side effects, especially if you have a health condition such as diabetes, thyroid disease, high blood pressure or heart disease. If the condition for which you are taking OTCs doesn't get better-for example, if you have indigestion or pain for several days-you should contact your health care professional. Indigestion is a symptom that could be harmless, but it can also be a warning sign of a heart attack or other heart-related problem in women that is often overlooked. Persistent indigestion and other gastrointestinal discomfort may also be a symptom of ovarian cancer. Any persistent symptom should be discussed with a health care professional.
It's also not wise to take an OTC for a condition you are experiencing for the first time; in such a case you may be guessing at what you have. For example, you should see a health care professional the first time you get a yeast infection, rather than trying to treat it yourself, to make sure your symptoms truly are associated with a yeast infection and not another type of condition.
Some other tips for safe and effective medication use include:
Read the label every time you take the medication to prevent mistakes. This is especially crucial if you take more than one drug. Also, you might find that some OTCs have different directions from the last time you purchased them.
Don't chew, crush or break any capsules or tablets or mix with a liquid unless instructed. Your body could absorb some long-acting medications too quickly if you chew or crush them; other medications either won't be effective or could make you sick.
If your health care professional prescribes a medication that only comes in one dosage that can be safely split and you only need one-half the dose, purchase a pill cutter or ask the pharmacist to split the pill. These are inexpensive items that you can buy at your local drug store. They make cutting pills easier, more even, and you won't lose the other half of the pill when it flies away onto the floor!
If a tablet or capsule is too difficult to swallow, ask if a liquid or dissolvable form is available. The University Health Center of College Park, Maryland, offers this advice for those having difficulty swallowing pills: "Don't follow your instincts and tilt your head back trying to flush the pill down with water. This causes the pill to float up into the front of the mouth and become more difficult to swallow. Instead, take the pill with a sip of water, bow the head forward and swallow. This leaning forward causes the pill to float backward, over the base of the tongue and into the throat. Then it is quickly propelled downward to the stomach by muscular contractions."
If you are taking a liquid medication, or giving one to your child, be sure to use the correct measuring cup or spoon. Some medications come with marked cups-keep them together with the medication and don't use the cup or dropper for a different medication. Also, don't use regular household spoons, which can vary greatly in size. Use an actual measuring spoon. Your best bet is to get one a medicine spoon-or even an oral syringe-at the pharmacy (often they are free) to be sure you measure the correct dose. But do not use a hypodermic syringe to draw the medicine up.
Use a memory aid to help you take your medications at the correct times-whether it's on an empty or full stomach, upon waking or before going to bed, every four hours or every six hours, etc. Weekly pillboxes, marking on a daily calendar, charts, or your own system will help you not miss a dose.
Forgetting to take your medication is not uncommon. Whether to take a missed dose depends on the drug. In some cases, it may be appropriate to take the missed dose as soon as you remember. In other cases, it may be too close to the time you need to take your next dose. If you didn't get enough information on what to do in this case from a drug-information sheet or from your pharmacist at the time you filled the prescription, just call him or her for advice.
Don't stop or change your dose for any reason-even if you are feeling better-without first talking it over with your health care professional; otherwise he or she won't have all the information needed to continue treating you effectively, and your care will be compromised.
Keep medications in their original containers so you'll know what they are and how to take them. Keep medications out of direct sunlight and away from moisture. Also, be sure to store them where children can't see or reach them. If you have children or children visit your home, you should keep your medications in a locked box or cabinet. Do not store your medications with household chemicals or cleaners, and don't store them in the same place you keep pets' medications. Also, don't store tubes of ointments or creams near your toothpaste-a mistake when grabbing quickly could range from unpleasant to serious.
Child-resistant caps. If you have difficulty opening your medications because they have child-resistant caps, you can ask your health care professional and pharmacist for a non-child-resistant cap. This should only be done if there are no children in the home or children (or grandchildren) visiting the home and the prescription should be kept in the medicine cabinet. If you do use child-resistant caps, make sure you tighten them when you're finished taking your medicine or a child could still get into your medication.
Be sure to throw away any leftover prescription medications you are no longer taking. Also, monitor prescription and OTC "use by" dates and throw away expired ones; some drugs actually become toxic after the due date, others simply lose their potency. Don't throw them in an empty wastebasket, especially if you have children or pets in your home. Keep a list of all the medications you use, even if you buy them all from the same pharmacy. You should, in fact, record all of your personal medical information and responses to medications. Make a list of the medications, including:the name, the color and the imprint on each tablet or capsule.
the date of the prescription the dose or strength what it is for how much you take and how often how long you are supposed to take it any foods or other things to avoid likely side effects side effects you experienced the name and phone number of the prescriber the name and phone number of the pharmacy Also list any OTC medications, vitamins, nutritional supplements or herbal products that you take regularly. Another good think to add to the list is any medication or food allergies.
Buying Medications Or Supplements From Non-Pharmacy SourcesEveryone needs to be especially cautious when buying medications or supplements online or from non-pharmacy sources such as health stores or the grocery store.
While some Web sites offer great prices on prescription drugs, not all drug-dispensing sites are legitimate. You should be aware of the following when purchasing prescription drugs online:
Purchasing a medication from Web sites puts you at risk; you may receive a contaminated or counterfeit product, the wrong product, an incorrect dose or no product at all.
Getting a prescription drug by filling out a questionnaire without seeing a health care professional puts you at serious risk. You may end up with a drug that is unsafe for you or one that may not best treat you. Prescription drugs are regulated for a reason: They can be very dangerous if not used correctly.
You can check the legitimacy of a U.S. drug-dispensing Web site on the VIPPS page (Verified Internet Pharmacy Practice Sites) at the National Association of Boards of Pharmacy Web site at http://www.nabp.net/ or by calling them at 847-698-6227.
Only do business with Web sites that have an address and telephone number, and that allow you direct access to a registered pharmacist to answer your questions. When you receive the medication, ask the site's pharmacist all the same questions you would ask your local drug store pharmacist.
Monitoring your medications will be up to you if you use drug-dispensing Web sites. Of course you can ask the site's registered pharmacist about the potential of an interaction with any other medications you are taking, but the ultimate responsibility lies on your shoulders much more in this case than if you use a local pharmacy. Web site. Make sure you tell your pharmacist about any medications you purchase online.
A Note about Purchasing Drugs from Foreign CountriesPurchasing drugs from foreign countries can be a dangerous gamble with your own health. But, it can be tempting since Canada and many other countries control prices of prescription drugs, and medications you use may be significantly cheaper there. Before you consider mail ordering drugs from other countries or, if you live in a border state, driving over to Canada or Mexico every three months or so and refill all your prescriptions, know these facts:
Buying medications from other countries is illegal. Virtually all drugs imported to the U.S. from Canada, for example, violate the Federal Food, Drug and Cosmetic Act (FFDCA) because they are unapproved, labeled incorrectly or dispensed without a valid prescription. It is also illegal for any person other than the original manufacturer of a drug to import a prescription drug originally manufactured in the U.S. Potential punishment? Up to $250,000 in fines and 10 years in prison.
It's incredibly dangerous. Nearly 90 percent of imported drugs the FDA checked at the border in the summer of 2003 contained medications that were not approved for use in the U.S. Some of the drugs had been withdrawn from the U.S. market for safety reasons.
Internationally, the World Health Organization (WHO) estimates that five to eight percent of all pharmaceutical products are counterfeit, with that figure reaching 70 percent in some parts of the world.
If you get "ripped off," no U.S. agency can do anything to help you resolve the issue.
The FDA strongly cautions consumers against importing medications from other countries.
Labeling instructions may be in a different language.
Certain drugs, particularly combination drugs, aren't available in other countries. Thus, the pharmacy might send a substitute drug, just one of the drugs, or drugs at a different strength.
Even if the town where you live has passed legislation supporting the importation of such drugs, and Congress passes legislation making it legal to bring medications across the border, most drugs still would not be allowed over the country's borders because they would not have been approved or manufactured in the U.S.
Often, online pharmacies tell you that it's not illegal to import drugs because the FDA has a "personal use" exemption. However, that exemption exists only in certain cases where a patient has a very serious condition for which no effective treatment is available in the US. It certainly doesn't cover the importation of drugs like commonly available medications like Prozac or Viagra.
Nearly every major pharmaceutical company has created free discount card programs for seniors. Eli Lilly and Pfizer, for instance, offer their drugs for a flat rate of $12 to $15 a month for those who meet certain income guidelines. Supplemental insurance plans that provide additional coverage for Medicare beneficiaries usually offer prescription drug coverage.
In addition, when purchasing medications or supplements, including diet or energy pills:
Remember, some people will say anything to make a sale. Don't fall for anyone's claims of a "new cure" for a disease or condition, a quick cure-all for a wide range of ailments, or undocumented case histories showing "amazing" results. If there is any new cure or medication for your disease or condition, your health care professional will tell you about it; or, feel free to ask him or her about these claims. Be cautious of Web sites that use impressive-sounding terminology to disguise a lack of good science or those that claim the government, the medical profession, or research scientists have conspired to suppress a product.
Don't be taken in by anyone's claims that the medical community or government has conspired to keep a product out of your reach.
Before you take any new medication or supplement for the first time, be sure to ask your health care professional about it.
Weight-Loss, Energy Supplements And Herbal RemediesIf you are having problems with your weight, energy level or mood, you should turn to your health care professional for help. First, you may have an underlying medical condition that requires treatment. Even if this is not the case, there are many ways in which your health care professional can help with your weight, energy level or mood. There's no need to be embarrassed or "write-off" any of these very important health issues or any other concerns you might consider addressing yourself by using supplements or herbal remedies.
While they are safe for the most part, unregulated "natural" supplements such as ephedra, also known as ma huang can be dangerous; in fact, many of these have been linked to very serious illness and even death in some people. A risk associated with ephedra is its potential for raising blood pressure, which is a major cause of serious problems associated with this herbal supplement.
Also, if you begin taking these potentially dangerous supplements, chances are you are doing so without checking their potential impact on or adverse interactions with any other medications you use. In general, keep in mind that herbs and supplements are not regulated, and manufacturers are not required by law to back claims with thorough testing or clinical trials.
The fact is, you simply shouldn't try to diagnose yourself. But the availability of these "miracle" supplements encourages some people. While some herbs or supplements can be safe-and your health care professional may even recommend you use them-if they are not applicable to your underlying health issues, using them can be not only a waste of money, but dangerous.