Preventing Medication Errors

It is not hard to imagine how medication errors can occur. Bottles can be mislabeled or can be filled with the wrong medication. Patients don’t always read the label for directions and may take the medication incorrectly. Language can also be an issue.

Here are some helpful hints to help prevent medication errors. First always carry a current list of medications with you. Check it with your doctor and with your pharmacist whenever a visit is made and if there is a change in medication. If you take more than 2 medications more than once a day, it is safer to use a medication box. They come in all shapes and sizes and you will certainly find a type that works for you.

If you are filling a medication box yourself, make sure you pick a quiet time with little distraction. This sounds like simple advice, but this is where many errors occur. Check and recheck the label on a bottle of medication several times before filling the medication box.  Check the instructions on whether or not a medication needs to be taken on an empty stomach or with food as well.

If you are caring for someone else who may misread their box, forget what day it is or just be curious and move things around, make sure you or someone close looks over the medication box regularly to make sure things look right.

There are also automatic medication dispensers that dispense at designated times of day. For some people these work well. It is important that we think about the system that is most appropriate and holds the least chance of error for ourselves or the persons we are caring for. Then we can all breathe a little easier!

Source:  http://eldercareanswers.com

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A Natural Product Does Not Mean a Safe Product

Here are some important facts about dietary supplements such as herbs and vitamins:

They may affect how well other medicines work in your body.

Herbs and some plant-based products may prevent medicines from doing what they are supposed to do. These medicines can be ones your doctor prescribes for you, or even ones you buy off the shelf at the store.

For example, the herbSt. John’swort, which some people with cancer use for depression, may cause certain anticancer drugs not to work as well as they should. A pharmacist can warn you when your prescription drugs will cause a dangerous drug interaction, so you should be sure your pharmacist knows what supplements you are taking.

Herbal supplements can act like drugs in your body.

They may be harmful when taken by themselves, with other substances, or in large doses. For example, some studies have shown that kava, an herb that has been used to help with stress and anxiety, may cause liver damage.

Vitamins can also take strong action in your body.

For example, high doses of vitamins, even vitamin C, may affect how chemotherapy and radiation work. Too much of any vitamin is not safe–even in a healthy person.

Tell your doctor if you are taking any dietary supplements, no matter how safe you think they are. This is very important. Even though there are ads or claims that something has been used for years, they do not prove that it is safe or effective. It is still important to be careful.

Supplements do not have to be approved by the Federal Government before being sold to the public. Also, a prescription is not needed to buy them. Therefore, it’s up to consumers to decide what is best for them.

Source:  Agingcare.com

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Overmedication of the elderly is an all too common problem, a public health crisis that compromises the well-being of growing numbers of older adults. Many take fistfuls of prescription and over-the-counter medications on a regular basis, risking serious and sometimes fatal side effects and drug interactions.

Older adults like my aunt are the largest consumers of medications. More than 40 percent of people over age 65 take five or more medications, and each year about one-third of them experience a serious adverse effect, like a bone-breaking fall, disorientation, inability to urinate, even heart failure.

Too often, people with multiple health problems have one doctor who does not know what another has prescribed. A new prescription can lead to a toxic drug interaction, or simply be ineffective, because it is counteracted by something else being taken.

There is nothing to be gained, and potentially much to lose, by failing to disclose to health care professionals the use of prescribed, over-the-counter or recreational drugs, including alcohol. Nor should any chronic medical condition or prior adverse drug reaction be kept from your doctor.

Whenever a medication is prescribed, patients should ask about side effects to watch for. If a bad or unexpected reaction occurs or the drug does not seem to be working, the prescribing doctor should be told without delay. But patients should never stop taking a prescribed medication without first consulting a health care professional.

Nor should they add any drug or supplement to a prescribed regimen without first consulting a doctor. Even something as seemingly innocent as ibuprofen, acetaminophen,St. John’swort or an antihistamine purchased over the counter can sometimes lead to dangerous adverse reactions when combined with certain prescribed medications or pre-existing health problems.

Source: The New York Times, Health and Science

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Vial of L.I.F.E.

Emergency medical workers called to a home where a victim is alone can lose precious minutes trying to gather information about the person’s medications, allergies and illnesses. “Vial of LIFE” kits can help.

In 2008 the Medic One Foundation teamed up with Bartell Drugs to implement the Vial of L.I.F.E. program in King and Snohomish Counties. This program is designed to provide vital information to first responders in emergency situations. Thus, the acronym L.I.F.E. stands for “Lifesaving Information for Emergencies.”

Use of the Vial can benefit seniors and disabled individuals and is invaluable in medical emergencies when no one is able to communicate with the responders.

Each Vial of L.I.F.E. kit includes:

• A medical information form, on which you fill out such information as medical conditions, current medications, emergency contacts, insurance, and hospital preference. (It is important to keep the form up to date.)
• A five inch plastic vial. You place the completed medical form in the vial and then place it on the top shelf inside your refrigerator door. The vial is large enough to hold a copy of your durable power of attorney for health care and/or pre-hospital do-not-resuscitate form.
• A Wallet Card.
• A Vial of L.I.F.E. sticker, to be placed on the front door of your home or an adjacent window.
• A Vial of L.I.F.E. magnet to be placed on the outside of your refrigerator. The sticker and magnet inform emergency responders that you have a completed Vial of L.I.F.E.
• Instructions regarding use of the Vial.

The Vial of L.I.F.E. is available for purchase for $1.00 at Bartell Drug stores in King and Snohomish counties, generally in the pharmacy department. Persons with questions about the Vial of L.I.F.E. or non-residents of King and Snohomish counties who desire to obtain a vial should contact the Medic One Foundation through their web site or by phone at (206) 744-9425.

Projects similar to the Vial of L.I.F.E. are in existence in communities throughout the nation. The Bellevue Network on Aging and the Kirkland Senior Council have helped with the distribution of vials and publicity for the program in Bellevue and Kirkland. If you are interested in starting a program in your community, contact the Medic One Foundation at 206-744-9425.

Source: AARP.org

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Many people not diagnosed with depression take them

More doctors who are not psychiatrists are offering antidepressants to patients, often for vague complaints of fatigue, headaches or gloominess.

Indeed, the practice of prescribing these drugs without a diagnosis of depression is escalating and more common in men and women over age 50.

Nearly four of every five prescriptions are written by primary care doctors and specialists untrained in psychiatry who are dispensing powerful drugs that may have either no impact or harmful effects.

Antidepressants are now the third most commonly prescribed class of drugs in the United States, according to a study in the August issue of Health Affairs. (Prescription painkillers and cholesterol-lowering drugs were the first and second most prescribed drugs, the study reports.) Antidepressants also are one of the most costly medications to the health care system, with annual sales of approximately $11 billion.

The drugs are effective for a limited number of conditions, including clinical depression, chronic depression and some anxiety disorders.

“My sense is that we now have a large group of people taking them for unclear reasons,” says coauthor Mark Olfson, M.D., a professor of clinical psychiatry at Columbia University. “And when you treat less severe problems, it becomes harder to demonstrate that they’re helpful at all.”

The study looked at information from surveys conducted by the Centers for Disease Control and Prevention that considered more than 230,000 visits by adults to offices of primary care doctors and specialists who were not psychiatrists.

Researchers found that 73 percent of prescriptions for antidepressants were written for patients with no formal diagnosis of depression in 2007, compared with 60 percent in 1996.

The share of doctors who prescribed antidepressants without such a diagnosis increased from 30 percent to 55 percent in the same period. The typical patient who received antidepressants without a formal diagnosis was a white woman over 50 who had high blood pressure, diabetes or several medical problems.

Psychiatrist Dilip Jeste, M.D., of the University of California in San Diego calls the study’s conclusions important.

Jeste, president-elect of the American Psychiatric Association, says that recommending medications for reasons not approved by the Food and Drug Administration, a practice called off-label prescribing, “is not illegal, nor is it rare in clinical practice.” However, “antidepressants are powerful drugs and can have a variety of adverse effects, which are more common in older adults with multiple medical problems,” so “the study’s findings are worrisome.”

Depending on the specific drug, side effects can include dizziness, sleep problems, changes in blood pressure and weight gain.

Olfson says that people should recognize the difference between the sadness and grief that becomes more common with age and the persistent and distressing pattern of depression that interferes with sleep, appetite and concentration. He advises people to talk over these feelings with a doctor.

“Find out if your doctor feels your symptoms fit the definition of clinical depression, and why, and whether medication will help,” Olfson says. “And because antidepressants don’t work immediately, ask how long it will take before you can expect to see a difference.”

You should be able to take time to talk about these matters with your doctor and not try to rush through the conversation in the course of one hurried 15-minute visit.

“This discussion will help you understand your own treatment better so you can recognize if it is or is not working,” counsels Jeste.

Source: AARP.org

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Most Patients Don’t Tell Their Doctors They Take Supplements

Did you take your multivitamin today? Toss down a fish oil supplement? Swallow a couple of chondroitin capsules to ease your aching, arthritic knees? Pop a ginkgo biloba to improve memory?

You could be doing more harm than good.

Are My Meds Making Me Depressed?

Q: I’m 72 and being treated for hypertension, hypothyroidism and swelling in my ankles. Shortly after I went on metoprolol for my hypertension, I started having strange dreams and difficulty sleeping all night. The doctor prescribed ramelteon to help me sleep, but it hasn’t seemed to help. Then I started having leg cramps almost every night. The doctor prescribed a muscle relaxant, cyclobenzaprine, but I didn’t like the way it made me feel, so I stopped taking it after the second dose. I also takelevothyroxene for my thyroid condition and furosemide for the swelling. 

Through all this I have become more and more depressed. My doctor said he didn’t think the medications were causing me to feel this way and I would just have to learn to live with it. Is he right? Is it just that I am getting older? Or is it possible that the medications are causing my depression?

A: The problems you’re having are almost certainly related to the metoprolol, which is in a class of blood pressure medications called beta-blockers. Many doctors do not know that beta-blockers should not be prescribed to people over 60 with uncomplicated hypertension (high blood pressure without angina or heart failure), especially because they are associated with a higher risk of stroke and other adverse events, including new-onset diabetes and even death.

The nightmares, insomnia, muscle cramps and depression that you’re experiencing are all telltale side effects of beta-blocker use in your age group.

I would recommend that you ask your doctor about changing to a benzothiazepine calcium channel blocker — another form of blood-pressure medication. This would need to be done over five to 10 days to avoid problems related to sudden withdrawal of a beta-blocker. I’m confident that, with this change, you will no longer need the sleeping pill and the muscle relaxant, as they were dealing with problems caused by the metoprolol.

Source: AARP.org

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Researchers have long known that many drugs can make us feel down or even depressed and that, as we age, our changing body chemistries put us at a greater risk for this side effect. But few doctors think to review the medications list when their patients have the telltale symptoms of depression: lack of energy, listlessness, feeling rundown, excessive fatigue, changes in appetite and sleeping patterns, sadness, despair. As a result, they often layer on top of the drugs causing those symptoms a new drug, such as an antidepressant, for treating them, which may in turn trigger additional side effects.

How to Get High Blood Pressure Medicine Right

Starting with two drugs may be better than one

A new study challenges the traditional method of prescribing blood pressure medication — to start with one drug and add others if the first isn’t enough — and some experts are calling for a change in guidelines that could help doctors with the delicate and often frustrating dilemma of getting blood pressure meds right.

People with high blood pressure who start treatment on two medications see a substantially greater improvement — without paying the price in added side effects — than those who begin with a single drug, according to the results of the study published Jan. 12 in The Lancet, a British medical journal.

The study’s authors, from the University of Cambridge, the British Hypertension Society, the University of Glasgow and the drugmaker Novartis, conclude that, rather than starting with one medication, initial treatment with a two-drug combination “can be recommended” for patients with a systolic blood pressure of at least 150.

Systolic is the top number in a blood pressure reading: For example, with a blood pressure of 150 over 90 or 150/90, the systolic pressure is 150. Although both numbers are important, doctors pay special attention to high systolic pressure in people over 50, because it’s closely linked to heart disease.

Current U.S. guidelines, published in 2003, call for two drugs right off the bat only in treating especially high blood pressure (systolic above 160), but this study strengthens a previous recommendation by the American Society of Hypertension that starting with two medications might help people with less severe elevations in blood pressure (systolic readings between 140 and 160).

In the British study, 318 patients started on aliskiren (Tekturna) alone, 316 took amlodipine (Norvasc) alone and 620 began treatment with both drugs. After 16 weeks, patients on the combination therapy had their blood pressure drop 6.5 points more than those taking a single drug. Between weeks 16 and 24, when all patients in the study took both drugs, those who’d started on one medication nearly caught up with those taking a drug combination from the beginning, but their average blood-pressure reduction still lagged.

George Bakris, M.D., a hypertension specialist at the University of Chicago who helped develop both the U.S. professional guidelines for treating hypertension and the more recent American Society of Hypertension (ASH) statement on the subject, endorsed wider use of initial combination therapy in an editorial accompanying the Lancetstudy. In order to get their blood pressure to an acceptable level, he says, the great majority of people with high blood pressure will need two drugs that work in complementary ways. Traditionally, doctors have started many patients on one drug, then may have slowly increased the dose or added second and even third drugs over a period of months.

But leaving blood pressure uncontrolled in the initial phases of treatment can leave patients vulnerable to strokes and heart attacks, says Bakris. And in the new trial, starting on combination therapy produced no more untoward effects — such as swelling in the legs — than introducing medicines sequentially. “If combination therapy gets you to your blood pressure goal faster, safely, then why not do it?” he says.

Physicians have been reluctant to adopt combination therapy for hypertension, partly, says Bakris, because of a lack of training in the area. Indeed, according to William Cushman, M.D., a leading hypertension researcher at the University of Tennessee College of Medicine in Memphis who also worked on the hypertension guidelines panel, a key reason to push for early attainment of blood pressure goals is the reality of “clinical inertia.”

Blood pressure medications can be notoriously tricky to get right, and, over many months and repeated physician visits, “either the doctor or the patient bails out,” says Cushman, and optimal blood pressure control is never achieved.

Although the study looked at two specific drugs, Bakris says the research speaks to the value of “combination therapy in general” rather than to the superiority of particular drugs. In fact, the ASH statement lists as “preferred” four combinations of established drug classes. Insurers often prefer these combinations, many of which are available as generics, including some single-pill combinations.

Source: AARP.org

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How Much Vitamin D Should You Take?

Although scientists continue to debate among themselves how much vitamin D is enough, they agree that deficiency is widespread and that current federal guidelines are woefully inadequate.

The guidelines, last updated in 1997, call for 400 IU (international units) a day for adults ages 51 to 70 and 600 IU a day after age 70. New recommendations will be released in a few months, but several professional groups and vitamin D researchers have already called for far higher levels.

Creighton University’s Robert P. Heaney, M.D., a vitamin D researcher, encourages people over age 50 to take a daily supplement of between 1,000 and 2,000 IU, “in addition to the vitamin D they’re getting from sun exposure, milk and multivitamins.” As far as the likelihood of getting too much vitamin D from supplements, according to Heaney, you’d have to consume more than 30,000 IU a day for many months before you would need to be concerned about health problems from too much D. And there is no way to get too much vitamin D from the sun, because the skin breaks down any excess.

The International Osteoporosis Foundation advises an across-the-board daily supplement of 800 to 1,000 IU for men and women over age 60 who are not getting substantial, regular sun exposure — “and that’s practically everyone,” says Tufts University’s Bess Dawson-Hughes, M.D.

Odds are you’ll need at least 2,000 IU a day to achieve adequate blood levels if you’re overweight or obese, rarely get outside, routinely use sunscreen and cover up when you’re in the sun, fall a lot, or have dark skin or osteoporosis.

Some experts recommend a vitamin D blood test only if you fit into this high-risk group. Others recommend that all adults ask their doctor to order the test. Results should show a vitamin D level of at least 30 ng/mL (nanograms per milliliter).

Source: AARP.org

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