Did you know that almost 30% of the hospitalizations in the United States are related to problems with drug therapy? Adverse drug events also rank fifth among the top preventable threats to the health of elderly Americans. Our pharmacists are trained to help detect drug related problems. If you were wondering what a pharmacist does other than counting pills, take a look at how we search for and try to resolve drug related problems. As we fill your prescription, our pharmacists ask:
1. Is the DOSE of each of the medicines you use appropriate for you as an individual?
Issues that affect dose include your size, age, and state of health. Another important issue to consider is the method each drug is removed from the body. If a drug is mostly removed through the kidneys and a person is elderly or has poor kidney function, then a medication that is eliminated through the kidney would have to be given at a very low dose if at all. We also must take into account any other medicines you take which may increase or decrease your response to a drug. An example includes the drug verapamil when used with digoxin. If the two drugs are used together, verapamil causes digoxin levels to increase. In this case, the dose of digoxin must be decreased in some cases.
2. Are you experiencing any SIDE EFFECTS?
Most any medication you take has the potential to cause unwanted side effects. Our job is to make sure you understand what these might be and to help minimize them by offering suggestions. If a medicine causes upset stomach, often taking it with food helps. Medicines that can cause drowsiness can be taken at bedtime. We can help avoid side effects in some cases. In other cases, side effects are not tolerable and another medication can be suggested to your physician. Alternatively, many drugs cause uncomfortable side effects initially, but they subside after continuing the medicine for a period of time. Communication with your pharmacist about side effects is essential. Until we know you are having a problem taking a drug, we cannot help you find solutions. The literature suggests that side effects from drugs are one to the top reasons why people stop taking needed medications.
3. Is this the RIGHT DRUG for you as an individual?
Most every time a condition is treated, there are several choices of medications and treatment approaches. Most categories of drugs have more than one choice. The chemical structure of a drug in a given category is similar, but not exactly the same as other drugs in the class. These differences explain the different responses and adverse effects to the medications. For example, Pepcid AC, Tagamet HB, and Zantac are all in the same category. They all treat acid reflux, but they each have unique qualities that might make one the best choice for an individual. Tagamet is not the right drug for a person who is taking multiple other medicines because it causes interactions. On the other hand, Zantac is the not always a good choice for a person with severe kidney problems.
Another way your pharmacist assures you are on the right drug for you is to look at your list of conditions. Often drugs can be used to treat more than one thing. Such is the case with many blood pressure medicines. If you have both high blood pressure and a prostate problem, you may be able to use one drug to treat both. Another drug is good for treating both high blood pressure and migraines. If you had both of these conditions, we could perhaps suggest that your doctor try treating both with one drug.
4. INTERACTIONS with drugs or diseases
Whenever a person takes more than one drug at a time, there is a potential for the drugs to work adversely together. There are several reasons for this. Most often drugs interact when both drugs are eliminated from the body in the same way. The body has a very complicated system for recognizing and removing each different chemical introduced into the body. When two different drugs use the same pathway to get removed, it can lead to drug buildup. In many cases this is not desirable and should be avoided.
Drugs can also interact because they attach to the same cells while they are in the body. If two drugs must compete for the same spot on a cell, one or both of them may accumulate to higher than the recommended level.
Sometimes drugs are not recommended for use together because they cause the same side effects. If used alone these side effects may be tolerable, but together it becomes a more serious effect. This is especially true if a person already has a condition which would put him or her at risk for the side effect. At times an existing condition or disease may be cause for avoidance of particular drugs.
5. Are you ADHERING to the regimen as prescribed?
Much study has been done on the topic of adherence. The research reveals that less than half of the time when a doctor writes a prescription, the patient takes the drug as prescribed if at all. Additionally, once a person starts to take a medication which is intended for long-term use, the chances of the person continuing the medicine drop dramatically during the first few months of using it.
We make attempts to notice when a drug which appears to be a long-term treatment is stopped prematurely. Our job is to help you understand the risk versus benefit of stopping a medication. Recognizing that the choice to take a medicine is yours, we hope to help you make an informed decision. If you have concerns about the long-term use of a drug, we can help you know your options.
6. Do you have a condition or ailment which is not currently being treated?
Between doctor visits, sometimes issues arise which warrant attention or treatment. Your pharmacist can help you by helping advise you on whether you need to see a doctor and by communicating the necessary information to your doctor. Nagging health issues which do not clear up over a long period of time sometimes are hard to sort out. If a doctor visit is not scheduled for another year, attention to the problem may be needed before then.
Often people live with symptoms for long periods of time because they simply do not know to seek treatment for them. By serving as a point of triage, your pharmacist can minimize this. Whenever you wish to discuss an issue with one of our pharmacists privately, we are available to do so and have taken careful consideration of ways to accommodate this. Please let us know if you desire more privacy by asking for a quiet moment with the pharmacist. We make every attempt to recognize this need as it arises, but would like you to let us know if we do not.
7. Are you taking a drug that is no longer necessary?
There are numerous treatments which are used for only a select period of time then stopped. One example is the use of blood thinners after a person has a blood clot in the leg called a deep venous thrombosis (DVT). After six months of treatment, the anticoagulant may be discontinued in many cases. If we know why you are taking a certain medication, your pharmacist can be sure to remind you and your physician to discuss the possible discontinuation of the drug.
The pharmacist uses a systematic method of determining if any of each of the possible drug related problems exist. With proper communication, we can help you prevent or solve drug related problems before you become a part of the hospitalization statistics. As always, we welcome any questions about your medications.
