Managing Medication Mayhem
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This document summarizes a presentation about managing medications effectively. The objectives covered include understanding why medications are prescribed, improving adherence, developing management strategies, and maintaining an up-to-date medication list. Key points discussed include the importance of medication adherence for health outcomes, the high costs associated with non-adherence, and strategies to improve adherence such as pill boxes, reminders, and understanding dosing instructions. The presentation emphasizes consulting pharmacists for any medication questions or concerns.
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Managing Medication Mayhem
- 1. Managing Medication Mayhem Presented by: Laura Balsamini, Pharm D., BCPS and Gwen Egloff, Pharm D., BCPS December 8, 2016
- 2. Objectives • Explain the importance of knowing your medications and why you take them • Improve medication adherence • Develop strategies to best manage medications • Learn techniques to maintain an up-to- date medication list
- 3. What you need to know! • Name: Generic/Brand • Dose: How much? • Directions: How often? • Indication: Why you take them? • Duration: How long you will take them? • Side effects and how to manage
- 4. Reading a Prescription Label
- 5. Medication Adherence “The extent to which a patient’s behavior, whether it be taking a medication or following lifestyle modification recommendations, corresponds with agreed-upon recommendations from a health-care provider”
- 6. Question # 1 What percent of patients DO NOT take their chronic medications as prescribed?
- 7. Answer to Question # 1 50%
- 8. Medication Non-Adherence • >25% of new prescriptions never filled • Up to 50% of patients don’t take their chronic medication as directed • Worse outcomes Up to 50% of treatment failures 125,000 deaths annually • Higher cost to patient and healthcare $100 Billion per year in hospitalizations
- 9. Making Your Meds Affordable • Consult your pharmacist! • Generics Equivalent product at lower cost • Generic Combination Products 2 or more medications in one pill • Patient Assistance Programs • Coupons • Medicare Part D
- 10. Generic Medications • Cost 80-85% less than the brand • Same quality, purity, effectiveness, performance • All FDA-Approved generic drugs must be equivalent to the brand name drug Same active ingredient Same strength Same dosage form Same route of administration
- 11. Reduce Your Pill Count • Generic Combination Products • Once daily doses • Minimum necessary medications
- 12. Reduce Trips to the Pharmacy • 90-day Supply • Medication Synchronization
- 13. Patient Story
- 14. Question # 2 Raise your hand if you ever MISS doses of your medication
- 15. Taking Your Medications Daily • Pill Box • Unit-dose packaging • Automatic refill • Reminders Alarms Calendar MyMeds
- 16. When to Take Medications • Empty stomach • With food • Bedtime
- 17. Missed Doses • Don’t panic! • Rule of thumb: Take as soon as you remember If it is close to your next dose, skip the missed dose Do not take 2 doses at the same time • There are exceptions to this rule • When in doubt, call your pharmacist
- 18. Over-The-Counters • Nasal Corticosteroid Sprays • Proton Pump Inhibitors • Oxybutynin Patch • Antihistamines • Histamine-2 Antagonists • Sleep Aids
- 20. Question # 3 True or False? The FDA guarantees marketed supplements are both safe and effective.
- 21. Answer to Question # 3 FALSE!
- 22. Herbal Products • FDA does not review for safety and effectiveness before they are marketed Manufacturers are responsible to ensure safety • Supplements can interact with prescription and OTC medications • Check with your doctor before starting any supplement
- 23. Drug Interactions • Grapefruit juice • Alcohol • Calcium/Magnesium • Herbals
- 24. Adverse Effects • Allergies • Intolerance • Side Effect
- 25. Up-to-date Medication List • Hand written list • Printed List from SMG Patient Portal • MyMeds Smart Phone App
- 26. Safely Storing Medications • Store in secured location • Store in cool, dry place; avoid bathroom • Store in original container or pill box • Avoid storing medications for different people in the same area • Clean out your medication closet annually • Some medications require refrigeration
- 27. Discontinued Medications • Tell your pharmacist • Update your medication list • Dispose of medication properly
- 28. Take-Home Points • Maintain an up-to-date medication list • Bring medication list to all appointments • Consult your pharmacist before starting any OTC medication or supplement • Medication adherence saves money and lives • Consult your friendly pharmacist for medication questions and concerns
- 29. Questions?
Editor's Notes
- Laura Are you or a loved one overwhelmed with multiple medications? Learn how to manage a complex medication regimen to improve health and well-being. Pharmacists will be on hand to share helpful tips and answer questions.
- Laura
- Laura Can always ask pharmacist to add what the medication is for on the label Loved ones need to know your medications, up to date copy Add up-to date med list slide
- Laura
- Gwen Who has heard of “medication adherence” before? Medication adherence is ….. So in summary, medication adherence is how often patient’s follow their providers recommendations which includes medications, diet and exercise
- Gwen We have our first knowledge check. Does anyone have an idea of ……… Any other guesses?
- Gwen 50%! So only half of patients are taking their medications as prescribed by their doctor
- Gwen Medication Non-adherence, or not following doctors recommendations, is an extraordinarily complex issue The greatest concern with non-adherence it is directly linked to worse outcomes. Patients who don’t take their medication are more likely than patients who do take their medication to have worse outcomes that directly relate to higher medical bills. To give you an idea of the magnitude of this issue Over ¼ of patients never fill a new prescription Additionally as we reviewed with Question #1, ½ of patients don’t take their chronic medication as directed Non-adherence causes ~30% to 50% of treatment failures and 125,000 deaths annually Not to mention, patients not taking their medications leads to $100 Billion per year in hospitalizations every year
- Laura Can’t afford your medications, your pharmacist may have affordable alternatives to suggest
- Laura The Lower Price Doesn’t Mean It’s Inferior.
- Laura Minimum: PPIs, Abx, Opioids Discuss with provider if necessary
- Laura
- Gwen As a pharmacist, Laura, Walter, Venus, John and I have so many patient stories to share about the benefit of taking medications as prescribed. Medicine taken incorrectly- I see a number of patients on statins that take their medication in the morning instead of the evening which is the best time to take these agents. Medicines taken with no clear indication- I see this a lot with PPI. I see a lot of patients that take this class for extended periods of time. When I question how their stomach feels they generally say it feels fine but have not attempted to d/c the item. Cost-I know we want to get away from brand name meds but there are cases where the MD and patient have decided this is the best course of treatment. One of the things we help patient’s a lot with here are co pay cards. We enroll them right on the spot and they realize an immediate savings. Xarelto is a great example where this works well.
- Gwen I would like to ask for some audience participation again. Please ….. Everyone misses their medication! No one is immune to being too busy to take medications or occasionally forgetting a dose or two. Thankfully, there are plently of tips and tricks we can all employ to improve how often medications are taken and therefore improve our health.
- Gwen Taking medications everyday, sometimes multiple times a day, is tough! Although not every tool will work for everyone, it is important to find what works best for you to ensure you are able to take your medications every day. Some patients find a pill box to be helpful. Now pill boxes come in so many shapes and sizes. Pill boxes are available in 7-day sets, 7-day morning and evening, morning, lunch, dinner, evening, month pill boxes and even more! Some pharmacies provide “Unit-dose” services which are very helpful for patients who take several medications multiple times per day. The pharmacy pre-packages all the medications to be taken at the same time in one convenient pouch. For example, for a patient that takes medication in the morning and evening, the pharmacy would provide all morning medications in one pouch and all the evening medications in another. Another great tool is setting reminders. I personally find alarms helpful. I set it on my phone for a time I am always home, and when the alarm goes off, I take my medication. Other patients use a calendar to mark off once medications are taken on that day. This is especially helpful for patients who take medications only on certain days of the week. Walgreens pharmacists like Walter can print out a list to help keep track of medications that includes all your medications and you can check off once it’s taken. Finally, MyMeds is a fantastic app for patients with smartphones. This is a comprehensive health app. Patients can add all medications, doctors, allergies and even their pharmacy! This is also helpful is you help to manage someone else’s medications. In that case, you could set them up with this app, and then you are able to set up access as a caregiver with the ability to edit the medications list, view adherence, etc. In addition to storing medication information, this app can remind patients to take their medications 3 ways! The app can text you and you text back yes when you take your medication. It can also e-mail you or send a notification to your phone to take your medication. What tools are you using to remind you to take your medications?
- Gwen Whenever you have questions about when to take your medications, always talk to your pharmacist! Some medications work best with or without food or even at bedtime. For example, some medications work best on an Empty stomach, PPIs which reduce stomach acid. Other medications are best on an empty stomach because they are Improve effectiveness: Proton pump inhibitors Improve absorption Some antibiotics Iron Bisphosphonates Some HIV meds Levothyroxine Separate from calcium Tetracyclines Quinolones Some medications should be taken with food because it reduces stomach upset, like Advil or metformin, or taken with food because it helps make the medication work better, like With food Reduce stomach upset Corticosteroids Opioids NSAIDs Metformin Improve absorption Lovastatin Rivaroxaban Bedtime Other medications like some cholesterol medicaitons including simvastatin/zocor, work best at bedtime. This is because your body makes the most cholesterol overnight. Some statins: simvastatin, fluvastatin, lovastatin Real life examples http://pharmacistsletter.therapeuticresearch.com/pl/ArticleDD.aspx?nidchk=1&cs=RITEAID~CEPDA&s=PL&pt=2&fpt=31&dd=320511&pb=PL&searchid=58842340&segment=9682
- Gwen As I previous mentioned, everyone can miss doses when life happens. It’s important to know what to do when this happens. General principles, miss dose > 6 hours (PL) Don't panic if you miss a dose of your medication. Take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your regular medication schedule. Do not take two doses to make up for the dose you missed. http://my.clevelandclinic.org/health/healthy_living/hic_What_You_Need_to_Know_About_Taking_Your_Medications
- Laura New agents now OTC: nasal steroids, PPIs, H2 Blockers, antihistamines, sleep aids
- Laura
- Laura FDA is not authorized to review dietary supplement products for safety and effectiveness before they are marketed. FDA regulates both finished dietary supplement products and dietary ingredients. FDA regulates dietary supplements under a different set of regulations than those covering "conventional" foods and drug products. Under the Dietary Supplement Health and Education Act of 1994 (DSHEA): Manufacturers and distributors of dietary supplements and dietary ingredients are prohibited from marketing products that are adulterated or misbranded. That means that these firms are responsible for evaluating the safety and labeling of their products before marketing to ensure that they meet all the requirements of DSHEA and FDA regulations. FDA is responsible for taking action against any adulterated or misbranded dietary supplement product after it reaches the market. http://www.fda.gov/Food/DietarySupplements/
- Laura FDA is not authorized to review dietary supplement products for safety and effectiveness before they are marketed.
- Laura Caution FDA Takes action against adulterated or misbranded dietary supplement product after its on the market FDA not reviewed: FDA alerts, what’s contained http://google2.fda.gov/search?site=FDAgov-recalls&client=FDAgov-recalls&proxystylesheet=FDAgov-recalls&filter=0&getfields=*&sort=meta:posted:D&q=SUPPLEMENT&requiredfields=recall_category:Food&ie=UTF-8&ulang=en&ip=47.19.100.18&access=p&entqr=3&entqrm=0&wc=200&wc_mc=1&oe=UTF-8&ud=1&start=0 FDA regulates both finished dietary supplement products and dietary ingredients. FDA regulates dietary supplements under a different set of regulations than those covering "conventional" foods and drug products. Under the Dietary Supplement Health and Education Act of 1994 (DSHEA): Manufacturers and distributors of dietary supplements and dietary ingredients are prohibited from marketing products that are adulterated or misbranded. That means that these firms are responsible for evaluating the safety and labeling of their products before marketing to ensure that they meet all the requirements of DSHEA and FDA regulations. FDA is responsible for taking action against any adulterated or misbranded dietary supplement product after it reaches the market. http://www.fda.gov/Safety/Recalls/ucm463048.htm FDA, as well as health professionals and their organizations, receive many inquiries each year from consumers seeking health-related information, especially about dietary supplements. Clearly, people choosing to supplement their diets with herbals, vitamins, minerals, or other substances want to know more about the products they choose so that they can make informed decisions about them. The choice to use a dietary supplement can be a wise decision that provides health benefits. However, under certain circumstances, these products may be unnecessary for good health or they may even create unexpected risks. Given the abundance and conflicting nature of information now available about dietary supplements, you may need help to sort the reliable information from the questionable. Below are some tips and resources that will help your patients be savvy dietary supplement users. Basic Points to Consider Should I check with my prescriber or health care provider before using a supplement? This is a good idea, especially for certain population groups. Dietary supplements may not be risk-free under certain circumstances. If you are pregnant, nursing a baby, or have a chronic medical condition, such as, diabetes, hypertension, or heart disease, be sure to consult your prescriber or pharmacist before purchasing or taking any supplement. While vitamin and mineral supplements are widely used and generally considered safe for children, you may wish to check with your prescriber or pharmacist before giving these or any other dietary supplements to your child. If you plan to use a dietary supplement in place of drugs or in combination with any drug, tell your health care provider first. Many supplements contain active ingredients that have strong biological effects and their safety is not always assured in all users. If you have certain health conditions and take these products, you may be placing yourself at risk. Some supplements may interact with prescription and over-the-counter medicines. Taking a combination of supplements or using these products together with medications (whether prescription or OTC drugs) could under certain circumstances produce adverse effects, some of which could be life-threatening. Be alert to advisories about these products, whether taken alone or in combination. For example: Coumadin (a prescription medicine), ginkgo biloba (an herbal supplement), aspirin (an OTC drug), and vitamin E (a vitamin supplement) can each thin the blood, and taking any of these products together can increase the potential for internal bleeding. Combining St. John’s wort with certain HIV drugs significantly reduces their effectiveness. St. John’s wort may also reduce the effectiveness of prescription drugs for heart disease, depression, seizures, certain cancers, or oral contraceptives. Some supplements can have unwanted effects during surgery: It is important to fully inform your prescriber about the vitamins, minerals, herbals, or any other supplements you are taking, especially before elective surgery. You may be asked to stop taking these products at least 2 to 3 weeks ahead of the procedure to avoid potentially dangerous supplement/drug interactions -- such as changes in heart rate, blood pressure, and increased bleeding -- that could adversely affect the outcome of your surgery. Adverse effects from the use of dietary supplements should be reported to MedWatch: You, your health care provider, or anyone may directly report an adverse effect to FDA if you believe it is related to the use of any dietary supplement product, by calling FDA at 800-FDA-1088, by fax at 800-FDA-0178, or by reporting online at http://www.fda.gov/Safety/MedWatch/HowToReport/ucm053074.htm. FDA would like to know whenever you think a product caused you a serious problem, even if you are not sure that the product was the cause, and even if you do not visit a doctor or clinic. Who is responsible for ensuring the safety and efficacy of dietary supplements? Under the law, manufacturers of dietary supplements are responsible for making sure their products are safe before they go to market. They are also responsible for determining that the claims on their labels are accurate and truthful. Dietary supplement products are not reviewed by the government before they are marketed, but FDA has the responsibility to take action against any unsafe dietary supplement product that reaches the market. If FDA can prove that claims on marketed dietary supplement products are false and misleading, the agency may take action also against products with such claims.
- Gwen Drug interactions are a serious concern for patients taking multiple medications and supplements. Drug interactions can occur between 2 or more medications, but can also occur between medications and over-the-counter supplements, herbal products or food/alcohol. When medications can interact it can make one medication more effective, but can also make it totally ineffective. Some common drug interactions include cholesterol medications with grapefruit juice where grapefruit juice increases cholesterol medications in the blood and can leads to side effects. Grapefruit juice should be avoided with all statin cholesterol medications. Alcohol can effect antibiotics Calcium and magnesium can effect thyroid medicine, by decreasing the dose of thyroid medication you would get And although they seem benign, herbal products can significantly interact with your medications. For example garlic, ginger and ginko can all interact with coumadin and increase your risk of bleeding. Drug interactions are one of the many reasons why you should fill all your medications at one pharmacy. When your pharmacist knows all your medications, they can check for drug interactions and make sure the medications you take can safely be taken in combination. Grapefruit juice: statins Supplements Stress 1 pharmacy to fill all medications Get to know your pharmacist, develop relationship; comprehensive med list Grapefruit juice: Experts also suggest avoiding grapefruit with atorvastatin (Lipitor).48 Consider pravastatin (Pravachol) (not affected), rosuvastatin (Crestor), or fluvastatin (Lescol) as alternatives (not metabolized by CYP3A4).4
- Gwen Does anyone know the difference between an allergy, intolerance and side effect? Allergy: Patients truly allergic to a medication can experience rash, trouble breathing. An example of this is when a patient takes an antibiotic and breaks out in a rash or experiences difficulty breathing, requiring a visit to the UCC or ER. Intolerance: Examples of intolerances are upset stomach, nausea, headache or dizziness. Some patients experience nausea with some pain medications. This is an intolerance, not an allergy, and can possibly be alleviated if the pain medication is taken with food. Side effects are known potential adverse events associated with particular medication therapy. For example, a side effect of pain medication is constipation. Because we know this is a side effect, patients can be made aware of this and take a stool softener and laxative to prevent constipation Upset stomach vs. anaphylaxis
- Gwen Maintaining an up-to-date medication list is essential to staying organized. At the end of the day, you see multiple providers and although doctors do discuss, keeping an up to date list makes less work for your providers. You can fill out a printed sheet like the one we handed out, you can ask your pharmacist to print a list, you can print a lsit from the portal or you can maintain it on your smartphone in the MyMeds app. Walgreens offers a print out option for patients
- Laura Insulin Humulin N, Humulin R, Humulin 70/30, Lantus, Humalog, Novolin brands are the most common insulin's Bottles are considered closed until the seal is punctured If unopened, refrigerated bottles are good until the expiration date on the bottle Once opened (punctured) most insulin's are only good for up to 28 days Xalatan Prescription eye drop used to treat glaucoma Usual dose is one drop to the eye at bedtime Unopened vial can be store in refrigerator until the expiration date listed on the bottle Once opened (in use) the bottle may be stored at room temperature for up to six week Should be protected from light
- Laura http://www.state.nj.us/dep/dshw/rrtp/disposal.pdf DO NOT FLUSH unused medications* DO NOT POUR them down a sink or drain* Dispose of Unused Medication in Household Trash *except for FDA identified exceptions Heading straight to the toilet or sink is not the correct method to dispose of your medications. Your household trash is a much more environmentally friendly alternative. However, don’t just throw medications without altering them into the trash; pets and children are in danger if they come into contact with any unused medication, as well as the environment. Flushable medications: Reyataz Capsules (atazanavir sulfate) Zerit for Oral Solution (stavudine) Meperidine HCl Tablets Percocet (Oxycodone and Acetaminophen) Xyrem (Sodium Oxybate) Fentora (fentanyl buccal tablet) Actiq (fentanyl citrate) Daytrana Transdermal Patch (methylphenidate) Duragesic Transdermal System (fentanyl) OxyContin Tablets (oxycodone) Avinza Capsules (morphine sulfate) Baraclude Tablets (entecavir)
- Laura Direct to Walter
- Laura