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Medication Interview
My dad had a stroke 10 years ago, after that he was prescribed lipitor and daily baby aspirin. I asked him what he knew about the medications and why he was taking them. He said aspirin was to prevent more clots and that Lipitor was a beta blocker for his cholesterol (close but not quite). Mostly he knew that it was very very expensive until it went generic. He didn’t know the side effects or mechanism of action of either of these meds, and the fact that he brought up the term “beta blocker” makes me suspect he was also prescribed one of those but just forgot. However, my dad hasn’t taken any of his prescribed medications in 4 years, so I can’t be too mad at him for having so little idea of what he was taking. Instead, he became a very strict vegan and decided he didn’t need any of his medications anymore. After 6 months of this new lifestyle, he went to his doctor for a physical and blood work and she told him “Just keep doing what you’re doing.” This was a huge validation for all his hard work, and he has been able to stay a vegan (despite me and his girlfriend complaining) ever since. Now the only medications my dad takes are supplements and homeopathic. He takes red rice yeast for his blood pressure, ginko biloba to prevent alzheimers, and saw palmetto for prostrate health. Instead of over-the-counter medications, he only takes homeopathic when he has a cold and completely swears by it. One of the big things I noticed when talking to my dad was how self-assured he is about his lifestyle and medication choices. Going off your meds because you “feel like you don’t need them anymore” is probably not a good idea. But for him, it was like he took charge of his own health and that independence made him so much more responsible than he was before. Because the choices are his own, he is very very committed to his health, while he didn’t even pay attention to the pills he was prescribed.
How well do you know your meds?
My parents, both in their 60s are very active. A few summers ago they hiked true John Muir Trail from Yosemite to Mt Whitney and I joined them the last week. They eat very well, mostly home cooked meals with vegetables from the garden. They have been going to their general practitioner for 20+ years. In 2009 my father was diagnosed with prostate cancer, luckily caught very early. He opted for surgery and is very lucky to be in remission without side effects or complications after surgery. I also remember once he came home from the doctor with reported cholesterol on the high side. He stopped eating ice cream every night and started going to a spinning class with my mom.
I asked him about his medications that he and mom take and he went to the medicine cabinet and listed off the medications.
>Levothyroxine (25 mgs)-for subclinical hypothyroidism, no apparent side effects experienced.
> oxybutynin chloride (5 mg)-for over-active bladder, experienced swelling (hand/fingers, throat).
> oxaprozin (600 mg, day pro)-NSAID pain killer, experienced hives d/c due to side effects
> acetazolamide (125 mg), altitude sickness, no apparent side effects experienced.
> doxycycline (100 mg), tick bite, no apparent side effect experienced.
> ciprofloxacin (500), diarrhea, no side effects experienced.
> erthromycin (cream, eye infection), no side effects experienced.
> rizatriptan (10 mg), migraines, sleepiness.
> cyclobenzprine (10 mg), muscle relaxant, no side effects experienced.
All of these medications I either knew why he was taking them or why he had them in his cabinet. It was also very encouraging that he knew what he was taking and why and what side effects. If I was his nurse I would feel comfortable with the education he had received about his medication.
I know this isn’t always the case.
My grandma was recently diagnosed with rectal cancer and depression and she made it through chemo and radiation but getting her to take antidepressants is a struggle. She doesn’t think they work but she won’t go to the doctor to try difference kinds of adjust the dose. It’s almost the time when you wish there were long term dose options that didn’t have terrible side effects but were easier to monitor use.
Medication Survey
This week I took an informal survey of the family members and roommates regarding medications.
I surveyed a total of six people, two roommates and four family members. From these individuals’ responses it is safe to conclude that they are health literate.
Of the individuals who take medications, they are aware of the names and why they take them. They know what resources to turn to — pharmacists, drug guides, package inserts — to determine important information about the drug (dosages, side effects, emergency signs/symptoms to notify MD).
All of the individuals had taken an OTC at least once in their life. The majority could identify the difference between generic and trade names as being the same drug, just less expensive.
Only two of the individuals stated they used homeopathic remedies and herbal medications. This could be due to a misunderstanding of what defines homeopathic remedy and/or herbal medication. The remedies include the use of essential oils, teas, massage, yoga, prayer, and meditation.
Med Knowledge
I spoke with a number of friends and family about regarding their knowledge of OTC and prescription medication. Most people I know don’t take a regular prescription medication but do use OTC meds occasionally. Of the five I spoke with, most had a reasonable estimate of what each dose and max dose per day should be for ibuprofen and acetaminophen. One concern arose when my friend said she takes two acetaminophen when she has a headache, but when she showed me the bottle I saw that is was extra strength, 500 mg/pill. She did not know that these pills were a higher concentration of medication and did not report treating them with the consequent caution. Related to this, I just bought a bottle of acetaminophen and I couldn’t find any that wasn’t extra strength despite looking in two stores. I hope consumers know what their getting and how to use it. Another friend told me that he has been on one prescription for many year (he didn’t share what), but said that he didn’t know the dosage until he had been taking it for about 5 years. I think that this is pretty common, people have their medication and maybe know how to use it but don’t necessarily pay attention to the details of what it is. This could be a problem if one day the doctor changed the dosage and they got a new dosage of pill but didn’t know to take more or less of the medicine. A couple of my roommates pretty much never use western medications and only use herbal remedies. They are both pretty healthy fellows, but occasionally I find some of their practices concerning, even more so because the products they use are unregulated. For example, I once watched my roomate put pieces of dried herbs under his eyelids to “open his tear ducts”. I don’t remember what the herb was, but I do think the potential for mechanical harm from dry scratchy plant material directly on the cornea poses a risk. Another friend likes to take colloidal silver as a regular dietary supplement, a practice which no scientific evidence supporting it and poses the risk of silver accumulation in body tissues (Bauer, 2014).
Bauer, B. (Aug 5, 2014). Mayo Clinic Consumer Health: Expert Answers. Retrieved from:
http://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/colloidal-silver
/faq-20058061
How Well do You Know Your Own Meds?
This week we were prompted to look at how much our family members, friends, coworkers, etc. know about drugs. For the last couple years my father has been hovering around the pre-diabetic range in terms of his fasting blood glucose and A1C. He recently started taking Metformin so I decided to chat with him to see what he knows about it.
With my father being an engineer, he is very analytical in his thinking. He seems to actually enjoy taking his blood glucose after meals because he likes to interpret the data and analyze how his meal affected his blood glucose. He has also become interested in how adding a glass or two of wine or beer to his meal affects his blood glucose.
When asked how metformin works he was able to give me a generalized explanation of type II diabetes and how metformin works to counteract these effects by increasing the sensitivity of insulin receptors in certain tissues. We spoke about how metformin also regulates blood glucose by reducing glucose production by the liver and partially reducing absorption of glucose in the GI tract.
We also spoke about possible adverse effects from taking metformin. He noted that he sometimes gets an upset stomach when he drinks wine with metformin but otherwise hasn’t had any issues. He had vaguely remembered something about the risk of lactic acidosis and also knew it is not advisable to drink heavily when on metformin but wasn’t quite sure how these two factors were related. I explained that metformin can inhibit the breakdown of lactic acid and in rare cases can lead to lactic acidosis if it accumulates to toxic levels. We went over the early signs of lactic acidosis (hyperventilation, myalgia, malaise, unusual somnolence) and also discussed how alcohol can contribute to the risk of lactic acidosis as it also inhibits the breakdown of lactic acid.
Although my father likes to drink a glass or two of wine with dinner and is fascinated with how alcohol drops his blood glucose levels, he understands that drinking heavily while on metformin is not advisable. We also talked about how drinking alcohol in general can contribute to the development of type II diabetes by desensitizing insulin receptors. Even though metformin seems help regulate his blood glucose levels and keep him in the pre-diabetic range we talked about how important it is to still continue to try to manage his blood glucose as much as possible through diet and exercise. As with anything, a glass of wine or dessert is okay but do it in moderation!
Medications at Home…a Closer Look
It so happens that when this blog was assigned, an interesting medication teaching opportunity came up with a relative of mine. She has diabetes type 2 which is controlled by diet and exercise only; her doctor has not yet prescribed any single medication for her blood sugar control. If/when we are together and eat, I always chat with her about her blood glucose number. It so happens that on that particular day we were visiting, and she was telling me about the lunch she had at a new restaurant up the street. When I asked about her blood sugar level, she said that it was 275! When I asked her what she was going to do about it, she replied that she was going to take her cholesterol medication for it! I gave her a glass of water to drink and asked to if she wanted to take a short walk (to help lower her blood sugar). My plan was to chat with her on the walk about her medication and to retest her BGC when we returned. (By the way, it later went down to 135 to my relief).
I initially thought that she was confused about the difference between cholesterol medication and blood sugar control medications. She told me that when she tests her blood sugar and found it high, she has been taking a dose of her cholesterol medication, believing that her BGC level would decrease. I assumed she was referring to a statin and asked her to show me her medication packaging. I was surprised with my findings…
Her medication is named Welchol. It is a bile acid sequestrant, and considered an alternative to taking a statin to reduce/control high cholesterol levels. It works in the bowel to help remove bile acids from the body, then the body’s cholesterol to make more bile acids, which causes blood cholesterol levels to decrease. Ingenious!
Further intrigued, I went to the manufacturer’s website to investigate this interesting drug and saw…large banners that Welchol helps to lower blood sugar levels! Then I realized that is why/how my relative came to the conclusion that Welchol would symptomatically reduce her blood sugar levels. I read the “for patients” information section and found that this medication mostly works “in addition to” blood sugar lowering drugs, such as metformin and insulin. There was absolutely no mention of it helping to reduce blood sugar levels on its own.
Later, I pulled up several websites on Welchol to review with her. She was not aware that Welchol was not lowering her blood sugar. She also thought that she was supposed to take the Welchol symptomatically. Directions say to take it every day with food and to not miss a dose. She was also unaware of the potential side effects, so I reviewed those with her as well. I encouraged her to also chat with her doctor if she had any other questions and to keep on top of her blood sugar regimen.
I felt bad that I had not reviewed her medication with her before. We do, after all, educate patients at the hospital clinicals…why not educate out family too? I had just assumed that her provider had educated her, or that she had received information at the pharmacy. I should not have assumed, and decided from hereon that I would spend some quality time chatting with other family members about their medications (with their permission of course!). I also decided to take my own “medicine” so to speak, and to review the details, side effects, etc. for a medication that I am taking as well. Although I read the entire attachment that came with the one medication I take, it was a year ago and I decided that it would serve me well to have a review, just in case.
This was a great assignment…it reminds us to not take anything for granted, especially our medications. We have a responsibility to understand them and I am renewing my dedication 
References:
Deglin, Judith Hopfer, and April Hazard Vallerand. Davis’s Drug Guide for Nurses. 11th ed. Philadelphia, Penn.: F.A. Davis, 2009. Print.
“FDA Expands Advice on Statin Risks.” FDA Expands Advice on Statin Risks. U.S. Food and Drug Administration, 14 Jan. 2014. Web. 12 Oct. 2015.
Shah, R. V., and A. B. Goldfine. “Statins and Risk of New-Onset Diabetes Mellitus”” Circulation (2014): E838. Print.
Health literacy and Medications
To my surprise, the health literacy of the individuals in my family vary greatly. I am going to use my father and my father-in-law as examples because their similarities and differences provide an interesting illustration. Both men are in their seventies, both are a healthy weight and have lived active lives, both received a Masters degree from Columbia University and had successful careers.
My father was diagnosed with type II diabetes mellitus when he was in his forties. His treatment plan includes oral antidiabetic medications along with exercise and diet modification. He is in good health and knows more about the physiology of his body than most members of the general public. In addition, he is married to a Nurse Practitioner who keeps him on informed about his medications, as well as aware of any signs and symptoms that indicate potential problems. He is knowledgeable about what medications to take, what they do, when to take them, and what is doses are.
My father-in-law has been healthy for most of his life. Three years ago he was diagnosed with prostate cancer. After consulting with his physician he decided that the best intervention was no intervention. He, like many elderly men with prostate cancer, is using the approach of “watchful waiting” and “active surveillance.” He lives alone in an apartment in midtown Manhattan. About a year ago he started to show signs of early memory loss and has since been diagnosed with the Alzheimer’s disease. Several factors now contribute to his low health literacy level and confusion about medications. One problem is that while he was gifted in mathematics, he had little interest and is not knowledgeable about how the body works. Having lived a very healthy life, he has little experience with medications or the medical system. In addition, one of the first signs of changing cognitive function is difficulty solving math problems (eg paying bills). While he can remember what medications he is taking and when to take them, he is not able to understand safe doses.
I think both of these men illustrate how two seemingly similar individuals can have two totally different health literacy levels and require different approaches to education about medications. Being able to recognize the needs of the individual is paramount and requires careful assessment.
