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Who knows about drugs?? Take an informal survey of family members, friends, or coworkers. Do they know the medications they take? If they don’t take medications, do they know about over the counter medications – drug/pharmacological/generic/brand names? Do they know the side effects and safe doses? What about homeopathic remedies and herbal medications? Let’s do some “close to home” education and see what happens! In class we can decide if you want to blog, voicethread, or just talk about what you found out…

Mom takes:

Glipizide (used to take Metformin) – “for my diabetes”

Simvastatin – “to control my cholesterol”

Amlodipine – “to manage my high blood pressure”

Cozaar (losartan) – “this is also for my high blood pressure”

My mom did a good job of telling me both the trade and generic names of her medications. She knew what each one was for, and even knew the actions of glipizide. However, she did not know the side effects of all her drugs. She said she’s never experienced any side effects, so she didn’t bother to look them up.

Dad takes:

Norco – “for shoulder pain” (he broke his arm and it gives him pain every once in a while)

Tramadol – “also for shoulder pain”

My dad knows the trade/generic names of the pain medications he takes, their pharmacological actions, the side effects, and safe doses. (He’s a healthcare provider and knows what’s up!)

Following this activity, I realized that my family is much more in tune with their medications and their indication for use because of my dad’s career as a healthcare provider. I work as a med tech at a retirement community and often find that many of the residents don’t really know what they are taking. Of course, they are on medication management because of their inability to manage their medication scheduling, or can’t remember to take their medications at all–but I feel that anyone taking medications should know what they are taking, what they’re for, and what side effects are associated with their medications (in case that these side effects affect normal activity). I’ve also known friends who would take Tylenol throughout the day, not realizing there is a suggested “not to exceed” or maximum dose per day due to its deleterious effects on the liver.

During my study abroad trip to Ireland this past winter, we were asked to go through the Irish pharmacies/drugstores and see how they were different from ours back in the US. We all immediately noticed that medications that were normally over the counter (like Tylenol, or Advil) were behind the counter, and required patient education from a pharmacist. I thought this was both weird and interesting, but coming back and thinking about it I realize the importance of patient education–even for OTC drugs.

Medication Education

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My family is fairly well educated and able to search out the information they need when self-administering. However, there are still typically gaps in knowledge due to a lack of understanding of foundational aspects of pharmacology and pathophysiology. I have one family member who is on many medications, and she is actually highly motivated to educate herself; she knows most of her medications fairly well. However, there are certain aspects of which she is not aware and so I’m careful to ask her questions pretty regularly about which medications and doses she is taking currently. Some months ago, her physician changed some of her meds and forgot to add a potassium sparing diuretic to her medication regimen, which includes Lasix and Digoxin…and her labs that week indicated K+ of 3.4. Since she was not aware of the implications regarding potassium, I had the opportunity to educate her on signs of hypokalemia and Digoxin toxicity, and on the need to supplement her diet with potassium until her physician came back from vacation and could correct her medication regimen.

In terms of homeopathic and “natural/herbal” medications, I find that even my friends/family who are knowledgeable about the broad spectrum of supplements do not base their beliefs on evidence, but simply what is reported by respected individuals or magazines; there is a strong media influence on adoption of these supplements into a person’s lifestyle. They are especially not aware of the act that these natural supplements can interact with most medications, the most serious of which include the anticoagulants and anticonvulsants.  I have also found that this is the most difficult education in terms of meeting resistance.  Some of my family members will keep using homeopathic medications despite my explanations.

In conclusion, in addition to educating our patients in the facility, there is a need for us to ensure that those closest to us are practicing caution with the medications needed for their health. I am grateful for the opportunity to be a resource to my family and friends in this way; even if I do not know the answer, I know where to find a good source that can offer an explanation.

Medication Knowledge

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So after interviewing my friends and family I realized many of them are unaware of the medication that they take. The individuals who were most aware were my parents and in laws. I’m not sure if it is an age reason, or the fact that they take daily medication for comorbidities such as hypertension and cancer. Not only did they know the name of the medication they were taking, but they also knew dosing and side effects. The people closer to my own age however  were very unaware about  the medications they take. Most of the people I asked do not take anything on a regular basis,  but when asked about common over the counter medicines, many of them were naive to the side effects and correct dosing. To be totally honest, even my own husband has no idea how much Tylenol to take. When he is sick I have to remind him to check labels on cold medicine so he doesn’t consume too much acetaminophen. This is an issue nurses must be aware of though,  and we must know the right questions to ask to assess the history of our patients. In regards to homeopathic medications, I know that many of the individuals who use these remedies do not know that side effects are common and should be anticipated. I have never checked the label on homeopathic remedies, but I would hope that side effects are listed somewhere on the container for consumers to access.

Knowledge is Power

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When it comes to my family, my step-dad is the only one that takes prescription medications. He has hypertension and hyperlipidemia. Prior to this assignment, I was even unsure what he was taking so it was interesting for me to ask him. Here is a recap of what was said:

Me: “Do you know what medication/s you are taking?”

Ray: “Yeeeea, ummm- let me walk into the bathroom and look at it.”

Me: “Would you recognize it if I said it, or have you never looked at the label?”

Ray: “No, I would recognize it, it’s fairly new becuase the last one I was on didn’t have a generic version so it was super expensive. Ok, its Benicar HCT.

Me: “Do you know what that is or what that means?”

Ray: “Yea, I did ask my doctor and from what I understand, it’s a heart medication with a diruetic to get rid of some of the fluids in my body.”

Me: “Wow, I am impressed. That is right.”

Ray: “Well honey, I only am on one medication. If I was on more than one, I would most likely mix them all up and have no idea what is what!”

Me: “See, that’s the problem that most people face….”

So, my stepdad passed my test! I was actually impressed becasuse he isn’t really the kind of guy that would care too much about the medication he is on. He is more of a “do what the doctor says and don’t ask questions” sort of guy. I thought his comment on him only knowing the medication because it is only on one was interesting. As I told him, that is a major issue with non-compliance today. People have so many prescriptions, they can’t keep them all straight and because of that, the desire to maintain their treatment because they “know” why they need the medication falls to the wayside. Then, they are back in the hospital- a trend that is happening far to often in America. This emphasis once again, the importance of patient education.

 

 

 

“I’ll just have itchy, watery eyes!”

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Let’s start with a little comic relief…

While Jeff Foxworthy makes a funny joke with some exaggerated side effects caused from medications, sadly, he isn’t far from the truth!  You only have to watch about 15 minutes of tv in order to see a commercial advertising a new medication. The commercials always present the drugs as the quick-fix, miracle pill that will make that specific health problem disappear in a snap. The drug may be effective in treating the specific health concern, but the commercials fail to paint the whole picture of the medication. They  always save the potential side effects for the very end of the commercial and list them off at a barely comprehensible speed, usually ending in “and in rare cases may cause serious injury or death.”  As Jeff Foxworthy so candidly stated, “I’ll just have itchy, watery eyes.”

With the combination of pharmaceutical advertisements and uninformed media coverage of medications, most of the American population approaches prescription medication in one of two ways. They either blindly take whatever their doctor prescribes or their neighbor lets them try because it “worked wonders” for them, or they stay as far away from all medications because they just poison the body. As nurses, we have a great opportunity to step into both camps of thinking and help our patients (and family and friends) have a more accurate understanding of medications so that they can make informed decisions about their health.

For my informal survey, I decided to ask my mom about the medicines that she takes. Thankfully, she does not take any prescription medications and is very healthy. However, she does take some OTC medicines.

-Do you know the names of the medications you take? And why you take each of them?

“Yes, I take ibuprofen for joint pain and headaches. And I recently started taking melatonin at night to help me go to sleep. I very rarely take Tylenol with ibuprofen instead of melatonin. Ibuprofen is the same the as Advil and Tylenol is acetaminophen.”

-Do you know the potential side effects of those medicines?

“Well, ibuprofen can cause stomach bleeding or something like that so I have to take it with food and not on an empty stomach. I took it on an empty stomach when I was also sick and I had bad stomach pain after. Now I always take it with food. I don’t know about any side effects of melatonin; it’s a natural supplement.”

-Do you know if any of those medications interact with each other when you take them together?

“Well, for a long time I thought that ibuprofen and tylenol could not be taken at the same time, but I looked into it a bit and it seems like it is totally fine to take them together. I don’t know about the melatonin.”

I have talked with my mom about some of the medications she takes, so I was encouraged to know that she is understanding and retaining a lot of the information. Talking with her about melatonin reminded me that most people take vitamins and natural supplements without thinking twice about potential side effects or whether or not they even need it  because they do not consider it a medicine. I didn’t know much about melatonin (as a natural supplement) either so we looked it up and made sure it was okay to take with ibuprofen and was appropriate for her to be taking on a regular basis.

I think this was a good reminder for her as well to be more aware of the medications she is taking and gave her some specific key questions to ask before taking new medicines.

Remote medical support at home

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As people live longer with chronic disease and depend more often on complex medication regimens at home, the burden of managing home therapy continues to fall, unassisted, on the patient and family. As I sat listening to my overwhelmed and tearful friend tell me about how her father ended up in the hospital for CHF exacerbation, I couldn’t get this out of my head. He had not been taking the increased dosage of one of his heart medications that the doctor had prescribed because the information had simply gotten lost in the mix. Though my friend typically helped her parents keep track of these things, issues with her own family came up, her brother tried to help but is not well versed in medical lingo… They had each done their best but before they knew it her father’s condition had deteriorated, and here we sat.

Unfortunately, programs and services designed to support patients in the management of their chronic conditions at home have not grown at the same rate as the complexity of the home regimens themselves. Case management in the hospital focuses on medical equipment, and home health nursing services catch those patients without adequate support at home, but where is the support for everyone else? My friend is the most medically literate family member involved in the care of her father and her understanding of the medications that he takes is limited to a general understanding of what it is for (e.g. heart, blood pressure, blood thinner), where to look on the bottle to find how much he should take.

What our healthcare system needs is more robust case management that works in association with the primary care provider and regularly checks in with patients living with chronic disease, to confirm that the patient is taking the right medications, at the right dosages. This service could be staffed by nurses trained in over the phone triage that can discuss with the patient, or primary caretaker, any questions regarding their current condition, and changes to home therapy regimen made at the previous doctor’s appointment. This service would compensate for the ever decreasing amount of time that doctors can spend with their patients, would decrease the number of turn-around admissions to hospitals, and provide support to the patient’s support network… which in the end would improve everyone’s quality of life.

 

Rx Knowledge

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Running Pills

For a class assignment, I took an informal survey of my family members and friends to assess their knowledge about the medications they take. To assess their knowledge, I asked a series of five questions about each medication they take.

  1. What is the name of the medication?
  2. Why are you taking that medication?
  3. How much of the medication do you take?
  4. When do you take the medication?
  5. What effects do you look for regarding this medication?

In asking these questions, I was hoping to discover whether or not they know the Trade name of their medication or the generic name; if they knew why they were prescribed each medication; if they know the dose they are supposed to take; if they know what time of day they are supposed to take their medication; and both the desired effects and the adverse effects of the medication.

I also asked them about some common over-the-counter (OTC) medications like ibuprofen (Advil, Motrin, Midol), acetaminophen (Tylenol), aspirin (Bayer, Excedrin), and naproxen (Aleve). About half of those I surveyed were very knowledgeable about the medications they take and could correctly answer most of the questions. The other half of the people I surveyed were not as knowledgably and didn’t know that ibuprofen is the same as Advil which is the same as Motrin and that acetaminophen is the same as Tylenol.

Advil-Bayer-Tylenol

When it comes to prescription drugs, whether they knew the trade or generic name of their medication depended on whether or not their prescription medication was generic or brand name. Everyone I surveyed was able to tell me at least one (generic or trade) of the names of their medications and they could tell me what they take it for. The next few questions became increasingly difficult for them to answer. Everyone could tell me how many pills they take and when they are supposed to take it but only a few could tell me the exact dose in milligrams they were prescribed. For those that knew the milligrams prescribed, I further asked them if they knew the safe dose of that medication and nobody was able to answer that. Lastly, I asked my friends and family what effects they look for when taking their medication. I asked them what the desired effect is and what some adverse effects are. Everyone could tell me the desired effect, the reason the medication was prescribed. When it came to adverse effects, most knew the typical nausea and stomach upset but most people struggled with this question.

Overall, I learned that there is a need to improve the knowledge of the community regarding prescription and OTC medications they take. As a nurse, I am going to play a key role in patient education and my goal is to make sure that all of my patients are adequately informed on the medications they are taking as well as the resources available to them if they have any follow-up questions or concerns.

PRESCRIPTION-DRUGS

Who knows about drugs?

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I was fortunate enough to be able to travel and see my family this past weekend, many of whom are strongly against taking any medications (they are very familiar with generic/brand names, take herbal supplements and know to tell the doctor always, and are aware of the side effects) so I was only left with interviewing my grandfather. To start off, I asked my grandfather what he knew about his hypertension medications with which he replied, “what… I don’t have hypertension?” And I said I thought you were on high blood pressure medication and he replied, “blood pressure medication, yes… but I don’t know about hypertension.” This demonstrated to me the need to simplify the language we speak with our patients because clearly my grandfather was unaware that high blood pressure and hypertension were the same thing. My grandfather only knew that he took a cholesterol medication, high blood pressure medication, and a diabetic medication (metformin), or so he says “his essential medications.” He also takes various others but knows that these are the ones he should never skip. He knew the purpose of his medications and could recognize them by color. When asked if he knew the side effects and safe doses of his medications he replied that he was explained everything at one time when he initially began this medication regimen (5 years ago). And said that the pharmacy offers the information again when he picks up his medications, but he has little desire to speak with the pharmacist or read the information. My grandfather is opposite of most of my family who take herbal supplements as he thinks herbal supplements are not reliable and trusts doctors more than the “natural people at the healthy stores who try to get you to buy all this junk.” I taught my grandfather the essential cliff notes version of his medications (as he doesn’t really care to be educated on meds he’s taken for so long but was willing to hear me out for a few minutes). We discussed some side effects and actually spent most of our time talking about how to better manage his glucose levels and my grandfather frequently eats only once a day (which he claims is best since he should be losing weight) and I discussed with him the importance of keeping his metabolism going in addition to better managing his glucose levels by eating smaller frequent meals.

Family Education on Medications

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Education on Medications

It was fun assessing two of my family member’s knowledge on the medications that they are currently taking. One of my family members has diabetes type 2 and he is currently taking metformin HCL 500mg one tab twice a day and glyburide 5 mg daily every morning. He only knew he had to be compliant with his medication or his glucose level would get higher and told me that the medication was used to lower glucose levels. He didn’t know about side effects so I educated him on that having used my Skyscape app. I told him that Metformin HCL tells the liver to decrease the production of glucose, decreases the ability of your intestines to absorb glucose and increases the sensitivity of insulin. Also, metformin can cause abdominal bloating, diarrhea, nausea, vomiting, unpleasant metallic taste and hypoglycemia. Moreover, I told him that metformin helps control hyperglycemia but doe not cure diabetes. I also told him that if he experiences hypoglycemia to take a glass of orange juice or 2-3 tsp of sugar, honey, or corn syrup dissolved in water, and notify the health care professional.

The second medication he is taking is glyburide. The action of this drug is different than Metformin HCL, but its main goal also is to control hyperglycemia. Basically it lowers glucose levels by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites. Also, it tells the liver to decrease the production of glucose. Some of the side effects can be feeling dizzy, drowsy, feeling weak or having a headache. Moreover, it can cause constipation so I told him to drink lots of water and fiber rich foods like vegetables and fruits. It can also cause cramps, diarrhea, feeling of fullness, increases the appetite, photosensitivity so wear sunscreen when outdoors, hypoglycemia, and aplastic anemia (when the bone marrow does not make enough blood cells from the body such as RBCs that carry oxygen, WBCs to fight an infection, and platelets to control bleeding.

The second family member takes atenolol 50 mg once daily. Basically this drug decreases the BP, decreases frequency of attacks of angina pectoris (chest pain) and it prevent a heart attack (MI). Some of the side effects are fatigue, weakness, anxiety, depression, dizzy, insomnia, memory loss, blurred vision, stuffy nose, wheezing, decreases heart rate, constipation, diarrhea, nausea, vomiting, urinary frequency, and either hyperglycemia or hypoglycemia. Also, I educated her on managing her high blood pressure by loosing weight; avoid too much sodium intake, and practice stress reduction such as meditation. Overall, they were both amazed as too the many side effects that a tiny pill can cause. I loved this assignment!

Pharma-sea

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sea of pharmaceuticals

Many of us in America are swimming in the “pharma-sea” of medications. We are a pill popping nation. Interestingly, years ago when I was dating a frenchman, whenever we’d go to France to visit his family, his mother would request certain vitamins/supplements that are not available in Europe. Apparently pharmaceuticals isn’t as “pushed” or emphasized in Europe as it is in the U.S. I found that interesting. I don’t know how it is today in Europe (that was more then ten years ago and the frenchman and I have since parted ways) but, I think it is safe and credible to say that big pharma is a big business in America.

When I have spoken to my mother-in-law about ALL the medications that she takes and ALL the ones that she is in charge of making sure my father-in-law takes, she knew the basics on what they were for. However, she wasn’t truly aware of how the medications “work” or the possible side-effects they can have. My father-in-law is the sickest person I personally know. My in-laws kitchen counter top practically looks like an apothecary! My husband believes that the years of prednisone that his father had been on for rheumatoid arthritis for years has kicked him into acquiring chronic myelogenous leukemia.  It is worth mentioning that shortly after being on prednisone, my father-in-law gained quite a big of weight and eventually acquired diabetes. Perhaps it is my mother-in-laws generation that doesn’t question what the doctors prescribe them. They just want to feel better and they trust their doctors. My husband on the other hand isn’t as trusting. He has even done much research on the many medications that his father takes and even came across an article that said taking prednisone long-term is like giving yourself HIV because of how much is suppresses the immune system. When my husband spoke to his parents about the information he found on the certain medications his parents were taking, it seemed to go in one ear and out the other. Sad.

It is prudent to say that before we dive into the “pharma-sea” of drugs out there, we should definitely get some swimming lessons or at least wear our floaties, lest we sink.