Chapter 9
Medications
The purpose of this chapter is to teach you about medications in general. This is not like most material written about medications. Other pamphlets and books tell you the details of specific types of medication. This chapter focuses on the things you should know about medicine. This includes how they work, why they come in varied forms, and how to read medicine advertisements. But more than that, it centers on what it means to be a smart consumer. All of this will help you to work with your doctor and health-care team to better plan your medications.
Each person is unique and may require different dosages or have varied responses to certain medications. Side effects will not always occur in every person who takes a given drug. Ask your medical staff to recommend what is best for you.
HONESTY IS THE BEST POLICY
The biggest part of the help you give is honesty. You will need to give your doctor a complete medical history and a list of your current medications, both prescription and over-the-counter. This should include any "natural" alternative supplements. Your medical history tells your doctor what kinds of reactions, illnesses and problems you have had. These are very important in understanding your past treatment and planning your future care.
You must keep in mind that medications not only affect your body, but they also affect other medications as well. For example, even if you taking something as simple as aspirin, it may defeat the ability of some other drug to work. (For more on this, see the section in this chapter on drug interactions.) Certain over-the-counter drugs like cold remedies can affect your bladder and bowel medications.
PREGNANCY
If you are pregnant or suspect that you may be, tell your doctor. Any time that you are taking medication, your baby is taking it too. Depending upon the type of medication, it can have serious results.
HOW DRUGS DO WHAT THEY DO
The starting point of how drugs work is knowing that your body is mostly made of chemicals. Medicines are chemical too. When you take drugs, they mix with the chemicals of your body.
Drugs work in two ways. One kind of drug works just the way it is, in the same form it was when you took it. Others work only after your body has broken them down into some other form so that they can mix with the chemicals and tissues in your body.
Most drugs are not things your body would normally use, so you eventually get rid of them through urine, bowel movements, tears, sweat, or your lungs. Each drug takes a certain amount of time to go through your body. This affects the dosage you are given. For example, some drugs pass very quickly through your body. Others are meant to build up and have a lasting effect.
Drugs Come in Different Forms
The drugs you take come in many different forms. There are tablets, capsules, syrups, chewables, injections, or ointments, to name a few. The form the drug comes in depends on how it is supposed to work in your body. Below are some example of drug forms and how they are used.
- Chewable tablets: Fast-acting, often given to children.
- Swallowed tablets, capsules: Long-acting. They must be swallowed whole so that all the medicine is not released at once, but over time.
- Injections: For fast-acting effects or for drugs that cannot be taken orally and digested (such as insulin).
- Syrups: Mostly cough medicines, they are usually thick, and may contain sugar.
- Suppository/enema: Medicines that are taken through the rectum. For those who cannot swallow medicine, medications that may cause nausea, or some medications that act directly on the rectum.
- Ointment/creams/lotions: Mostly for skin condition. An exception is nitroglycerin gel, sometimes used to treat autonomic dysreflexia.
- Suspensions: Contain large amounts of solid medication suspended in liquid. The solid tends to settle to the bottom, so you must be sure to shake the bottle before using in order to mix the contents.
- Skin/transdermal patches: Release medication slowly into your body by absorption through your skin. Be sure to apply the patch to a clean, dry skin area that has little or no hair and is free of scars or irritation. Remove the previous patch before applying a new one. Do not try to trim the adhesive patch to adjust the dosage.
- Inhalers: Contain medicine that must be inhaled to work properly. It is best to receive instructions on how to correctly use the inhaler delivery system, and ask a health-care professional to watch you give yourself a dose. Read instructions carefully, because some inhalers require rinsing your mouth out with water afterwards.
- Eye drops: Should be applied only after you wash your hands. Do not let the tip of the applicator actually touch the surface of your eye.
Side Effects
It is important to know about possible side effects from medications before you take them. Your pharmacist, doctor, nurse, or other member of your health-care team should explain this to you. It is also important to tell your doctor about any side effects that concern you after you take the medication. It is a good idea for you to learn both the generic and brand names of your medicines. Make a list of all the medicines you take, and keep this with you at all times. This is important when you need routine or emergency medical care.
Side effects are classified in various ways:
- Pharmacologic (FARM-ah-co-LODGE-ick) effects: These are the chemical side effects of the drug itself. They are often predictable and controllable. In addition, many drugs do more than one thing in your body. The size of the dosage you are taking can make a big difference. In some cases, your body may just need time to adjust to the drug or its side effects.
- Allergic reactions: Allergic reactions come in many forms, showing up immediately or even as late as several weeks after the medication is taken. Skin reactions are the most common symptom. They range from redness and itching to swelling and sores. Allergic reactions have nothing to do with the action of the drug or the size of the dosage. They are often unpredictable in occurrence, except that people who have allergies such as hay fever tend to react more to medications. Reactions of this kind are a good reason why your medical history needs to be complete. There may be less of a chance that a reaction will occur if your doctor knows about your past experiences with medications.
If you do experience some kind of reaction to your medication, call your doctor immediately. You may need to stop using it.
- Anaphylaxis (ANN-ah-fill-AX-iss): A severe, immediate response to a drug. It is a life-threatening situation of decreased blood pressure and difficulty breathing. Stop using it immediately and CALL 911.
- Drug interactions: This refers to the effect two or more drugs have on each other. Occasionally, both keep on working, but their actions combined create yet another action.
Alcohol is likely the drug most often combined with other drugs. For example, alcohol more than doubles the effect of tranquilizers. Keep in mind that cough syrups contain enough alcohol to have the same effect. Alcohol should not be taken with any medications.
Again, the best policy is to tell your doctor about any drug you take on a regular basis. Even if it’s just aspirin, it could make a big difference.
Over-the-Counter, Prescription Drugs, and Herbal "Natural" Preparations
The foremost difference between the over-the-counter medications and prescription medications is that medicines sold over the counter have a wider margin of safety. This means that they have fewer and milder side effects and little or no chance of addiction. Herbal ("natural") preparations include diet supplements, botanical phytomedicines, vitamins, minerals, and other substances. See the chapter on Alternative Medicine for more information.
This dose not mean that over-the-counter medications or natural supplements are harmless. Used unwisely or along with other drugs you are taking, they can affect your health a great deal. So tell your doctor if you are using any over-the-counter medicines, natural supplements, or any prescription medications.
Many herbal supplements are added now to various food items. Be sure to read the label, and be careful about eating something that would interact with your medications. See the chapter on Alternative Medicine for more information.
WHAT DOES YOUR PRESCRIPTION SAY?
Most prescriptions include the following elements:
- Your name and address.
- "Rx" - the symbol marking the area where the actual prescription is written.
- The name and strength of the drug.
- The quantity to be prepared.
- The directions of how to take the drug.
(These are abbreviated on the prescription but will be written out for you on the drug container).
- Refill information.
- The date.
- The prescriber's name, address, and registration number.
- The prescriber's signature.
In most cases, your doctor will be able to give a drug order to the pharmacy over the phone. However, this cannot be done with prescriptions for controlled substances. These include such drugs as narcotics and stimulants. They can only be obtained with a written prescription taken to the pharmacy. Refills for your prescriptions are convenient to get with refill order forms. (See figure 9.1.) Be sure to send in refill orders to your pharmacist in plenty of time, at least two weeks, to ensure you do not run out of medication.
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FIGURE 9.1. Sample Prescription Refill Form
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Refill forms contain almost the same information as your original prescription, except that this one keeps a running tab on how many refills you have used and are still allowed. As long as you still have refills on your original prescription, you will get an updated refill order form for your next refill. If you have used your last refill, you will get a form for reordering the whole prescription. This form only works with your doctor’s signature. Most pharmacies, clinics, and hospitals use a computerized system to facilitate ordering your medications and keep track of refills.
Refill laws limit the number of refills you can have written onto a prescription. Drugs are put into different categories that tell how many refills they may have.
ADVERTISEMENTS ABOUT MEDICINES
As a consumer, you should be aware of all the information about a drug, not just what the advertising source says. Check with your doctor about what you should take. Do not be fooled by advertising. Read it carefully, and if you still have questions, ask your doctor or pharmacist.
AT HOME
In the hospital, you have many people around you to make sure that you take your medications safely. They tell you how much to take and when to take it. They will also tell you about what you are taking and how it works.
At home, you will be the only one responsible for your medicine chest. You are responsible for taking your medication on time and in the proper dosage. Be aware of any changes that may occur while you are taking your medication and let your doctor know about them.
Being responsible also means that you have to keep yourself informed about what you are taking. Read the labels of everything you take. If you still have questions, ask your pharmacist. This applies to both your prescription and over-the-counter medications.
The information you read about medications does not make you an expert in planning your own medication. Planning drug therapy is a science. Consumer guidelines cannot replace the medical knowledge that your health-care team has. Your pharmacist can assist you in understanding your medications and how to take them safely and effectively.
RESOURCES
Publications
Advice for the Patient, Drug Information in Lay Language, Volume II, 19th edition
Purchase
The United States Pharmacopeial Convention Inc.
Micromedex, Inc.
6200 S. Syracuse Way, Suite 300
Englewood, CO 80111
The Pill Book. The Illustrated Guide to the Most-Prescribed Drugs in the U.S.
H. Silverman. CMD Publishing. Bantam Books, 1997.
The John Hopkins Complete Home Encyclopedia of Drugs.
S. Margolis. Medletter Associates, Inc. 1999.
The Medical Advisor. The Complete Guide to Alternative and Conventional Treatment.
Time-Life Books, Alexandria, Virginia. 1996.
Web Sites
www.mayohealth.org
The Mayo Clinic’s Health Oasis website has an icon for Medicine. It leads you to news, a searchable drug guide, "Ask the Physician", reference articles, links to other sites, and more.
www.healthtouch.com
Healthtouch Online allows you to search for information on specific drugs. Information provided includes generic and brand names, dosages, side effects, and more. Individual drug companies are credited with information on specific drug pages.
www.virtualdrugstore.com
This site provides basic information use, side effects, and cautions on prescription and nonprescription drugs.
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Medications