medications

Perspective

Wrong Assumptions lead to Bad Medicine

Posted on by Michelle Fritsch, Pharm.D.
Perspective
Avoid wrong assumptions that lead to incorrect actions.

When was the last time you made and acted on wrong assumptions? It is so easy to do. You see something from your perspective and your mind fills in the details of the who, what, when, how, and why. It’s often long after you have acted that you are provided with a different perspective that makes the entire situation look different.

A quick, fun example is in this picture. Another proof that I am a geek. I get such a kick out of these pictures.  If I believed my eyes I might run in to help the poor guy being lifted into the air.

This happens in healthcare, too. Keep in mind, the provider that is making decisions in the emergency department or the hospital usually knows VERY LITTLE about you. Any information you or a loved one or friend can give is all they have at first.

One day, hopefully soon, these providers will be able to access your medical records and make much more informed decisions. Right now, your doctor has to be contacted then the information sent to the hospital. If it is the weekend or an evening, that can take hours to days. The information then needs to get to your hospital provider from the fax machine or the electronic messaging system. Even then, there might be important information about you that is not even in your doctor’s record.

This leaves those of us making decisions about your care to rely heavily on what we see right now.

I have seen SEVERAL examples in the last few weeks of an older adult reaching medical care confused. The quick wrong assumption has been that the person has dementia. When confused, behaviors often change. A confused person can yell, pull at catheters and IV’s, try to get out of bed, and generally not cooperate. Since the assumption has already been made that dementia is the cause, calming medications are given. These then assure further confusion (but calmer) and make it very hard for the person to get to a point of no confusion.

What can you do to prevent wrong assumptions?

  1. Carry in your wallet a list of your:
    1. Allergies
    2. Medications
    3. Diagnoses
    4. Emergency contact information – name, phone number(s)
  2. If you are accompanying someone to the hospital who is newly confused, explain this to the medical team. Help them understand what this person was like before this event. They need to know the ‘baseline’. If this person was living independently, driving, managing their finances the team needs to know that. If this person was unable to do those things and was getting frequently confused at home, the team needs to know that.
  3. Share any known history about the current event. If you have been feeling worse and worse for the past three days, make sure they know that. If you have been having pain, explain that including what it feels like, how often you feel it, what makes it better or worse.
  4. If you have been taking different medications for the past few days, make sure they know that. This often happens when we are in pain or have a cold. We take over-the-counter medications or left-over medications from prior prescriptions. These can cause confusion when mixed with our normal medication regimen.

Speak Up

Again, I have seen several instances in the past few weeks where assumptions are made when someone gets to the emergency department or hospital that make a situation worse.

  • In one instance the person’s confusion started as soon as a particular medicine was given. The family member noted that but didn’t speak up. Then medications were added to treat the confused behaviors. We are still trying to taper off of those medications and get this person independent again.
  • In another instance, the person had a urinary tract infection. These are famous for making older adults confused. But since no one was there to explain how odd this confusion was for this person, the team assumed this was normal and didn’t find the infection for a while.   By then, a couple of medications had been added to treat the confused behaviors. It will take us weeks to taper her back off of these medications.
  • In a third instance, the collection of pain medications given after a surgery left the person sleeping most of the day and unable to think clearly. The spouse was dutifully giving the prescribed medicines around the clock. The wrong assumption made here was that this very healthy person over 60 could handle these medications like someone in their 30’s.
  • One more instance involved using a medication to treat the side effect of another medication. The second medication (the one used to treat the side effect) is on a list of medicines to avoid in people over 60. Rather than treat the side effect, it made the person nearly unresponsive. In this case, as in several of the others, rather than treat the underlying issue, wrong assumptions were made and actions were taken to treat the symptoms without understanding the back story.

Why ‘Bad Medicine’

Just a side disclaimer. When I was contemplating this blog I saw it as a chance to use the terms, ‘Bad Medicine’. I am a big Bon Jovi fan. I am also a pharmacist. So, I have to admit I love the song, ‘Bad Medicine’.

For more information about how to protect yourself from wrong assumptions leading to bad medicine, contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

I can think of a lot of bad assumptions leading to bad decisions in the Bible. One of the first is Eve’s decision to eat the apple. The Israelites made bad assumptions continuously. A few that come to mind are thinking slavery would be better than ‘suffering’ in the desert; people in lands they were to conquer were too mighty to overcome; Moses was not going to return so a golden calf was needed. The list goes on.

So, how often do you make bad assumptions? I suggest we all do it every day. We don’t act on all of them. I don’t think we realize most of them.

I am consulting right now in a place that serves a highly diverse and unique population of people. Assumptions about gender, culture, religion, socioeconomic status, or just about anything will quickly lead you down an incorrect path. It has been an adventure of constant striving to avoid any assumptions.

These verses are good ones for me to remember each day:

Proverbs 18:2 ESV

A fool takes no pleasure in understanding, but only in expressing his opinion.

Matthew 7:1 ESV

“Judge not, that you be not judged.

Proverbs 25:8 ESV

Do not hastily bring into court, for what will you do in the end, when your neighbor puts you to shame?

Bad assumptions and temptations to act on them are one more test.

As I understand the Word, truth trumps all of the assumptions. Love trumps all of the wrong actions.

1 Corinthians 13:6 ESV

It (love) does not rejoice at wrongdoing, but rejoices with the truth.

1 Corinthians 13:7 ESV

Love bears all things, believes all things, hopes all things, endures all things.

The laws in Deuteronomy give us good advice even here in 2016.

Deuteronomy 17:13 ESV

And all the people shall hear and fear and not act presumptuously again.

I encourage you (and me) to guard against assumptions and focus on truth and love.

Blessings,

Michelle

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Appropriate medications – same at 30, 60, and 90?

Posted on by Michelle Fritsch, Pharm.D.
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Appropriate medications over age 60

Should the same medications and doses be prescribed for all ages? No! However, we find that often they are.   If a medication was a good choice for you at 30, is it still a good choice at 60 or 90? Not necessarily. So, why does age matter?  How do you know that you are taking all appropriate medications?

What changes as we age?

Even if you eat right, exercise regularly, and make good choices about alcohol and tobacco, changes occur over time.

  • Kidney function starts a very gradual decline in your late 30’s or early 40’s.
  • Liver size and blood flow to your liver diminish. The number of cells shrinks. There is less activity of the enzymes that break down medications.
  • Food and medications move through the intestine more slowly.
  • The volume of urine that the bladder can hold decreases. Bladder muscles weaken.
  • For men, the prostate gland increases in size.
  • For women, the urethra shortens and comes thinner. So, risk of urinary tract infection goes up.
  • Muscles weaken as growth hormone levels decline.
  • Aldosterone levels decrease, so risk of dehydration goes up.
  • The immune system slows down. So, risk of infection and cancer go up. Also, it can take longer to treat an infection.
  • Heart muscle and blood vessels get stiffer. This can increase risk of high blood pressure. Also, with exercise, the heart can’t pump as much blood or speed up as much as it did at younger ages. So, exercise capacity is lower.
  • The muscles involved in breathing weaken. There is a decline in the number of small sacs in the lungs where oxygen is passed to the blood.
  • The amount of water in the body goes down while the body fat goes up.

This list is not meant to depress anyone. These are just some of the very natural changes that occur in all of us. So with all of this change, the need for medication, the types of medications that are needed, and the doses of medications are all different.

Nearly all medications leave the body through the urine or the stool. Most medications are changed as they pass through the liver. There are enzymes in the liver that break down those medications. When the kidneys and liver become less functional, it takes longer to get the medications back out of your body. This means a single dose can last longer or have a bigger impact.

Most medications have a preference for water (hydrophilic) or fat (lipophilic). Since body water and fat both change, medication concentrations also change.

Guidelines for taking appropriate medications

There are so many changes to manage that guidelines have been written to try to decrease some of the more common mistakes that are made. These are oriented to people over age 65. The Beer’s List was first developed by a group of doctors in 1991. It has since been updated many times. It contains a list of medications not to use and another list to use with special precautions. There is also a guideline called STOPP that lists medications to avoid in adults over 65. For both guidelines, there are safe options to use in place of the medications on the lists.

If you are 60+, is there a specialist in medication use for people of your age monitoring your medication use? Can you really afford to avoid this review? We have found there is some issue to address 98% of the time we provide an assessment. For your personal assessment, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Medications change as you age. And so do so many other things. Many of these changes are wonderful! You benefit from the many lessons you’ve learned through your life so far. You are able to share those experiences, insights, and lessons with others. You probably sweat the small stuff less. You also tend to enjoy the little things more.

I heard a message today that really captured my attention. A picture was painted about grace and faith and their relationship.

As stated by John Stott, ‘Faith’s exclusive function is humbly to receive what grace offers. Grace gives and faith takes’.

Grace is offered to you on a constant basis. But, it has been my experience, it takes time and lessons learned to really develop faith so that grace can be received. Faith tends to grow with time and experience.

Ephesians 2:8 ESV

For by grace you have been saved through faith. And this is not your own doing; it is the gift of God,

Hebrews 11:1 ESV

Now faith is the assurance of things hoped for, the conviction of things not seen.

Romans 10:17 ESV

So faith comes from hearing, and hearing through the word of Christ.

Salvation by grace is a gift. Faith is how you receive that gift.

Ponder this great news this week!

Blessings,

Michelle

New Year’s Resolution, Take Only In-Date Medications

Posted on by Michelle Fritsch, Pharm.D.
Old medicine bottles
Take in-date medications

The new year is upon us. I hope your 2015 has been full of happy memories and joyous occasions. Now, as we move on to 2016, I have a New Year’s challenge for you. I challenge you to take only in-date medications.

WHY In-Date Medications?

Sometimes we think expiration dates are just there to make us keep buying new medicine. But, in reality, there are TWO big reasons expiration dates are important. Extensive research is done when medications are created to determine for how long they are effective and safe. This date, when either changes, is the expiration date.

Past this date the medicine will not work as well. If you take a medicine to control your blood sugar that is expired, it might not lower your blood sugar as much. If you take an expired medicine for pain, your pain might not go away.

The other risk is a safety risk. Chemicals change over time. Have you ever opened an outdated bottle of aspirin? It smells like vinegar. That is because it changes into new chemicals over time, one of which is vinegar. Other medicines change into chemicals that can be extremely dangerous.

It is not worth the risk.

HOW

Go through ALL of the medications in your house, cars, purse, etc. Check the expiration date on each one. If it is expired, put it in your discard pile. (But don’t throw it in the trash just yet, there are two more steps).

Next remove all labels that contain information about you or your family. Shred or cut up the label. If you can’t get the label off, scratch out your name and prescription number at least. This is one of many forms of possible identity theft.

Now comes the tricky part. What do you do with all of these medications? There is not an easy answer. In order of ‘best options’, dispose of them in one of these ways:

  1. Take them to a ‘Medication Take-Back’ event sponsored by the Drug Enforcement Agency. Or call the DEA’s Registration Call Center at 1-800-882-9539
  2. Talk with your local pharmacist to see if you pharmacy can dispose of medication. Or, your pharmacist should know who in your community does dispose of medication, if there is a source.
  3. Dump them out of their bottles and put with kitty litter, coffee grounds, or something else that you can’t eat. Then, seal the container and put it UNMARKED in a garbage bag and out with the garbage.
    1. DO NOT flush the medication or put it down the drain. This leads to it reaching the water supply. This used to be encouraged, and now many medicines/hormones/chemicals have been found in the water supply.
    2. Ultimately, putting them in the trash can lead to them being in the water supply as the trash breaks down and leaches into the ground.
    3. This is why an official ‘take-back’ event is the safest option.

REPLACE

As you are sorting out your expired medicines, keep a list of those you use so you can replace them. If it is a prescription medicine, your can see on the label if there are refills remaining. Note, for non-controlled medicines, there are usually available for up to a year. For controlled medicines, the time might be shorter. If you are beyond that time, and you still need the medicine, call your physician to inquire about another prescription.

As you are replacing medicine, over-the-counter medicine, vitamins, and supplements, know that generic versions are just as good as brand. I purchase generic for my family. They have been carefully tested and regulated by the Food and Drug Administration to assure they contain the same key ingredients and work the same.

Here at the end of the year, if you have a health-savings account, check the rules to see if you can use that to replace your expired medicines.

This is an important step in your New-Year’s fresh start. It is important for your safety and the safety of your family.

Happy New Year!

For more information about expired medication and proper disposal, contact us at www.medsmash.com.

BIBLICAL APPLICATION

We are entering a new year. It can be a time to think of fresh starts and hope for the future. It is a great time to reflect on how your life has been changed through your faith.

At the moment we give our life to Christ, we know that our old self is gone. We now live a NEW life in Christ.

Ephesians 4:22-24

To put off your old self, which belongs to your former manner of life and is corrupt through deceitful desires, and to be renewed in the spirit of your minds, and to put on the new self, created after the likeness of God in true righteousness and holiness.

Philippians 3:13-14 ESV

Brothers, I do not consider that I have made it my own. But one thing I do: forgetting what lies behind and straining forward to what lies ahead, I press on toward the goal for the prize of the upward call of God in Christ Jesus.

2 Corinthians 5:17 ESV

Therefore, if anyone is in Christ, he is a new creation. The old has passed away; behold, the new has come.

Philippians 3:13-14 ESV

Brothers, I do not consider that I have made it my own. But one thing I do: forgetting what lies behind and straining forward to what lies ahead, I press on toward the goal for the prize of the upward call of God in Christ Jesus.

Galatians 2:20 ESV

I have been crucified with Christ. It is no longer I who live, but Christ who lives in me. And the life I now live in the flesh I live by faith in the Son of God, who loved me and gave himself for me.

What a refreshing reminder! Bask in the glow of your new life in Christ as you enter this new year.

I challenge you to take a challenge I FINALLY took in 2015. Read the Bible from cover to cover. I have read my Bible, participated in Bible studies, had several Bible-based lessons, but I had never actually read it start to finish. It has been so enlightening! So many things make more sense. And I hear from those who have done this several times, the insights are new and different each time.

I am praying you will be richly blessed in 2016,

Michelle

 

Image Source:  National Library of Medicine; National Institutes of Health; U.S. Department of Health and Human Services