side effects

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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Over-the-counter NSAID pain medicines – how safe are they?

Posted on by Michelle Fritsch, Pharm.D.

Slide1Some people think medicines that are available over-the-counter are always safe.   I don’t want you to be one of those people. Ibuprofen and naproxen are a class of medicines called nonsteroidal anti-inflammatory drugs (NSAIDs). They can treat pain, inflammation (swelling and redness), and fever. Hundreds of million of Americans take them every year. You probably have some in your home right now.

The NSAIDs that you can buy without a prescription are ibuprofen (brand names Motrin, Advil) and naproxen sodium (brand name Aleve). They are part of a class of over 20 medications that are available by prescription.

5 IMPORTANT THINGS about NSAIDs

There are five important things I want to make sure you know about these medicines:

  1. They do work to treat mild to moderate pain, fever, and inflammation. They all work the same way. No measurable difference between them in how they work has been found. So one is not better than another.
  2. They irritate your stomach lining. If you already have reflux, gastroesophageal reflux disease (GERD), ulcers, or have ever had a stomach bleed, please tell your doctor. Whether or not you already have stomach problems, always TAKE NSAIDs WITH FOOD.
  3. They cause you to retain extra fluid. This can raise your blood pressure. It can also make heart failure worse and increase your risk for a heart attack if you have heart problems. Talk with your doctor if you have high blood pressure or heart problems BEFORE you take an NSAID.
  4. They can worsen kidney function. If you already have diminished kidney function, talk with your doctor before you take an NSAID.
  5. They make your platelets less sticky. This lowers your chance of have a clot. But, NSAIDs do this for a limited time. ASPIRIN can make your platelets less sticky for the entire life of the platelet. That is why aspirin, usually 81mg baby aspirin, is used to help prevent a clot that leads to a heart attack or stroke.

I always buy the generic version. It will save you some money and give you the very same effect.

If you have pain or fever, there is an option that does not have the stomach, heart, or kidney issues. That option is acetaminophen (brand name Tylenol). For pain that does not include inflammation (redness, swelling), acetaminophen controls the pain similarly to the NSAID.

The problem you do have to watch with acetaminophen is it can hurt your liver. The most you should take in a day is 4 grams (2 extra strength tablets four times daily). The Food and Drug Administration might even recommend that you not take more than 3 grams per day soon. Also, if you drink alcohol more than 2 drinks per day or have any liver condition, then acetaminophen might not be your best choice. Please talk to your doctor before you take it if you have liver issues or drink more than 2 drinks per day.

For more information about safe pain medicine options, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Many people think that any medication you can buy on your own, without a prescription must be safe. I hope you now realize this isn’t always true. In some patients, with some other conditions, a relatively safe medication can be downright dangerous.

So, how do we know what is true? On what can we truly rely?

“Voice of Truth” by Casting Crowns took on a whole new meaning for me this week. I love this song. I have heard it countless times. On this particular day, when it came on the radio I wasn’t even listening very intently.

Then, the words, ‘this is for my glory’ hit me suddenly in a whole new, EXTREMELY POWERFUL way. I have been working through a large, unexpected life transition over the past couple of years. It is not a bad situation. It is just a very big transition leading down a path I can’t really see yet. The whole experience has been and continues to be a real faith walk. I often pray for guidance, help with decision-making, and peace while waiting.

Then, out of the blue, I hear the lyrics, “The voice of truth says, “This is for My glory”. It hit me; none of this is even about me. If I could be in the future looking back, I would be telling myself to “stop it, be quiet, just wait and see, God is doing something here.” It’s not about me at all. It’s all about God working through this situation for HIS glory.

I felt a wave of peace, a wave of admonition, and a lot of emotion. I fluctuated between laughing and crying.

I just love such spontaneous GOD moments!

Proverbs 16:9 ESV

The heart of man plans his way, but the Lord establishes his steps.

Acts 18:9 ESV

And the Lord said to Paul one night in a vision, “Do not be afraid, but go on speaking and do not be silent,

Listen to the ‘voice of truth’ and wait to see what He is cooking up that is for His glory in your life.

Blessings,

Michelle

 

Know before you decide

Posted on by Michelle Fritsch, Pharm.D.

What is a tmedication-sliderhorough medication evaluation? Would you benefit from one? Don’t other people already
evaluate your medications on a regular basis? Do you worry about hurting someone’s feelings if there is a difference of opinion about your medication regimen?

You likely have several different healthcare providers – your primary care doctor, any nurse practitioners or physician assistants in that office, your specialist doctor(s), your local pharmacist, and maybe a chiropractor, physical therapist dietician, and others. Surely between all of them someone is providing you with a very thorough evaluation of your medications?

Do you take anything for a cold? Or a stomachache? Or to help you sleep? Or for pain?

Do you tell your healthcare providers about these things you take only once in awhile?

Do you take vitamins or supplements or herbal therapies that you select for yourself? Do you tell your healthcare providers about these?

Do you always take your medications at the same time every day? What do you do when you forget to take them? Do you take some of them only when you feel like you need them? Have you ever stopped taking a medication without telling your providers?

A thorough medication evaluation will cover all of these things. Our research has shown that in 98% of visits there is at least one thing that you didn’t know about your medication that you really should know.

As a clinical pharmacist, I am looking at all of your prescribed medications and other substances you take to assure none of these nine problems exist:

  • Each dose is not too high (You have more side effects than needed or even have toxicity.)
  • Each dose is not too low (You take it but it doesn’t work for you.)
  • All conditions that should be treated with a medication are being treated with the best medication(s) based on current medical studies.
  • Each medication you take is actually necessary. (Sometimes there are medications that have been on your list for a long time but no one remembers why.)
  • No medications interact with each other making your health worse. Also, your diet and supplements don’t interact with your other medications or each other.
  • You are able to obtain and take each prescribed medication. (Sometimes pills are too big, inhalers are hard to use, eye drops are hard to get into the eye, or medications are too expensive or not covered by insurance.)
  • None of your medications for one condition make another condition worse.
  • You are able to safely take all of your medications. Allergies and medication intolerances will be reviewed and clarified for your healthcare team.
  • You are taking each medication at the optimal time in relation to food, other medications, and potential side effects.

Clinical pharmacists have extensive training specific to all aspects of medications and how they work., more than any other health professional. Often, having a clinical pharmacist working with the rest of your providers will further assure that all of your medication use is necessary, safe, and effective.

For more information about a thorough medication assessment, contact www.medsmash.com.

Biblical Application

Just like medication intended for good can sometimes actually cause harm, are there elements of our spiritual lives that can be more harmful than good?

There are many interpretations of the content of the Bible. There are many preachers and teachers and blogs and radio programs and television programs and articles written.

Are they all true and accurate?

How do you determine what to believe and what to implement in your life?

Jesus, Paul, John, and others warned us about false teachers and the importance of discernment. Well, that sounds good, but how do you actually do it?

First, here is what the Bible says.

1 John 4:1 (MSG)

My dear friends, don’t believe everything you hear. Carefully weigh and examine what people tell you. Not everyone who talks about God comes from God. There are a lot of lying preachers loose in the world.

John 7:24 ESV

Do not judge by appearances, but judge with right judgment.

Proverbs 2:1-5 ESV

My son, if you receive my words and treasure up my commandments with you, making your ear attentive to wisdom and inclining your heart to understanding; yes, if you call out for insight and raise your voice for understanding, if you seek it like silver and search for it as for hidden treasures, then you will understand the fear of the Lord and find the knowledge of God.

Discernment might sound difficult or only for those with advanced theological training, but the Bible encourages us to pray about it. When you hear or read something that you’re not sure about, pray and ask God to guide you. Jesus says that the Holy Spirit is with us at all times.

Matthew 28:20 ESV

Teaching them to observe all that I have commanded you. And behold, I am with you always, to the end of the age.

Joshua 1:9 ESV

Have I not commanded you? Be strong and courageous. Do not be frightened, and do not be dismayed, for the Lord your God is with you wherever you go.

(And there are several more such verses throughout the Old and New Testament).

Let God lead you with discernment and love.

Blessings,

Michelle