The Medical Minute: Talk About Prescriptions 2010

By John Messmer

We’re living longer than previous generations. As we advance in years, there’s a good chance we will develop some sort of chronic condition: high blood pressure, high cholesterol, arthritis, heart disease, cancer for example. Very often, chronic medical problems require one or more prescription medications. Sometimes several different physicians and other health care providers are involved in prescribing treatments.

Then there are over-the-counter medications and supplements. Often people use over-the-counter products to avoid prescription medications or in an attempt to improve or maintain one or more of our body’s functions. All natural or not, they are drugs, just like the medications your doctor prescribes.

What about foods? Just to complicate matters even more, many foods and beverages interact with medications. For example, grapefruit, apple and cranberry juices can affect the metabolism of certain medications, increasing or decreasing the effect, depending on the drug.

Because it’s so complex, each person must play a part in his or her medication management. Everyone should have a primary care physician (PCP) — a family physician, internist or pediatrician — to be the “captain” of the health care team. Your pharmacist can help you understand how to take medications and how they interact, but it is your physician who has your complete medical history and who can put the various drugs and their effects into perspective.

Everyone should carry a complete list of all prescribed and over-the-counter medications they take, even occasionally, plus any herbal product or nutritional supplement they take. The list should state when it is taken and for what reason and should include the brand and generic names. For those who are visually impaired or have low literacy skills, fastening one of the pills or a picture of it on the list next to the name can help to identify which medication is which.

The next part is most important: Any time there is a change — by the primary care physician, a specialist or after surgery or discharge from the hospital — the medication list must be reconciled. Your primary physician should review the list for appropriateness, possible interactions, correct dosage, and therapeutic duplication and can help you understand whether each product can be taken with food and the likelihood of side effects.

Learn the medication names and what they are supposed to do. When new drugs are prescribed, ask why this particular medication is being used and how to know if it’s working. Should it be continued or stopped at some point? Should any monitoring blood tests be performed and how often? If a dose is missed, should it be made up? Can it or should it be taken with food?

Compare your bottles to your list to check for errors. If your physician handwrites a prescription, can you read it? Many drug names look similar; if you can’t read it there’s a chance your pharmacist may misunderstand it, too. Many physicians use e-prescribing now. Legibility is an obvious advantage, but many e-prescribing programs help the physician to check for interactions and may be able to provide an up-to-date list for you to take home.

Prescribing and using medications is more complex than ever. While there are great benefits from modern medicine, the risks are also more pronounced than ever. Be an active participant in your health, and talk about your medications each visit to your physician or other health care provider.

John Messmer is associate professor of family and community medicine at Penn State College of Medicine and a staff physician at Penn State Hershey Medical Center.

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