Take Charge of Your Medication; 5 Guiding Principles

Today I have been given the wonderful opportunity of speaking about pharmacy with a group at one of our local retirement communities.  While preparing for this opportunity, I pondered quite a few different topics, such as Medicare D drug benefits, mail-order pharmacy, different disease states or possibly even just open ended questions and answers.  Finally, I came upon a topic I like to call Medication Responsibility.

I sat and took some notes about this topic and before long I had a list of items going that was far too long for a 40 minute discussion.  After a bit of thought about my audience, I narrowed this down to five particular different areas.  I realize that the term Medication Responsibility will mean something different for different people; however, these five topics are a good fit for this particular group of individuals living at this retirement community.

#1           Develop a working relationship with a Community Pharmacist.  I have a good story about a gentleman who endured a frustrating visit to the emergency room and another few days of extreme dizziness that may all very well have been avoided had he first called his Community Pharmacist with a question.  I realize that many people fill their prescriptions via a mail-order pharmacy.  When you have a question about your medications, are you able to phone that mail-order pharmacy and reach a pharmacist that you know and trust?  If the answer is yes, fantastic.   If the answer is no, then is the cost savings worth not having a Community Pharmacist available who knows your medication profile.

                Community Pharmacy is much more than just a place to fill your prescriptions.  When a Community Pharmacy is responsible for filling your prescriptions, the Pharmacist is available to you for questions whenever they are open for business.  The Pharmacist has your medication profile in front of them and can evaluate what you are currently taking and compare that with any type of medication or disease related question you may have.  This is a great service and should always be considered as a first option if you are feeling a little out of sorts and wonder if one of your medications may be causing you to feel this way.

#2           Medication Reconciliation.  This is a fancy phrase for having a complete list of your medications with you at all times.  Write up a list that includes all of your current prescription medications, over the counter medications, dietary supplements, and medication allergies.  Take this list with you to each visit you have with any health care provider and have them look at it.  Make certain that the list that they have matches your list.   This is a working list and will need to be updated or validated with each visit to your Doctor or Pharmacy. 

                This Medication Reconciliation process is especially important if you have had a recent visit to the hospital.  Quite often medications change when you have a short visit to the hospital and you need to be sure your list is complete and approved before heading home from your visit.

#3           Take Charge.  This is important and sometimes difficult to address.  Everyone needs to do this; however, in my experience it is quite often overlooked.  Pick someone, either a family member or a caregiver, and have a conversation with them about your medications.  You are picking someone who will agree to handle your medication for you when you are no longer able to handle them yourself.  This is a push to have you be an active participant in creating your plan, so that a plan is not created for you. 

#4           Medication Storage.  I encourage everyone to keep their medications in a safe, dry location such as your bedroom.  It is important to not keep your medications in the bathroom because the moisture may begin to deteriorate the integrity of the tablet or capsule.  More importantly, store your pain medications in a location that is not visible to visitors.  As incredulous as this may sound, it is not uncommon for a visitor to come into someone’s home and take a few pain medication tablets out of their prescription bottle when the owner is not looking.  Store your pain medications in your bedroom, out of visual sight from anyone who may be entering your room.  Storage in a dresser drawer or your closet works well.

#5           Medication Disposal.  How do I get rid of my medications when I don’t need them anymore?  Please, it is a good idea to get rid of any old medications.  Prescriptions that have been changed or eliminated do not need to be kept around the house just in case you might need them at a later date.  It is more likely that there may be a medication mis-adventure if these are kept in the house. 

                Please, do not give your expired medications to anyone else to take, especially if it is a prescription medication.   It is against federal law to share prescription medication.  An individual needs to be evaluated by a healthcare practitioner and prescribed a medication before they may legally take a prescription medication. 

                Do not flush your medications down the toilet.   Check with your local pharmacy or your waste management program to see if there is a medication take-back program available.
                If there is no medication take-back program available, then you may take the medications and put them in a container such as a zip lock bag. Mix in something unpalatable such as kitty litter or coffee grounds then add a little water to the mixture. Now, take the container and put it in a brown paper bag and put it in the garbage.

I realize that many people may have many more ideas of what Medication Responsibility means to them; however, if you are able to master these five topics, you are well on your way.


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Thyroxine (which we call T4), is a thyroid hormone which is secreted by the thyroid gland.  T4 is then converted to its stronger active metabolite, triiodothyronine (which we call T3).   The thyroid hormones bind to receptors and exert their metabolic effects, which include helping maintain normal growth & development, utilization of stored sugars, protein synthesis and metabolism. 

T3 hormone is approximately 4 times more potent than T4 hormone and the body does its best to maintain an appropriate balance circulating in your blood system at all times.  Maintaining an appropriate thyroid level is important for maintaing normal mental and physical function.  In children, maintaing a normal thyroid level is vital for mental and physical growth. 

Symptoms of low thyroid level may include a slow heartbeat, tiredness, muscle aches, weight gain, dry skin or sensitivity to cold.  If you experience any of these symptoms on a regular basis, please contact your doctor and let them know. 

Thyroid replacement hormone is used to treat an under active thyroid (hypothyroidism). This therapy will provide additional thyroid hormone if the thyroid is only partially working, or it will replace the thyroid hormone if they thyroid is completely shut down.  The thyroid may decrease in its function naturally over time, or it may become damaged through injury, certain medications, radiation therapy or certain types of disease conditions.

To learn about the medications used to treat hypothyroid disorders, pleasesupport AudibleRxTM by becoming a member, and then have full access to all of the Medication Specific Counseling SessionsTM.

  • Levothyroxine (synthetic T4) (Levothroid-TM, Levoxyl-TM, Synthroid-TM, others)
  • Liothyronine (synthetic T3) (Cytomel-TM)
  • Thyroid (natural thyroid from pigs) (Armour Thyroid-TM, Nature Throid-TM, others)


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XL, CD, LA, ER...Is there really a difference?

An interesting development has happened in the naming of medications over the past 15-20 years.  After a medication has been on the market for a few years, quite often, the manufacturer will have done some more research and developed a longer acting form of the same medication.  We like this.  Medication adherence is a HUGE issue and whenever we are able to offer a patient once daily dosing, rather than 2 or 3 or 4 times per day dosing, we are greatly increasing the chance for medication compliance.

Here is the issue.  There has been absolutely no standardization in the naming of these medications.  Acronyms are batted around like dented ping-pong balls, and they are not interchangeable.  This is difficult to explain without being too confusing; however, I am going to give it a try.

After the name of the medication, you may see any number of acronyms describing that this particular product is a longer acting product.  Some examples may be as follows: 

·         XL (extra-long?)
·         CD (controlled delivery)
·         LA (long acting)
·         ER (extended release)
·         XT (extra time?)
·         SR (sustained release)
·         SA (sustained action)
·         DR (delayed release)
·         EC (enteric coated)
·         TR (time release)
·         HS (bed time dosing)
·         PM (bed time dosing)
·         CC (continuous control?)
·         XR (extra release?)
·         CR (controlled release)

The point is, there are numerous acronyms, and zero standardization.  Each acronym is considered part of the name of the product and is specific for the product it is designated to.  In other words, there is no set definition for any of the above acronyms and how they apply to the medication they are associated with.

To confuse matters more, there are a few medications that have two different forms of acronyms.  For example, one product has an EC which is a twice daily dosing product and an ER which is a once daily dosing.  Another product has an SR version which is twice daily dosing while it also has an XL version which is once daily dosing.

These acronyms pose as special problem for pharmacists when filling prescriptions.  Not only are we evaluating the entire patient profile to make sure the medication is appropriate for the current situation, we also need to assure that the dosing parameters associated with the particular medication are appropriate for the acronym designation.

Please, if you take any medication that has some sort of long acting or extended release acronym associated with it, take a moment to discuss with your pharmacist exactly what this means.

You may also be interested in reading:

Medication Responsibility
My Pills Look Different


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Who's In Charge Here?

So, the other day in the pharmacy, a patient called me on the phone to ask if her refill was ready to pick up.  She had called in the day before and used our automated refill line to request a refill of her cholesterol medication.  An electronic request had been sent automatically to her prescriber because there were no refills remaining on the prescription.  When I looked at the prescription in the computer I informed her that no, the doctor’s office had not yet called back and her prescription was not yet ready.

After a few moments of back and forth conversation, we identified that this particular medication had been prescribed to her when she was discharged from the hospital last month.  The prescriber was the “hospitalist of the day” and only practices in the hospital.  I looked at her chart and found who her primary physician is and let her know I would send the request off to this doctor. 

She then let me know that because of her insurance she had to recently change HMO’s and now she is with a different medical group.  She has the name of her new primary care physician; however, she has yet to be seen by her new doctor. 

This information changes the game.  I explain that I will print out a request for the refill of the medication.  I will then write a note to the new physician, explaining the situation, and fax the request to the new doctor.  I also discuss with the patient that it would be a great idea for her to call her new doctor’s office and leave a message with the medical assistant explaining the situation.

I have noticed from the patients profile that it has been 32 days since we have filled the prescription.  Before we end the conversation, I ask her if she has any of her medication left.  She says that she took her last dose two days ago and didn’t take any yesterday.  Because this is a maintenance medication and I don’t want her to go without, I ask that she stop by the pharmacy with her empty bottle and I will give her 72 hours’ worth of the medication, to hold her over until the doctor gets back with us.

In this situation, if the doctor does not get back with us within 2 days I will be on the phone calling the office to see what is going on.  We in the pharmacy certainly may not refill the prescription without the physician’s approval; however, it is perfectly reasonable for a pharmacist to provide the patient with three days of maintenance medication while we are waiting, assuming it all appears clinically appropriate and we document all that we have done.

When you call your pharmacy for a refill, please press the button to speak to someone in the pharmacy, rather than using the automated system, if you have recently changed doctors.  Time will be saved if the pharmacy can send a refill request to the correct doctor on the first try. 

This, my friends, is an example of what can be done in a community pharmacy.  Like I have said many times, take the time to develop a relationship with a community pharmacist so that you have someone to go to when you have questions about your medications.  Regularly we get patients who come in who have not yet received their medication from their mail-order pharmacy and they are out of their medication.  We will gladly work with them and do what we can; however, if we have not been filling their prescriptions on a regular schedule, we cannot forward them some until we hear back from the doctor.

You may also be interested in reading:


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My Heart Beats For You

So, the other day I was at the counter talking with a patient about their new blood pressure medication.  As we were talking, the patient asked me a question that I had not had before, “If this is a calcium channel blocker, will I need to change the amount of calcium I take in my diet?”  I explained that in all of the years of counseling patients, I had never been asked that question. 

No, the amount of calcium you ingest does not necessarily change how a calcium channel blocker medication works.  Calcium channel blockers work by decreasing the influx of calcium ions into vascular smooth muscle during contraction.  This process effectively relaxes this type of muscle. 

Relaxation of vascular smooth muscle allows for an opening up of the blood vessels which decreases blood pressure.  Relaxation of coronary (heart) vascular smooth muscle helps dilate (open up) the blood vessels in the heart and deliver more oxygen to the heart cells.  Oxygenation of the heart helps treat angina (chest pain).   This relaxation also slows down the rate at which the heart beats.   

By doing this, the resistance that the heart needs to pump against is decreased, heart rate is decreased, and the heart does not need to work as hard to pump blood.

To listen to a Medication Specific Counseling SessionTM on any of the following Calcium Channel Blockers, please registerto become a member of AudibleRxTM and then have full access to all of the counseling sessions for a full five years. 

  • Amlodipine (Norvasc-TM)
  • Diltiazem ER (Cardizem CD-TM, Dilacor XR-TM, Taztia XT-TM and others)
  • Felodipine (Plendil-TM)
  • Isradipine (Dynacirc CR-TM)
  • Nifedipine ER (Procardia XL-TM, Adalat CC-TM, and others)
  • Nisoldipine (Sular-TM)
  • Verapamil SR (Calan SR-TM, Isoptin SR-TM, and others)

You may also be interested in reading one of the following blogs about blood pressure, your heart and circulation.


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I Have A Cold

A colleague that I work with shared a story with me the other day that is definitely worth repeating.  Now and again this gentleman goes out to dinner with a group of friends.  This particular evening, he said that he walked up to one of his acquaintances at the dinner and put out his hand for a welcoming hand shake.  He was then impressed when the gentleman folded his arms, refusing the handshake, and informed my friend that he has a cold. 

My colleague watched, inconspicuously, throughout the night.  This gentleman with a cold was consistent the entire night about not touching anyone or getting too close to anyone.  He did not reach for the bread or butter and did all he could not to touch any communal cutlery.  This gentleman was being as conscientious as he was able to help prevent transmission of his cold to any unsuspecting neighbor.

I am truly impressed when someone goes to great lengths to help protect their neighbor.  My only concern here is did he do enough to prevent the spread of his cold virus?

The only way to get a cold is to get the virus from someone giving it to you directly (i.e. touching you or sneezing/coughing in your direction), or, putting the virus on something that you touch.  Generally, the most common way to catch a cold is from someone who sneezes or coughs in their hand and then touches you with that same hand. 

The gentleman who was doing his best to help prevent transmission of his cold may not have been doing enough.  It is possible for cold virus to live on many surfaces such as door knobs, chairs, table cloths, forks and wine glasses for several hours.

Other individuals may have been infected when they moved the chairs, cleaned the table, walked out the door, used the sink in the bathroom, or flushed the toilet.    Of course, we run into this every single day of our life as we go to work and use phones, computers, cafeterias, restrooms, elevators and all of the other public space our life is made up of.

The following two paragraphs come directly from this web page:

“Hand washing is an essential and highly effective way to prevent the spread of infection. Hands should be wet with water and plain soap, and rubbed together for 15 to 30 seconds. Special attention should be paid to the fingernails, between the fingers, and the wrists. Hands should be rinsed thoroughly, and dried with a single use towel.”

“Alcohol-based hand rubs are a good alternative for disinfecting hands if a sink is not available. Hand rubs should be spread over the entire surface of hands, fingers, and wrists until dry, and may be used several times. These rubs can be used repeatedly without skin irritation or loss of effectiveness. Hand rubs are available as a liquid or wipe in small, portable sizes that are easy to carry in a pocket or handbag. When a sink is available, visibly soiled hands should be washed with soap and water.”

So, please, this cold and flu season, if you have a cold, do all you can to keep from passing it on to someone else.  If you are in a public space and touch anything, wash your hands with soap and water or use an alcohol-based hand cleanser as soon as possible.

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Have you ever logged onto a website looking for some information, and then spent the first 60 seconds looking at the web page just trying to figure out what to read?  Advertisements on the right, left, top and all through the middle.  What the heck!?!?  Where is the information I was looking for when I arrived at this web page?

When someone sells space on their website for someone else to advertise, they are making money from them and are definitely affiliated with them.  Also, when and individual sells product for a company, they are much more likely to recommend their product over their competitors.  That’s how business affiliation works.

As I state on the front page of www.AudibleRx.com

AudibleRxTM is not affiliated with any drug manufacturer and offers no advertising. Every effort is made to keep the recordings provided by AudibleRxTM completely objective and unbiased.

I am a pharmacist who is attempting to fill a need.   I do not sell advertising on my website.  I do not have a drug manufacturer or institution of some kind paying me to put this program together.  I take one category of drugs at a time, research the pharmacy reference materials, script out a counseling session, record it, then post it to the member area of the AudibleRxTM website.    Please follow this link for a complete description of how I put together a Medication Specific Counseling SessionTM.

Prescription counseling is a necessary part of a patient’s health care.  Individuals need to understand why they are taking their medications and how to take their medications if they are to achieve their best possible outcome.   The Medication Specific Counseling SessionsTM offered through AudibleRxTM will help and individual realize what they do and don’t know about their medications so they will be equipped to take educated questions back to their own doctor or pharmacist. 


TERMS OF USE: These recordings are meant to supplement your knowledge and understanding of your medications and are not a replacement for counseling with your pharmacist or doctor. AudibleRx maintains no liability for your medication education, understanding or usage. This information does not allow you to take a prescription medication that was not prescribed for you. AudibleRx has performed extensive review of each topic to assure the information provided is current and relevant; however, AudibleRx maintains no liability for and can not guarantee the accuracy of the information provided in the recording sessions. Talk with your pharmacist or doctor before taking your medication and if you have any questions regarding your medication. All information provided "as-is" and with no express or implied warranties, including warranties directed to accuracy, non-infringement of any proprietary rights or a third part or fitness for a particular purpose.

PERSONAL USE ONLY: AudibleRx is for personal use only and is not to be used for patient educational training programs without first obtaining licensing rights. 

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