Feel the Tablet (medication misadventure)

About a year after I graduated pharmacy school, I settled into a very nice hospital pharmacy position in a small community hospital in a mountain town in Northern California.  I am the youngest of eight children, and since I was now officially out of the big house, Mom and Dad felt it time that they sell and move into a more comfortable small house environment.  Mom thought they would travel the state, visiting their children, and find a small house near one of them. 

The first town they visited was the small town in Northern California that my wife and I lived in.  Wouldn’t you know, after a couple of days in our town, Mom had found this cute little house that was no more than 30 feet away from the local Catholic Church, just around the corner from the grocery store, and one block away from the hospital that I worked at.

Over the years of having eight children, Mom had been through quite a few surgeries, including C-sections, gall bladder, heart valve replacement (twice) and a few others I am sure.  When an individual is opened up this much, we are all now aware that the normal fluid that keeps the bowel lubricated begins to deteriorate.  The bowels begin to stick together which leads to adhesions.  

My point here is not to discuss my mother’s medical history, rather, express the point that she was in the position to receive quite a bit of medical care.  Needless to say, the medical and nursing staff at the hospital that I was working at became quite familiar with my mother.  Of course, they also became quite familiar with Dad, being that he was at her side every step of the way.

At the time, I felt like I had gone to pharmacy school specifically to be in a position where I was able to help my Mom with her medications.  At least once weekly, and sometimes daily, I would be at her house helping her set up her medications.  We had a pill box that she would use for the scheduled medications and then the “as needed” medications would be set in a row and she would take them when necessary. 

Mom was pretty darn hip and with it.  She understood her medications, what they did, why she was taking them and I never noticed her express the slightest bit of confusion or frustration with regards to her medication profile.   Because of the adhesions that Mom had developed, she eventually had some of her bowel cut out and had an exterior drainage bag placed.  After a couple months, the surgeon was able to go back in and reconnect her bowels.  This was great; however, she had constant diarrhea and a very difficult time absorbing nutrients.

One of the medications that Mom took to help the diarrhea was called Lomotil.  This medication decreases the propulsion through the GI tract and can quite significantly slow diarrhea.  One morning this was a particular issue.  Mom had taken a Lomotil tablet every 2 or 3 hours throughout the morning and afternoon.  By evening, the diarrhea had not decreased, and she was getting very short of breath and gurgling in her chest.

Here’s the deal, Mom was so familiar with how her tablets felt, she was sure she was taking the correct medication.  The bottles were the same size and the tablets felt similar.  She had not been looking at the label.  Mom had been taking her Digoxin tablets all morning and afternoon.  This overdose significantly decreased her heart function and allowed for a backup of fluid.  Mom was quite weak already, so this didn’t help matters much.  She was admitted to the hospital and stabilized, came home and passed a couple days later comfortably in her own bed.

One would think that a mother of a pharmacist, who was as mentally sharp as they come, would not need to worry about taking the wrong medication. 

It is difficult to imagine how an elderly patient, living on their own, who is prone to slight confusion, can manage their medications without some help. Medication misadventures happen.  We need to be vigilant and have a plan to help prevent these situations. 

Become familiar with using a 7-Day pill box for your maintenance medications.  This will help you assure that you take your maintenance medications on a regular basis.  Please leave your “as needed” medications in their original container so that they remain labeled and are easy to identify. 

Unfortunately, with generic medications, tablet colors and shapes change on a regular basis.  You cannot rely on what the tablet looks like or feels like.  If the appearance ever changes on one of your medications, please call your pharmacy to check to see if you have the correct medication.   

If you have a family member who may fit this profile, please don’t assume they have full understanding of their medication.  Ask them if you may lend them a hand in organizing their medications.  Being pro-active may help them prevent a misadventure.   

You may also be interest in reading the following:
Take charge of your medications (5 guiding principles)
My pills look different
Two Names (generic & trade)


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Are We There Yet?

Hypothetically speaking; I saw this gentleman walking by the pharmacy.  Every day he would walk by at about the same time.  He was not in a hurry, didn’t look like he was going anywhere in particular and he never had anyone with him.  One day I was out eating lunch and I saw him walking by.  I spoke up and asked him if he wouldn’t mind chatting for a moment.  I explained that I had seen him walking by the store on a daily basis for months now.  I was just wondering what he was up to.

The gentleman looked at me quizzically and said that he wasn’t up to anything.  He just said that his doctor had told him to start walking.  He said that he gets up every morning, gets ready for the day, and starts walking.  He continues until the end of the day and then goes home, cleans up and goes to bed.  I asked the gentleman if the doctor had mentioned anything else like how long he was to walk each day, or for how many days per week he was to walk?  Had the doctor recommended that he talk with anyone on a regular basis to see if the walking was working for him?  How was he to know if he was walking fast enough, or walking to long, or if he was even walking in the right direction?

I let him know that, in my opinion, when doctors advise their patients to start walking, there are usually some parameters associated with it.  He thought for a few minutes and slowly began telling me that he doesn’t even remember exactly why he had gone to the doctor in the first place.  He remembered that he hadn’t been feeling very good, perhaps a little depressed; however, he agreed that he didn’t know how long he was to continue this walking.  After a few more words, we concluded that it would be a good idea for him to have a conversation with his doctor and discuss whether he needed to continue his walking.

I know that was a far fetched analogy; however, the last few months I have run into quite a few patients who have been prescribed an anti-depressant medication and have been taking it for years.  We have a short discussion about the medication, asking them how they think it is working, and more often than not they are not able to answer the question.

Anti-depressant therapy should not be taken with a set-it-and-forget-it mind set.  This category of medication works best when the patient is an active participant in the therapy.  When someone picks up an anti-depressant medication for the first time at our pharmacy, I always spend some time with them describing them how it works.  We discuss the neurotransmitter function so the patient has a general understanding of what neurotransmitters are.  We also discuss how the medication will help elevate and then balance the level of neurotransmitters in their system. 

The patient needs to understand that this is not an overnight success story.  It may take 7-14 days for the neurotransmitters to become balanced, and a good five weeks before they see how well this particular dose is going to work for them.  At that point, the patient will visit with the doctor and discuss if they have gotten to where they need to be or if the dose needs to be adjusted.

It is important to realize that psychotherapy goes hand in hand with anti-depressant medication treatment. This is crucial for two reasons; first, your therapist will help you see and understand what it was that triggered the decrease in neurotransmitters and led to the depression, and second, it is a good idea to have a non-biased, third party, that you can discuss with how well the medication is working. They will help you define where you need to get to and help you know when you are there.

This is the point I was trying to make with my walking analogy at the beginning of this discussion.  If you don’t know where you are going, how will you know when you get there?

Many people will take anti-depressant medications for years.  This is appropriate if they are under a doctor’s care and are regularly following up with their psychotherapist to make certain the medication is still helping them get to where they need to be.  If you have made it there and are comfortable, it is reasonable to discuss the option with your doctor about tapering off of the medication. 

While you or your loved one is taking one of these anti-depressant medications, it is a wonderful idea to learn as much as you can about how the medication works and all of the other counseling information associated with your particular medication.  Please register to become a member of AudibleRxTMand then have full access to all of the Medication Specific Counseling Sessions.



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Mom and Her Coupons

I grew up in the 60’s in a town called Ben Lomond located in the Santa Cruz Mountains.  We had our small town pharmacy we would go to; however, I can remember that every now and again I would get in the car with Mom and we would drive the 13 mile trip down to Santa Cruz.  Once every couple weeks Mom would gather up all of the coupons she had cut out of the newspaper and she and I would travel from one side of Santa Cruz to the other picking up the specials from the different grocery stores.  Being that I was only 4 or 5 years old at the time, I vaguely remember this.  I have pictures in my mind of how the different grocery stores looked and what it felt like to ride around in the big Chevy Impala with my mom at the wheel.

My favorite stop was when we were at down town and were able to walk into the new Long’s Drug Store.  I remember this because at the front of the store there was a new vending machine that dispensed soda in a cup.  Mom would give me a dime that I would put in the machine, and then I would push the button for the soda that I wanted and then a tiny cup would drop into a slot and ice and soda would fill the cup.  It was not much more than a Dixie cup size; however, in all of my 49 years here on this planet I have never seen another machine like it.

To the best of my knowledge, Longs Drug Store was the first Chain Pharmacy Store here in Santa Cruz County.  Today, we have 15-20 Chain Pharmacy Stores including Safeway, Costco, Walgreens, CVS, Rite-Aid in addition to a handful of independent stores.   I tried to do a quick count in my head and quickly lost track.  Why so many pharmacies?  Well, they are needed to help fill the increasing number of prescriptions being prescribed.

Was it the increase in pharmacies that caused an increase in prescriptions?  Was it the increase in population?  Perhaps it was the advent of the five dollar insurance copay that made access to prescriptions so easy that led the way.  Maybe it was the ever increasing expectation that when we go to the doctor, we need to leave with a prescription for a medication or we feel the doctor has not done their job?  Regardless, that is not my point for today; however, it is a great discussion for another day.

My point is there are many, many pharmacies to choose from when getting your prescription filled.  All of these pharmacies are relatively busy and need to be staffed.  Some of these big stores are open for 14-24 hours a day and staffed by only the minimal amount of people.  Many of the pharmacists graduating pharmacy school these days owe more than 200 thousand dollars when they graduate pharmacy school.  These 24 and 25 year old pharmacists jump at the opportunity to make a decent wage at one of these chain pharmacy stores. 

The deal is, these new pharmacists are worked very hard and maybe don’t have the experience to stand up for what may be considered an inappropriate working condition from time to time.  My concern is, when working a 12 hour shift with little help and many distractions, what parameters are set in place to keep from preventing a miss-fill. 

Perhaps the pharmacist has filled two prescriptions during the day for meloxicam 7.5mg tablet.  They have this name in the back of their mind.  In a little while a prescription for moexepril 7.5mg tablet comes along.  They have already checked two prescriptions for meloxicam 7.5mg, they know what the tablet looks like and they are familiar with the NDC number verification already.  They are on the phone with a doctor, notice that two cars are at the drive up window waiting for service, the other phone line is ringing, and patients are waiting in line to be counseled.  They inadvertently verify the prescription with the wrong medication in the bottle. 

All pharmacists take special precaution to never miss-fill prescriptions; however, it happens.  I have said this before, when you look at your prescription, if the tablets look different than they did last time, call your pharmacist and ask them to double check the tablet identify for you.

Next time you go to your pharmacy, before you get in line, stand back and watch the workings of the pharmacy staff for 5-10 minutes.  Does it appear that there is enough staff for the workload?  Do the pharmacists appear stressed and hurried, or do they have time to do what is in front of them.  Is the staff at the counter friendly?  Do you see patients visiting with a pharmacist at the counseling area?

You are not required to go to the closest pharmacy when filling your prescription.  Take some time and “interview” a few pharmacies until you find one you feel comfortable with.  Your pharmacist needs to be approachable so you have the opportunity to get your questions answered.  If you have only used chain store pharmacies to fill your prescriptions, do yourself a favor and walk into one of the local independent pharmacy stores.  Ask to speak with the pharmacist and then ask them if there are any advantages of moving your prescriptions to their independent pharmacy.  You may appreciate what your hear.


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Copyright AudibleRx (TM), all rights reserved. Please do not copy or publish or distribute without consent and approval from AudibleRx (TM).