Healthy Living for Life – Who is on Your Pharmacy Team (Full Version)

– [Announcer] Living longer, living healthier, living better than ever before Welcome to Mountain-Pacific's Healthy Living for Life, a weekly series that gives you the information, education, and expert insight you need to become an active participant in today's ever-changing health care climate

Here now is today's program host – When it comes to making sure you understand your medications, who would you say is on your pharmacy team? Your doctor, your pharmacist? They certainly are, but you may be surprised to learn the most important member of your pharmacy team is you Welcome to Healthy Living for Life, a show dedicated to helping you do just that I'm your host, Beth Brown Today's show is about what you need to know about your medications

Stay with us, we'll be right back – Welcome back Part of being a member of your pharmacy team means knowing about the medications you're taking Joining us this morning is Lisa Sather to talk to us about how to do that Lisa, thanks for being with us this morning

– You bet, Beth, thank you – Can we start out by just explaining what is medication reconciliation? – Sure, that's a great question So medication reconciliation is when you make a complete list of all of your prescription and over-the-counter medications, and that includes the name of them, the dosage, how they're taken, the frequency, how many times per day, and you want to compare that with the medication list that your hospital, your provider, your pharmacy has So it's really important to have a complete list of those things, and typically that's done when you transfer care from one healthcare setting to another, like say you're leaving a hospital, going home, leaving a hospital, going to a nursing home, home to a nursing home, et cetera, et cetera, so that's what we're talking about when we're talking about transition of care – [Beth] Okay, and so who does a medication reconciliation? Does your doctor do that for you, can you do that for yourself? – Sure, really anyone can do that

Certainly you can do that for yourself Typically you're going to see a pharmacist doing that, a physician doing that, a nurse can even do that You can even ask a caregiver to help you do something like that It's just really important that you get a complete list and also it does somewhat help if you have someone that's skilled in medications and knowledge about those because names can be confusing and in order to understand that you're not having a duplication of a medicine and things like that, that's really where it does come in helpful to have someone that's trained in medications The whole basis of this is you really want to make sure your list is complete so that you don't miss a medicine when you're transitioning, you don't have a duplication of a medicine, things like that, that's the important pieces we're looking for

– So you mentioned that medication reconciliation happens at a care transition – [Lisa] Yes – Does it happen automatically? Is there a time when you should be requesting this to happen? – Sure, it really does depend upon the healthcare system So typically upon discharge from a hospital that's something that in most cases is going to happen at some level The situation is that sometimes there can be gaps and it is different from different healthcare system to healthcare system

So, definitely if it's not something that has happened for you it is something that you should definitely ask for The importance of that is it will also help you understand your medications, help you be in tune with that You are your, you know, one of your biggest advocates of course, and so if it is not something that you have had offered to you, it is definitely important to ask and get that done – Okay, great And why would you say you should perform a medication reconciliation, why do it? – That's a great question

So medication errors is really the biggie here Nearly half of all medication errors happen at some transition of care, and so that's important We know that if a person is missing at least one or more of their medications upon a transfer of care, they're more than 50% likely to have some type of an adverse drug event And they're also more likely to get hospitalized even within that first month after they leave the hospital That's why it's really imperative that we understand our medicines, and it will help you not to make mistakes

– Okay, perfect So a medication reconciliation you said is basically putting together a list of your medicines that you're taking It seems pretty straightforward just creating a list, but it can actually be really complicated, right? Can you talk about that a little bit? – Sure that's right, I kind of mentioned earlier, I mean, this process can vary from healthcare system to a doctor to a pharmacist There's not one national type list that's available in order to perform a medication reconciliation So, since the documentation differs, there can be sometimes inconsistencies in information, that's why it's just really important to work with those you're comfortable with, your providers, in order to put together that complete list

– [Beth] And you mentioned the inconsistencies, but the one constant there obviously is the patient And the problem or the difficulty there is the patient isn't necessarily an expert on his or her medications, and so for those folks out there who maybe feel a little bit overwhelmed, maybe they take a lot of medications, any advice on how to kind of put this together, make sure that everything is accurate, how do you go about doing it if you don't have that knowledge like you said – Absolutely, so I think the biggie is ask for help Whether that means seeking out your family member to sit down with you, help you sort through that I think even more importantly is to talk with your doctor and your pharmacist

Your pharmacist, if you're using one pharmacy, which we highly recommend, they're going to have that complete list, and share with them your over-the-counter medications So I think that's really imperative The other thing you can do is you can take all of your medicines in a bag to your doctor's office when you have a visit so that they're able to reconcile with the medicines that are on their list that they have on record there as well, and I think also another key point is that if you're in a hospital situation or a nursing home, and you're transitioning, to ask questions Make sure you understand, and it's important also, I remind people, take notes, if you don't have something that's printed out for you, even if you do, oftentimes it's very helpful to jot down notes to help you keep things straight, so make sure to do that – Okay, good advice

So what if you're working with your doctor or your pharmacist to do a medication reconciliation, is that also a time when you can check for maybe medications that might interact with one another? – You know, that's possible, it depends upon the skill obviously of the person doing the reconciliation At some level, obviously on your new prescriptions, and refill prescriptions and those kinds of things, if you're seeing one pharmacy, that should kind of be done at that point in time, but if you have any questions at all, you definitely should ask your pharmacist, especially if you have a new prescription that's being added – Okay, we have about a minute left here There are some websites online, they're called interaction trackers – [Lisa] Yes

– You can go in and sometimes they have lists of medications, sometimes you type them in, but you can put your medications in and find out if there are interactions Would you recommend these kinds of sites? – You know, certainly there are some trustworthy ones out there, drugscom has one, I was just online this morning, CVS has one, some of the national chains have those, they even link, you can pull up the drugs you take through those companies So yes, I mean, that is a good valuable tool, the important thing to remember about this is if you do go online and you do do that, it's kind of sometimes difficult to evaluate whether or not the level of interactions are extremely severe and those kinds of things, so I always recommend that you talk to your pharmacist about those if you do come up with something that's flagged to ascertain whether or not it's really clinically significant Also to follow up on that, another important thing is you want to make sure you don't just stop things cold turkey

You need to talk with someone first – Perfect, thanks Lisa We do need to take a quick break, but coming up next, there are several medications that patients must take with caution because they are notorious for causing drug-to-drug interactions not only with other prescriptions but with over-the-counter medications too We'll talk about that right after this Stay with us

– Welcome back With so many people over the age of 65 taking multiple medications in this country, it's a good idea to know when the wrong combination can make it so your medicines are no longer helping you, can harm you, or can even be deadly Lisa Sather is still with us to talk about this Are there certain prescription medications that doctors and pharmacists automatically know they're red flags because they just don't play well with others? – Sure, that's a great question, Beth I think it's important to firstly mention that medications can be life-saving and necessary in the treatment of medical conditions

– [Beth] Sure – But always there's a risk/benefit when we look at that And so yeah, there's kind of a group of medicines that we're always vigilant about and we'll just mention those, anticoagulants, or medicines that people know as blood thinners Warfarin, is kind of the old standard that we're used to, there are newer ones out there, Eliquis, Xarelto, Savaysa, Pradaxa the new agents, and then moving on, nonsteroidal anti-inflammatory drugs, those medicines like Ibuprofen, Naproxen, that are used to treat pain and inflammation are a biggie Medicines with anticholinergic side effects, that's kind of a big word, it kind of refers to the mechanism of action and how they work, but they definitely are things that can cause issues

And then we have benzodiazepines, used for the treatment of anxiety, sometimes sleep, those kinds of things, sometimes seizures, they have a red flag for us, and then last but not least, opioids, which are pain medicines used for the treatment of moderate to severe pain, and so those are kind of the five big classes – Let's dig into some of those and talk about some of the more common interactions Can you talk a little bit more about Warfarin? – Sure, so you know, as a pharmacist, one of the big things, there's a lot of things with Warfarin, but one of the things just that folks might commonly get prescribed are an antibiotic, and there are certain classes of antibiotics that can interact with Warfarin and cause increase in bleeding Nonsteroidal anti-inflammatory drugs as well, those drugs can increase bleeding, and so we're always vigilant about that Herbal supplements can sometimes even interact with Warfarin, garlic comes to mind as well

Another one that I recently came across, I wasn't familiar that this was an interact is glucosamine and chondroitin, folks sometimes take that for the relief of inflammation and pain in their joints, it's an over-the-counter medication, so think it's important to just mention that any time you're on an anticoagulant, either the older Warfarin or the newer ones, it's important to talk with your doctor, make sure your doctor or pharmacist understands all of the prescription medicines and over-the-counter medicines you're currently taking – Okay, and another type of medication that you mentioned in the big five there was NSAIDs, can you talk a bit more about NSAIDs? – Yeah, so, nonsteroidal anti-inflammatory drugs, some of the biggies with those, a couple of them, were blood pressure They can actually make your blood pressure medications less effective, so that's something to watch out for Also, water pills, diuretics, that's kind of along those same lines Also, you know, as a sidebar, folks that have stomach issues, if they're taking medicines for ulcers or those kinds of things, not necessarily interaction, but those medicines can make your stomach have more issues with being upset and things like that, so we want to watch out with that

Again back to making sure that your physician and pharmacist are on the same page and they know all of those medicines you're taking because NSAIDs are even available over-the-counter, it's not necessarily just a prescription – Right, okay And then another one you mentioned, and this, like you said, that is a tough one to say, anticholinergics – Yes, good job – Okay, thanks

Can you talk about the common interactions with those? – Sure, so anticholinergic medications, again, that's kind of referring to the mechanism of action which is more of a, you know, a pharmaceutical term, that class of medicines are often used to treat motion sickness, gastrointestinal disorders, overactive bladder, sometimes folks will deal with that as they age, and just by virtue of how they work, they can decrease the saliva we make, they can decrease our stomach motility, they can also cause drowsiness and dizziness and those kinds of things, so some of the medicines that might interact would be medicines for dementia, Aricept comes to mind, or if you're taking a medication that also causes drowsiness or dizziness and those kinds of things, that can just compound that effect Antidepressants, some medications that are used as anticonvulsants, and a common one that's over-the-counter is Benadryl It's an antihistamine, it has anticholinergic effects, people use it for sleep, allergies, that's a biggie – Okay, great And then you also mentioned benzodiazepine

– [Lisa] Sure – So what are some of the common interactions there? – Sure, as I mentioned, benzodiazepines are used to treat sleep, sometimes anxiety, sometimes seizures They can cause drowsiness, dizziness, confusion, so again, any other medicines that cause those same kind of side effects like opioids, seizure medications, sleeping medications like Ambien, that's really not per se a benzodiazepine, but it's like a benzodiazepine Muscle relaxers, sometimes people are taking those in conjunction because they might have muscular issues, so again those can all compound the effects, important to share with your physician and pharmacist if you're getting those from a different provider – Okay, and last but not least, let's talk about opioids, what should folks be aware of if they're taking an opioid? – Sure, opioids of course used to treat pain, mostly moderate to severe pain, typically following surgery

Those medications can cause drowsiness, a decrease in your respiratory rate, decrease in heart rate, so any other medicines, again that can increase the effects of those can cause more dramatic effects, more dramatic side effects Medicines that we use for seizure, muscle relaxers are notorious, benzodiazepines are notorious So it's, again, we're all going back to that same common thread, make sure your physician and pharmacist know exactly all the medicines that you're taking to minimize those potential issues – Perfect, good advice once again And we're running up on our commercial again, so one last question here really quickly, any other common interactions that folks should be aware of that maybe don't involve those big five? – Yeah, insulins is a big one to look out for

Sometimes medicines that are used to treat blood pressure can cause hypoglycemia, that's kind of one of the biggest issues we have with insulin and that can be very life-threatening if not treated appropriately Digoxin is a medicine used for heart conditions, there are others medicines that are used for heart conditions that can make it more pronounced and can cause issues, and then ACE inhibitors used to treat blood pressure, also used for diabetes, those kinds of things, for prevention, they have typical interactions with things like excess potassium, or you know, that can cause them to be, have increased adverse drug events, so there's a whole host of things, those are just a few – [Beth] Okay, so the main advice there, talk to your doctor or your pharmacist – Main advice, yes – Okay, let's take another quick break here, but when we come back, do you have questions about your prescription today? Your pharmacist probably asks you that every time you pick up a medication, but do you take that opportunity to ask your questions, or are you just not sure what you even should be asking? We're gonna give you some questions you should ask your pharmacist right after this

Stay with us – Welcome back We are always encouraged to ask questions about our medications, but if we don't know what questions to ask, we miss out on the opportunity to learn about the medications we're taking and how they might impact our health Lisa is still with us to talk about what questions you should definitely ask your pharmacist So before we get into the questions though, Lisa, are there times when we should be asking these questions, is it when we get a new prescription, even when we're doing a refill, when do we even ask these questions? – Yeah, sure, Beth, that's a great question

So my opinion on that is absolutely every time there's a new prescription, you should be asking these questions, but also I think it's always good to touch base on refill situations, you know, especially if any of your medical conditions have changed since the last time you filled a prescription, or if you have decided you're gonna start a new over-the-counter medication, I think that's a good time to check in with your pharmacist to make sure there's not going to be a potential issue with that Again, any time you have concerns or questions is a good time, that's what they're there for – [Beth] Great, and what about those folks who say I don't need to ask my pharmacist any questions, there's tons of information with this bottle they're giving me, I'll just go home and read it – Right, I think that initially that might be all right, but you really should take the time to understand what the directions are and the things we're gonna get into in a couple of minutes, and a lot of times if you, you get into that information when you get home, it can be very overwhelming and maybe not necessarily very patient-friendly Also it's difficult sometimes to really discern, what's really clinically important

You might read information on the printout that's sent with you, and it's a slew of information, it's a whole page Yes, there are opportunities where sometimes those types of side effects may occur, it may be in less than 1% of the population, but your pharmacist can really point out for you what situations specifically apply to you, and when you should really be looking for, you know, issues of concern I would always say if you are in a hurry and you can't, or your pharmacist is tied up and you can't necessarily talk with him right then, don't hesitate to give them a call once you get home and you've sat down and tried to digest the information – Okay, so let's give folks a list of questions that they can ask, what would be first on that list? – Sure, I think one of the number one most important things is what's the name of my medicine and what is it being used for? For example, I'm taking Lisinopril, and I'm using it for my blood pressure Is it a, you know, you should know the generic

Most medications anymore are available generically They work as well as their brand name counterparts, they are as effective, but they are less costly So if there's a brand and a generic, those are typically gonna be on the label, but I think it's kind of important to know that because when you're reconciling, making lists, you might think they're two different things and they're actually one and the same How to take it? Am I taking it as needed, and what does that mean, are there maximum amounts per day if I'm doing that, am I taking it scheduled, meaning a set time every single day, if it's twice a day, what times during the day? Am I going to need to take it with a lot of water or am I going to need to take it on an empty stomach, or am I going to need to take it with food? As a sidebar regarding food, you know there are some foods that do interact with medications and we didn't get an opportunity to talk about that earlier, but I think it's important, and your pharmacist should be pointing that out to you, you should have that on the label of the medicine if there are certain foods to avoid A biggie is grapefruit juice

People don't realize that it can interact with over 85 medications, and really can be very serious either decreasing their effectiveness or making them more potent and increasing the risk of adverse drug events, so that's important And how long are you taking the medicines for? Is it just for 10 days, do I take it till I feel better, can I stop it, those kinds of things – Okay So those are sort of the top of the list, what are some of the other questions that folks should take or ask about taking their medications? – Right, so we've kind of hit on this earlier and a big this is drug interactions Are there any things I need to be looking out for in terms of other medicines? That's usually gonna be done at the point of fill, you know, your pharmacist is going to be looking at those kinds of things

Do you have any allergies that are new that need to be discussed, and then whether the side effects that might occur are serious or not, and we talked about that a little bit earlier in the patient information – [Beth] Okay, so that, have we exhausted the list, or are there any other questions you would throw out there? – We could go on and on I think another important thing is storage Is it refrigerated, can it be stored just on the shelf? Are there refills on the medicine, do I need to talk to my pharmacy, or excuse me, my physician before I get a refill? Can I just refill it myself? Are there any activities that I need to avoid? Some medicines of course cause drowsiness, dizziness, we talked about benzodiazepines, and opioids earlier What happens if I miss a dose? I think that's important

Some medicines you can resume at the next dose, some you need to take it that same day, but also again if you forget to ask these questions at the pharmacy, don't hesitate to call if something comes up and you have a question, your pharmacist will be able to help you – Okay, and we just have a couple minutes left in the show, so let's spend that time talking about over-the-counter medications You did mention earlier that those can cause interactions too, whether it's aspirin or a supplement Is there a specific time when somebody should ask either their pharmacist or their doctor about an over-the-counter medication before they take it? – Yes, absolutely So it's important to remember, these are as significant in terms of the fact that they can cause adverse effects or issues as a prescription, you need to take that seriously and be diligent about that

I would suggest you read the label and that will give you general information, but any time you start an over-the-counter medicine and you are taking a prescription medication it is not a bad idea to check with your pharmacist about that, just to make sure – Okay, so going back to asking our pharmacist questions, are there questions that you should be asking about your over-the-counter medications? – Sure, I mean I think most importantly is will it interact with something I'm taking? Are there specific side effects to look out for? How long should I take it? A great example of that is medicine used to treat stomach ulcers now that's over the counter, the proton pump inhibitors, Prilosec, and you know, that's a two week deal normally There's reasons why we don't want to take that longer than that, or we can take it as needed So I think it's important to ask at least at minimum those types of questions – [Beth] Okay, and what are some of the common side effects that can happen with over-the-counter medications? – Sure, I think cough and cold is a biggie because we all always end up with a cough and cold at some point in time, and it really does depend upon the medication

So medicines for cold, if they have multiple ingredients can cause drowsiness, dizziness, dry mouth, those kinds of things The antihistamines, Benadryl, I mentioned that earlier, it's a sedating antihistamine, it can cause drowsiness, and so I think those are kind of the biggies – [Beth] Okay, perfect Lisa, thanks so much – You bet, Beth

– Great information, appreciate you being here And thank you for tuning in this week Be sure to join us again next week Until then, stay fit, stay well, and stay healthy for life with Healthy Living for Life Have a great week

– [Announcer] Healthy Living for Life is brought to you by Mountain-Pacific Quality Health We'd love to hear from you If you have suggestions for future programs, visit our website at MPQHForg or call us at 406-443-4020 You can also catch us on YouTube by visiting our website and clicking on the YouTube icon

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