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It has come to my attention that many of you are taking a LOT of pills, so today's diary is for everyone who takes prescription medications, vitamins, dietary supplements, OTC medications, and etc. It doesn't matter whether you are dealing with a serious illness that requires ingestion of large quantities of potent pharmaceuticals or if you are merely pounding down handfuls of vitamins, you should know how to take them safely. If you are helping care for an elderly parent you may find today's information particularly helpful.

Before putting any pill in your mouth, answer these questions:

Is it the right drug? Whenever you are handed a prescription, read it back to your physician. If you can't read the handwriting, what makes you think the pharmacy tech who will process it can read it? Many, many drugs have similar sounding names. Reading it back to the person who wrote it provides a double check for them, and it may keep you safe. Once you confirm the name of the drug, confirm the reason you need to take it: "I will take this [repeat the name of the drug again] to [state your understanding of the reason]?"

At the pharmacy, check all prescription labels. Every single time. If you are refilling a prescription look at the pills, too. Are you getting what you've been taking? If not, why not? The time to discover and correct errors is at the pharmacy. Not many things frustrate me more than hearing a patient say something like, "It's not MY fault. The doctor ordered/the pharmacy filled the wrong thing." Whose ass is laid up in the emergency room? The pharmacist's? We all need to accept primary responsibility for everything we put into our mouths.

Is it the right dosage? Same drill as before: double check the dosage when you're handed a prescription, check it again at the pharmacy and, if it's a refill, see if the pills are the same ones you've been taking.

Is this the right time to take it? There are two important considerations under timing. The first is scheduling. There is a difference between instructions that read, "take one capsule three times per day," and instructions that say, "take one capsule every eight hours." If the instructions tell you to take your medicine two or three or four times every day, you can space them out during your waking hours. If, however, the instructions are to take something every so many hours, e.g. every four hours, that is exactly what you should do. Again, be clear about timing when you get the prescription.

The second consideration under timing has to do with drug and food interactions. One classic example is calcium. If you take Synthroid (or a generic version) for hypothyroidism, you should be aware that calcium alters the effectiveness of the drug. If you take a calcium supplement along with your Synthroid, stop it. Take one of them later in the day. Some medications are greatly potentiated or diminished when taken with grapefruit juice. Some should be taken on an empty stomach, while others work better with food. I could give you a dozen more examples ... but I'm not going to. I want you to learn everything you can about YOUR pills.

The place to start in educating yourself is with the printout provided by the pharmacy. The more things you take, the more complicated it gets. As much as I love teh google my best resource when it comes to drug-drug and drug-food interactions is my pharmacist. Make a list of everything you're taking - and I mean EVERYTHING, including aspirin and acetaminophen - and show it to your pharmacist. Ask him or her to look it over and make suggestions about when to take what. Finally, list everything on a daily schedule, complete with times.

Are you taking it by the right route?  (Yes you, with the suppository at your lips!) Seriously, this can be an important issue for people with feeding tubes and/or implanted IV lines. I personally know a young nurse who ground up a medication that should have been given through a feeding tube ... but she put it into a PIC line. With deadly results. If you are caring for a child or a parent or a partner with lines of any kind, be extremely careful when administering medications.

Putting it all together:  Once you have your daily schedule and all your bottles of pills, it's time to deal with what I call the memory issue. Those pills won't do you any good if you don't take them. I take a minimum of 25 pills every single day. Ten of them represent six different prescription meds and the other fifteen are vitamins, probiotics, baby aspirin, and fiber tablets. I've got seven daily pill containers with four sections each. Once a week I spend some quiet time with my bottles and my list and my daily dispensers. Starting with the prescription meds, I dole out a week's worth of pills, checking the bottles against my list. Next I dispense the baby aspirin, followed by everything else, checking as I go. Each daily dispenser has a day of the week written on it. I line the seven dispensers up in a drawer, giving me everything I need - at the right time - for the next seven days.

My morning pills are impossible to forget because I wake up with a stiff back and there's a naproxen tablet waiting for me. Same thing twelve hours later - I rarely forget my 7 PM meds. The bedtime assortment is part of my nightly routine, and that routine also includes a final check of the day's pill dispenser. I do forget the after lunch batch once in a while, but I always catch the error by 7 PM. What can you do to remember to take your medicine? If you carry a cell phone or a blackberry at all times, does it have a multi-level alarm system you can set? Forgetting to take pills is a big problem so let's talk about it. Tell me what works for you.

There's one more step to that weekly quiet time. After dispensing all your pills for the coming week, take stock. Do you need to phone in a refill? Are you almost out of multivitamins? Make a list of items you need to replace so that you won't find yourself short during your next weekly quiet time.

Finally, a Nurse Kelley Alert about acetaminophen. Acetaminophen is the generic name for Tylenol. While this is a useful and generally safe OTC pain medication, it can cause irreversible liver damage when taken in excessive amounts. No adult should ever take more than 4000 mg in any twenty-four hour period. Liver damage can occur with a single overdose. Alcohol should be avoided when taking acetaminophen. Examine the list of ingredients on every medication you take because this drug is often combined with other drugs. If you take too much, seek medical attention immediately.

So tell Nurse Kelley:  How do you remember to take your medicine?

Originally posted to Nurse Kelley's Blog on Mon Nov 23, 2009 at 11:14 AM PST.

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