Countless people suffering from various diseases and ailments take countless medicines on daily basis. Apparently taking seems a simple task without any negative outcomes or other risks. Following are the common risks associated with inappropriate use of the drugs.
- Drug Nutrition Interaction
- Drug Abuse
- Reaction of the use of expired medicines
- Improper Storage, Identification, and disposal
Drug Nutrition Interaction
Each year thousands of people are sickened by dangerous drug interactions involving prescription (Rx) medications and over-the-counter (OTC) remedies. Many medications have potentially harmful side effects, particularly in older patients, whose metabolism may be less efficient in detoxifying drugs and clearing them from the body. In addition, many drugs interact with each other or with certain foods. Exercise and excessive physical activity can also produce harmful effects of certain medicines. In addition to interaction problems, older adults and family members also need to be aware of drug abuse.
Medications can be affected by many different factors. A drug-nutrient interaction may occur when a person takes a medication that is affected by:
- a beverage
- a supplement (like vitamins or herbal remedies)
Common Drug Beverage Interactions
Alcohol interacts with a variety of common drugs used by seniors, including but not limited to a variety of:
- medications to treat diabetes
- medications taken for delusions and hallucinations
- epilepsy medications
- pain relievers
- medications used for anxiety
- insomnia medications
Symptoms of Drug Alcohol Interactions
Drug alcohol interactions might include a variety of signs and symptoms that would depend on the dosage and type of medication and amount of alcohol ingested. Effects might include:
- decreased or increased effectiveness of the drug
- nausea and/or vomiting
- increased blood pressure
- dizziness and impaired balance and coordination
- breathing problems
- stomach bleeding and increased risk of bleeding elsewhere
- heart problems
- liver damage, particularly with acetaminophen
- increased side effects of the drug, some potentially fatal
Common Medicines that Interact with Fruit Juices
Common medications that interact with grapefruit juice include, but are not limited to:
- certain benzodiazepines, medications used to treat anxiety and/or relax muscles
- certain heart medications, like calcium channel blockers
- medications to decrease an immune response, like cyclosporine
- certain statin drugs for lowering cholesterol
- Milk and calcium-containing beverages may also interact with certain medications, particularly some antibiotics. The calcium can cause the body to absorb less of the medication in these instances.
Beverages, including sports drinks and nutritional supplements, might contain added nutrients such as vitamin K or fiber, which could potentially interact with certain medications, like blood thinners and digoxin.
Old Age Can Affect the Way Drugs Work
An elderly person has unique concerns when it comes to medication. Aging causes changes in metabolism, renal changes, gastrointestinal changes, an increase in body fat and decrease in body mass. The amount of water in the body decreases with age. These factors and many more affect the way certain medications work in the body.
Exercise Causes Changes in the Body
Exercise and medications don’t always mix, especially for elderly persons. Healthcare workers and rehabilitation therapists know that certain medications can cause adverse drug reactions (ADR), and stay within safe boundaries during the patient’s workout. It is up to a caregiver to ask the doctor, therapist or pharmacist questions about drug interactions with exercise.
A home caregiver may not be aware of drug reactions an elderly person could experience as a direct result of exercise. Exercise isn’t confined to a structured therapy workout in a rehab facility. Playing ball with the grandchildren may create enough exertion to exacerbate or minimize a drug’s effects on the body. The extra physical activity (walking, swimming, etc.) during vacation may also trigger adverse drug reactions.
Drug Types Affected by Exercise
There are many more new drugs on the market today than there were just ten years ago. It is imperative that the home caregiver become familiar with the details about any medications she has to administer. As the elderly person’s medical condition dictates, the caregiver has to know what medications may react adversely to excessive or prolonged exercise:
- Diuretics. Can cause fluid depletion in the body, but can also cause hyperthermia during prolonged periods of exercise.
- Antipsychotics. Can cause heat retention resulting in heat exhaustion or heat stroke (hyperthermia).
- Statins. Can cause muscle aching, weakness and cramps when combined with excessive exercise.
- Sulfonylureas. Certain sulfonylureas can increase the risk of developing hypoglycemia.
- Insulin. Diabetics usually require less insulin when exercising, but there are guidelines a person must follow to avoid an increase in blood pressure or high glucose level. Just as important is the type of exercise (resistance, aerobic, etc.) performed.
- Herbal products. Certain herbal products (such as creatine) can cause dehydration, heat-related illnesses resulting from impaired thermoregulation or an increase in metabolic heat production.
- Non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs, like aspirin and ibuprofen, relieve pain, but they also block prostaglandins – unsaturated fatty acids that aid in controlling smooth muscle contraction, blood pressure, inflammation, and body temperature.
- Beta blockers. Affect the heart and blood circulation. Beta blockers are used to treat various forms of cardiovascular disease, including hypertension and angina. Patients should be monitored closely during exercise.
Older Persons are Likely to Experience Dangerous Drug Interactions
Older individuals typically have more than one physician. Elders may also use more than one pharmacy to have prescriptions filled and to satisfy other medicinal needs. Using multiple doctors and pharmacies are just two situations where an older person may accidentally acquire incompatible drugs.
Modern technology has made filling prescriptions easier than ever by using the Internet, thus increasing the chance of mixing the wrong medications. Other ways deadly drug interactions may occur:
- Poor communication. An older person may unintentionally fail to tell a new doctor or pharmacist about all the medications he or she is taking, including vitamins, herbal medicines, and OTC remedies.
- Confusion due to old age. An elder may confuse the names of medicines or forget dosages when filling out history forms at the doctor’s office.
- Neglecting to throw out old drugs. Seniors may hold on to old drugs that are no longer needed. Taking both old and new medicines can lead to adverse reactions or overdose.
- Having someone else pick up the filled prescription(s) or OTC drugs. Pharmacies provide literature with prescription medications, but the patient (or caregiver) may fail to read or understand the information.
- Failure to heed drug warnings pasted on the container. An elder can easily forget a doctor’s instructions and/or fail to read the warnings on the drug package.
How Can a Caregiver Reduce the Risk of Harmful Drug Interactions?
A caregiver can reduce the risk of an elder experiencing an unsafe drug reaction by getting actively involved in the person’s medical care. If the care receiver lives independently, a family member can still monitor medications or any unusual patient behavior. A caregiver can become familiar with the elderly person’s doctor(s), pharmacist and the insurance company or program that pays for the drugs. The home caregiver can take steps to monitor an elderly loved one’s medications:
Schedule a medication review with a healthcare provider and take the time to discuss with the doctor and pharmacist the medications the elder is taking. Bring to the elder’s medical appointments a list of all the drugs, including OTC medicines and herbal remedies, so none are overlooked. Have a list of all the doctors the elder sees, as well.
Communication is vital between the medical professionals and the patient, as well as with the patient’s representative (caregiver). Questions regarding medications can also be answered at this time. Writing questions down before the visit will help to ensure that all questions are asked by the senior or caregiver. Writing down the answers can aid in recall later. The healthcare provider may also ask questions to ensure that medications are taken safely. For example, some medications should not be broken or crushed, and other medications might need to be taken at certain times related to meals. In addition to this, the caregiver should know what each drug is for, if patient should still be taking it, and if it’s safe to take it along with all your other medications.
Use one pharmacy to prevent confusion. Get acquainted with the pharmacist so that he or she becomes familiar with the patient’s condition. On a side note: Using one pharmacy can also help guard against medical identity theft. A pharmacist who knows the patient is likely to question anything out of the ordinary in the way of insurance prescription coverage, prescription drugs or doctor-prescribed medical equipment.
Medication schedules can become quite complex when seniors are on multiple drugs. Creating a written schedule can help seniors and caregivers to keep track of times, dosages, stop dates, and more at home. Some healthcare providers provide a printout of individual patient medication schedules. Hence, it is very important to Keep a drug journal for the elderly person. By keeping a log of the medications currently used, one can easily monitor dosages, side effects, and reactions. Keep all medicines in one location for easy access. Keep refrigerated drugs in one place in the refrigerator.
Go through the elder’s medicine cabinet at least once a month to see if anything needs to be thrown out. Frequently check the nightstand and any other places where medications might have been left (including the elderly person’s purse, if necessary). Keep tabs on drug expiration dates. Discard old medications properly; don’t flush pills or liquid medicines down the toilet or wash them down the kitchen drain.
Seniors may also wish to check the website of their medication manufacturers for information about nutrient interactions and other information specific to that medicine brand and may wish to read about the safe use of prescription and over-the-counter medications.
Many medications have labels that specify that a drug should not be taken with certain foods or drinks, but many seniors may be unable to see those warning labels due to poor eyesight or because the medications are in pill boxes or other containers in which the medicine was not originally packaged. It is also easy to forget about reactions to certain beverages if drinking it is part of the person’s daily routine.
If a potential interaction is identified, it is helpful to place a reminder label on the container if the medications are stored in a pill box, for example, although the safest approach is to keep medications in original containers. Removal of those beverages while on the medication can help to avoid accidental ingestion at home. If that is not possible, adding a note where the beverage is stored may also help to ensure that certain beverages are avoided when taking particular medications. Reminder notes may be particularly helpful if a variety of caregivers are assisting with medication administration or if the senior is traveling.
Some people stop taking medications because of price, allergic reactions, unacceptable side effects, lack of education, fear of drug addiction, lack of refills, forgetfulness, and many other reasons. Immediately inform the healthcare provider of any barriers to or problems with a prescribed treatment. Those who are experiencing severe allergic reactions should seek immediate emergency care.
Some medications to watch out for
Below are some of the medicines whose use, especially for the elderly, with other medications needs to be carefully monitored.
- NSAIDS: indometacin, ketoprofen, piroxicam
- Opiods: meperidine
- Heart rhythm drugs: quinidine, flecainide, digoxin
- Antibiotics: nitrofurantoin
- Antihistamines: hydroxyzine, clemastine, chlorpheniramine
- Urinary spasm medications: oxybutinine,solifenacine
- Blood thinners: ticlopidine, prasugrel
- Antidepressants: amitriptyline, doxepine, imipramine, clomipraine, trimipramine
- SSRIs: fluoxitine
- MAO inhibitors: tranylcypromine
- Anti-nausea medications: dimenhydrinate
- Cardiovascular medications: clonidine, doxazosine, prazosine, terazosine, methyldopa, reserpine, nifedipine (non sustained-release)
- Nervous system medications: thioridazine, fluphenazine, levomepromazine, perphenazine, haloperidol, olanzapine, clozapine
- Muscle relaxants: baclofen, tetrazapam
- Sedatives: chlordiazepoxide, diazapam, flurazapam, bromazapam, prazepam, nitrazapam, alprazolam, temazepam, lorazepam, zolpidem, zopiclone, zaleplone, doxylamine, chloral hydrate
- Anti-dementia medications: pentoxifylline, naftidrofuryl, nicergoline, piracetam
- Anti-epileptics: phenobarbital
Though media attention is often directed toward side effects, drug interactions, and medication errors, there is another aspect of drug product safety that it is important to consider.
This component of safe medication use relates to proper storage and handling of drugs and supplies. With regard to keeping medicines safe, there are three major considerations: storage and stability, identification.
Storage and Stability of Medications
Keep all medications—prescription and over-the-counter—out of reach of children, pets, or mentally altered or impaired adults. If you have children, make certain that medications in your home are equipped with childproof caps and are never left unattended at a level accessible to small fingers (or paws).
Select a cool, dry place to store medication away from direct sunlight. Though many bathrooms are equipped with “medicine cabinets,” these can be poor places for medicine storage. Bathroom moisture and heat levels are often high and can cause medicines to dissolve or degrade. Storing meds over the sink also increases the chance of losing a dose in the drain. A small upper cabinet in the kitchen, however, can be ideal. The height will ensure it is out of reach of most children, and, as long as it is not directly over the stove, the cabinet should remain cool and dry.
For medications requiring refrigeration—typically indicated by your pharmacist or pharmacy label—select a child-safe area within your refrigerator that maintains a consistent temperature. The door is not the best choice, as the repeated opening and closing of it may cause temperature variations.
Identification of Medication
If possible, when storing your medication, always use the original pharmacy container. Not only is this the legal requirement, it is your safest option. Mixing medications together in one large container can cause confusion and lead to double dosing or other med errors.
For older adults without children or pets, it is acceptable to use plastic dosage boxes with separate compartments for day of week or time of day. However, you should employ some sort of drug identification system for reference in case you forget or are unable to tell which medications are which.
- One option would be to leave one tablet in each original prescription bottle for visible reference.
- Another might be to photograph the front and back of each tablet, writing the name, strength, and expiration date of the medication on the back of the photo. The photos could then be kept in a small album.
- A third choice might be to record the name, strength, color, shape, and size of the tablet, taking care to include any imprinted codes and the expiration date on an index card. Then store the cards in a small file box.
Regardless of storage, it is a good idea to keep a list of your current medications handy.
The reaction of the use of expired medicines
Seniors who live alone often leave medications on the bedroom nightstand, in the bathroom, on the kitchen table, or even by a favorite chair in the living room. They keep daily medicines in pockets and purses, desk drawers, kitchen windowsills, and even in medicine cabinets. Elderly people are often forgetful, and most don’t see well enough to read the printed label on a small prescription bottle. Some older citizens even combine medications into a single bottle or add what’s left of an older medication to a newly filled prescription container.
It’s not uncommon for elderly persons to mistakenly take old or expired medications prescribed for an ailment or condition they no longer have. What’s worse is they may unknowingly take an old medicine that shouldn’t be combined with a newer, different prescription. Deadly drug interactions and possible over-medicating are among the primary reasons why caregivers are urged to keep check on medications for an elderly family member.
Is it Safe to Take Expired Medications Still Being Used?
Given the cost of some prescription medications and even some OTC (Over the counter) medications, many people frown on disposing of medicines that are still being used by the individual. Caregivers are warned that with some medications the chemical composition can become altered with age. Other elements that may affect the potency of a medicine over a period of time are heat, light, humidity, and temperature. There is a reason expiration dates are stamped on medication containers.
Under ideal conditions expired medications may retain their potency, according to the website, John’s Hopkins Health Alerts. Most medications, though, retain their potency well beyond the expiration date, and outdated medications, whether prescription or over-the-counter, are not usually harmful…But you should discard any pills that have become discolored, turned powdery, or smell strong; any liquids that appear cloudy or filmy; or any tubes of cream that are hardened or cracked
Other Reasons to Get Rid of an Elderly Family Member’s Old and Expired Medicines
When an elderly person is no longer taking a medication, it is best to dispose of it for safety reasons. The safety issue extends beyond the senior family member to younger family members that might come to the apartment or home for a visit. Other reasons to dispose of medications no longer used by an elderly family member:
- Children visiting may accidentally mistake pretty colored pills for candy. The elderly person’s home is not likely to be child-proof.
- Teenage drug abuse is on the rise, but it’s not illegal drugs attracting older kids. Legal drug abuse by teens has caused an alarming number of deaths, even among “good” kids that would never dream of trying street drugs. Kids are selling most any drugs they can get their hands on to make money, too.
- Elderly people may try to dispose of expired medications the old-fashioned way. Flushing pills and drugs down the toilet is unsafe for the environment. According to the American Pharmacists Association and the U.S. Fish and Wildlife Service, flushing medication down the toilet is a bad idea, since hormones, antibiotics and other chemicals can make their way into the water supply.
How to Properly Dispose of Expired Medications
Check to see if a local pharmacy will dispose of the medications. Consumers can also dispose of the expired pills, according to Brody, who says in the same article, “… crush pills and dissolve them in water; mix with kitty litter, coffee grounds, or sawdust to absorb the ingredients … ” Brody further instructs consumers to seal the ingredients in a plastic bag and toss it in the garbage. Sealing the ingredients prevents accidental animal poisoning.
There are a number of valid reasons for disposing of medications an elderly person no longer uses. Caregivers and seniors are urged to properly dispose of expired medications and any drugs that don’t have a normal presentation. It’s better to be safe than sorry where prescription and OTC medications are involved. Taking every possible precaution may very well prevent an accident.