Pharmacists Help Solve Medication Mysteries

by Food and Drug Administration (FDA)

When a diabetic patient called her pharmacist, Vern Gideon, to have her prescription refilled, Gideon looked up her records and noted that she still should have an ample supply of the medication. He called his client back, and she told him that her doctor had increased the dosage of the drug. She was taking two additional tablets in the morning and one in the evening. She also mentioned that even at the new dosage she did not feel quite right.

Gideon called her doctor to discuss the medication change and the patient's complaints. The doctor said that he had anticipated that the increased dosage would be more effective in lowering the patient's blood sugar. He didn't know why it wasn't working.

Gideon wondered whether the patient was taking the medication correctly. He repeated to the doctor the medication schedule the patient was following, and he and the doctor then discovered the problem. The patient had reversed the schedule: She should have been taking one additional tablet in the morning and two in the evening.

The patient's blood sugar level is now "back on track," Gideon says.

Simple Solutions

"Answering medication questions is the type of thing we do all the time," says Gideon, owner of Guardian Pharmacy in Arlington Heights, Ill. Many medication problems are common and the solutions simple. For instance, new clients often come in to have a prescription filled for a commonly prescribed arthritis drug. Gideon always cautions them against taking the drug on an empty stomach. And often the response is, "that must be why I felt sick the last time I was on this medication."

Whenever a patient comes in with a new prescription or for the first refill, Gideon discusses with the client how and when to take the medication, common side effects, and foods and drugs (both prescription and over-the-counter) to avoid when on the medication.

Gideon is remodeling his pharmacy so that he will have a special area where he can discuss medication problems with patients. "Patients are entitled to counseling about the drugs they take," he says. Gideon will even have a private room for patients who want to ask him about issues they find embarrassing--such as incontinence products or impotence caused by some medications.

Ask Your Pharmacist

Gideon is not alone in his commitment to patient counseling. According to a recent FDA survey, pharmacists spend about 23 percent of each workday counseling patients about their prescriptions. According to a 1988 survey from the National Association of Retail Druggists, which represents pharmacists who own independent drugstores, the questions patients ask most often concern drug side effects, drug use with alcohol, and how and when to take medications. Pharmacists cover a wide range of medication concerns, including dangers of prolonged use, proper storage, and use in pregnancy.

"Medicines have become a standard part of health care for Americans of all ages," says Bob Bachman, executive director of the National Council on Patient Information and Education (NCPIE). In the past eight years, NCPIE has pulled together 260 private and public sector groups to place prescription medicine misuse on the public health agenda. NCPIE's theme in 1990 was "Break the Rx Silence Barrier: Talk About Prescriptions." The organization provided a kit for health-care professionals with strategies for building medication counseling skills.

"Patients often aren't sure what to ask about their medications," says Curt Barr, owner of Barr Pharmacy in Blair, Neb. "I'll talk to a patient about a prescription, and then all of a sudden the neatest thing happens. The patient starts asking relevant questions about other medications--for instance, whether to take them before or after meals or what interactions to consider."

Joan Ballentine of Ballentine Pharmacy in Deckerville, Mich., is an advocate of what she calls "aisle visits." She often leaves her counter to answer questions and help patients choose over-the-counter drugs. These aisle visits, she says, remind patients that their "family pharmacist" is available to help them with their drug questions.

Best in Drug Information

"Pharmacists are the most accessible health-care professional," points out Robert Appel, an official at NARD. "Patients have easy access to their pharmacist and don't need an appointment to consult with him or her."

In addition to being accessible, pharmacists are drug experts. They receive five or more years of training in pharmacology (the science dealing with the preparation, uses and effects of drugs) and therapeutics.

Mark Todd, a pharmacist at the University of Florida's Medical Center, describes a consumer drug information service he offers in his community. "Drugs can cause serious problems if not taken properly," says Todd. To counter many patients' confusion about their drugs, five years ago Todd started a hot line that patients can call. "Most questions we get are so basic that it's sad," says Todd. For instance, he says that many people don't know why a drug was prescribed. They can't pronounce the name and are embarrassed to ask the pharmacist.

Todd says that in addition to answering questions, he tries to encourage patients to choose one pharmacy for filling all the prescriptions and to develop a relationship with the pharmacist.

Recently, an asthma victim called the hot line because he was feeling jittery and uncomfortable. Upon questioning, Todd learned that the patient had visited two different physicians, one for his asthma and the other for another ailment. Both doctors had prescribed inhalers that contained similar drugs. The patient had filled each prescription at a different pharmacy, and he ended up taking a double dose of the medication. If the patient had filled the prescriptions at the same pharmacy, the pharmacist would have caught the error that caused the side effects, says Todd.

Special Patients and Special Services

For some patients, such as the elderly or persons with a chronic health problem such as heart disease, a personal pharmacist is especially important.

NCPIE reports that one Australian study showed that elderly women took an average of about six prescription drugs and three over-the-counter drugs at the same time.

A pharmacist with all the drugs on file for a patient taking multiple medications, often prescribed by different doctors, would know whether certain drugs might cause serious side effects when taken together. This same pharmacist, who knows that a patient has a heart problem, for example, might caution her against buying an over-the-counter drug that would interact with prescribed drugs.

Many pharmacists are responding to the special needs of their elderly patients in unique ways. Nelson Showalter, president of Williamson's Pharmacy in Harrisburg, Va., conducts a walking club for his older clients. Gideon visits a retirement community every Wednesday afternoon to answer questions. Last week, he says, an elderly woman who uses a cane told him she was feeling wobbly on her feet and wondered whether her medication was causing the problem. Gideon reviewed her medications and then inspected her cane. He discovered that the rubber tip had come off and replaced it. She now has no trouble getting around.

Often, because of the number of medications they take, elderly patients have difficulty remembering when to take which medication. Many pharmacists develop special "compliance charts" for these patients, to help them keep track of their medications. Pharmacists also use large print or symbols on prescription bottles for their visually impaired patients.

Whitaker Moose, owner of Moose Drug Co. in Mount Pleasant, N.C., developed a coding system for illiterate patients and those who do not read or speak English. The system uses symbols of the sunrise, full sun, sunset, and night to represent times, as well as plate and utensil symbols to show whether a patient should take the medication before or after meals.

About the Author

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