My gran has over two dozen different prescriptions in her weekly pill cases.
They are ordered by four different types of doctors, cardio, dermatology, podiatry, etc. and may be added to by more than one doctor at each clinic or hospital. She tries to give them all updated lists every time something changes, but take the last time, she had a broken bone and a sports doctor gave her new stuff to take. She won’t see the hear doctor again for a couple of months. Would you trust that a sports doctor know about what’s good for her heart?
Do you think any pill maker even tries to test such combinations?
Do you worry about your own pills, to the extent you will try to limit the number prescribed?
Duplicate. Answer other thread. Thanks
I just closed the duplicate thread, so discussion can proceed in this one.
They may be prescibed by several various doctors, but so long as they are dispensed at the same pharmacy, the pharmacist should check for interactions and intervene if concerned. He/she knows more about drugs than the doctor(s), anyway.
We had a pit thread a while back “Why must I wait at the drugstore? Just put my damed pills in the bottle already.” This is one answer to that (non)rhetorical question. If you’re such a big-shot that you can’t be bothered, do like the Microsoft Billionaire whose prescriptions I filled when I worked at Longs’ on Mercer Island: send your flunkie in to wait for you. Oh, you don’t have a flunkie? Too bad.
PS: flunkie was so freaking hot, I almost filched some of the Accupril to recover.
I believe they try their best. The pharmacist is the second line and also checks. Techs use a program that has all the bad stuff already programmed in. If a Tech enters a script in that conflicts with one that they are already taking they get an error message. They then had it off to the Pharmacist and if they can’t figure it out they will call the original doctor.
If she has insurance than they should also catch the drug interaction if pharmacy does not.
Here’s the problem: we usually have a pretty good idea of potential reactions between two medications. Occasionally, very rarely, we have a known reaction between three medicines.
More than that? It’s anybody’s guess, really.
One of my attendings always said that someday we were going to put a patient on exactly the wrong combination of ten medications, and the patient would explode.
Aren’t there now computer programs that will help pharmacists and physicians keep track of drug interactions? I have a friend in the pharmacy biz – I should ask him. seems to me it would be a godsend – providing, of course, accurate info went into it.
If she goes to the same pharmacy to refill all her prescriptions, then the pharmacist will check to see if there are any interactions with her current medicines when a new prescription comes in. If there is, they will call the doctor and inform them of this fact, to find out what alternate treatment the doctor wants to give. ETA: Yes, Sunrazor, they use a computer program to alert them.
And yet within the last 3 months both pharmacies and doctors have missed identified interactions for patients in my family–so if you have any concerns, ask rather than assuming that everything is okay unless you hear otherwise.
What I’d suggest is asking whoever covers her cardiology.
My doctor sat down and looked at the interactions for drugs while I was there once. I was an extreme problem case, but he spent extra time on me. He did research beyond my appointments. I think most try to catch interactions, but I don’t expect them to never miss one.
I got $10 off once for asking the pharmacist why my medicine looked different. It was a different source, but they were happy that I paid attention.
That’s great! I wish that more pharmacies would be willing to do that to get patients to think about the pills they’re getting.
And DoctorJ, if you hit that 10 drug combo, please MPSIMS it when you find it!
A week ago my heart went into Atrial Fibrillation. I went to the emergency room. I told every single doctor there my history, including the fact that my stomach has been effectively removed.
Later in the day they prescribed Protonix for me. This is a medicine that suppresses stomach acid.
I questioned the nurse giving it to me. Protonix? Really? I don’t have a stomach.
She shrugged and said: Well, that is what was prescribed.
I spoke to the LPN. She covered her mouth to stifle a chuckle. “Whooops. I never would have made the connection.” She grinned. I spoke to the teaching doctor. *She *took it seriously. She told me to always question and to refuse anything that I have doubts about. She also assured me that Protonix won’t hurt me.
Protonix won’t hurt me, so it was no big deal. But the story should answer your question.
It’s pretty much knee-jerk reflex to put folks who are on meds that really really raise the risk for GI bleeding on acid blockers like that.
And unless I was sure that your entire stomach had been completely (not effectively) removed, I’d probably have put you on it too.
I know I try to keep my meds to an absolute minimum, and only have to balance 3 docs - an endo for my parathyroid issues and diabetes, my gp for the bp and cholesterol meds and my ob for the stuff for my pcos. I keep my list on my PDA, and will specifically ask about interactions. I just introduced my gyn to Byetta, she had to actually double check that what she was giving me as a temporary med would not have issues with anything else - she had never heard of it, and I had the paperwork in my glucometer kit so I gave it to her. Of course I let mrAru run my med list through the safety checking program at his job, [case manager with MetLife] just to make sure=)
Anti biotics sometimes wreak havoc with birth control pills. My dermatologist put me on some antibios–my gynecologist warned me about that, so I would know to use condoms. When I asked him about it (because I wanted to go off them, several reasons), he told me that that wasn’t true and that my gynecologist had probably fallen prey to an old wives’ tale. Yeah, I axed him soon.
Your dermatologist was correct.
There are hypothetical concerns about interactions between antibiotics and many meds, but no hard evidence that they interfere with birth control pills except for: Rifampin.
Would you like to meet my granddaughter. Oddly, that is exactly how she came to be.
Would it count if I explained to you that my stomach was *fully *bipassed - that the esophagus was now attached *directly *to the small intestine? Even if you didn’t believe me, certainly the CT scan that was done would have shown it. While technically the stomach is still there, nothing goes into it. This was explained to me by my surgeon and then again by the rather startled radiologist doing the upper GI.
I guess the new meds that there were administering might have put me at risk for GI bleeding - but before that I was taking nothing.
[hijack]Actually that is a big difference from what you said initially which was 'my stomach has been effectively removed". The medicines that increase your risk of GI bleeding and the medicines that reduce those risks (Protonix) will continue to act on your gastric tissue regardless of whether your stomach is attached to your esophagus and intestines (assuming you are still absorbing the medicines). Most of the effect takes place via the circulatory system and less through direct effects of being in the stomach.
In fact you may be more at risk for a bad outcome (I’m speaking theoretically here, I have no data about your particular surgery), because you may not have the typical warning signs of a bleed (black tarry stools) before your ulcer perforates.
QtM, do you agree?[/hijack]
As to the OP, JCAHO (the Joint Commission on Something Hospital Something), now known only as the ominous Joint Commission has mandated that all patients entering the hospital have a ‘medication reconciliation’ before they leave. If they come to my ER and are discharged, I’m expected to review every single one of their medications and make changes if I find any potential drug interactions. Do I do this? No, I don’t have the time or inclination to enter 30 medicines into a ‘interaction machine’ and review them all with the patient and I’m certainly not going to make changes in a patient’s chronic medications as this is beyond the scope of my practice or training.
Now, if I am prescribing a new medication or their visit is related to a medication then I will review those particular medications in detail and make changes if necessary. But if you come in for a stubbed toe, I’m not making any medications changes.