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Healthy Living

Know Your Prescriptions: Keep a List and Always Ask Questions

By Sheryl Kraft

Created: 01/28/2014
Last Updated: 01/28/2014

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When my grandmother was alive, she always kept a neatly folded piece of paper in her wallet. It contained a list of all the medications she took. I remember looking at it one time and being shocked at the sheer length of the list.

Since my grandmother lived into her nineties, I can only assume that some of these medications helped keep her alive. Still, it begs the question: Would she have benefitted by not taking some of them? Might some of the medications have been unnecessary or even harmful to her health?

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Those questions have no answers now. But what is known is that there is an overprescribing trend in this country. The average American fills 12 prescriptions each year, with 40 percent of adults over 60 taking five or more drugs.

It's easy to get caught up in the medication whirl, which makes it even more important to know your prescriptions. We live in a culture of quick fixes. Patients, in search of a "cure," often push for a pill or a shot. And health care providers, in their desire to help, might not want to turn them down. They may fear disciplinary action by their local medical board or even a malpractice suit.

Clouding the issue even more are advertisements promising the newest miracle drug, a crowded, rushed health care system that makes it more time-efficient for a doctor to write a prescription than to sit down and discuss the possible side effects or alternatives.

Sure, medications treat problems. But the flip side is that they can also cause problems. It's a fine balancing act of benefits and harms that can be difficult to tease out. It's not uncommon for patients to be treated for various conditions and end up with multiple prescriptions simultaneously from different specialists. And then, things can easily spiral out of control, with dangerous drug interactions occurring.

Before too long, you're (still) not feeling well (or even feeling worse)—but rather than blaming the health condition, you might want to blame the medication.

Here's an example of how easily and quickly things can go wrong.

You take a popular antidepressant; you also take a cholesterol medication. The combination can cause dizziness or seizures. Although the dizziness or seizures is a drug side effect, it ends up being treated with yet another medication. Before you know it, the side effects of each drug are being treated with a new drug.

That's how people can end up taking upward of 10 or even 20 medications, known as "prescription cascade."

A little while back, I spoke with Armon Neel, PharmD, a geriatric pharmacist in Griffin, Georgia, and author of Are Your Prescriptions Killing You? (Simon & Schuster, 2012), who told me about a woman, confined to a wheelchair, who was on 29 different drugs. "Each drug led to a side effect, which was treated with yet another drug. After careful analysis, she now takes just three medications and is out of her wheelchair," he said.

Neel also pointed out that sometimes the risks of a drug can start to outweigh the drug's benefits. For example, as you age, your kidneys become less efficient at clearing drugs from your body. Certain medications, like tranquilizers, can build up to toxic levels, leading to drug-induced sedation, which can then lead to dizziness and falls.

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"A drug that works at 25 may not work at all or may cause a lot of interactions at 60," Neel said. You have to know the chemistry and physiology of the individual patient, he explained.

While growing older might mean the need for more medications, here's how you can be a savvy patient and manage your needs.

The next time your doctor pulls out a prescription pad, ask the following questions:

  1. Why is this being prescribed?
  2. What exactly is this medication for?
  3. What are the most likely side effects? And what are the rare but more dangerous ones?
  4. What is the best way to take the drug—with or without food, for example?
  5. Could the medication interact harmfully with over-the-counter medications, dietary supplements, certain foods or alcoholic beverages?
  6. If I decide to stop this medication, can I stop taking it all at once or do I have to taper off? (For example, some blood pressure medications, if stopped suddenly, can cause a sharp rise in blood pressure or other dangerous "rebound" effects.)
  7. Are there other nondrug therapies (like diet modification or exercise) that might be appropriate?

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In addition, like my grandmother did (and now I do, as well) keep an up-to-date list of your current medications and their dosages with you at all times, and show it to any physician prescribing a new medication. Don't assume your doctors are in communication with one another about all the medications you might be taking.

Finally, it's a good idea to fill your prescriptions at the same pharmacy and ask your pharmacist any questions you might have. A good one: "How safe is this medication and what should I watch out for?" Often the pharmacist is the best point person because they're the last stop before the prescription hits your hands.

Comments

Good to know this. I'm not at the point yet where I take prescription medicine, but I know the day will come.

Nice that you don't have to worry about any of this yet, Helene. Hope that continues for a long, long time!

I keep a list in my phone. The hard thing is remembering to update it when things change. My parents are struggling with the fact that they now spend 4 mos of the year in FL. It is difficult to manage this with several drugstores, particularly with triplicate hard copy narcotics.

Wow, things can really get complicated, from what you describe. Proof that we need to really be on top of this.

I had to pay attention to this when overseeing my mom's care. I once came into her hospital room to see a new bag on the IV pole. I asked what it was, and it turned out to be a drug she SHOULDN'T have. I had the nurse page the cardiologist on duty, and when he arrived, I told him, "I'm sorry to throw a flag on the play, but I'm throwing a flag on the play." He checked with my mom's main cardiologist and came back, saying "You're right!" If I hadn't been paying attention and asking questions ... who knows what might have happened.

What a scary story, Roxanne. It makes you wonder what would have happened if you were not there, or not so aware. And for people who have no one to check on them? Potentially deadly consequences.

Excellent advice. So many people take nutritional supplement but may not tell their doctor because they think natural means safe. But many can have significant and adverse reactions when combined with prescription drugs.

So true - natural is not always harmless, especially when combined with other things.

These are great questions for anyone taking medication to ask. Thanks for the excellent info as always.

You are so welcome, Estelle - and thanks for reading and commenting!

You are so welcome, Estelle - and thanks for reading and commenting!

Thanks for a great article. Very informative and helpful. I keep my list of medications on my iPhone in Evernote.

Ah, you are so organized, Sandra. A good tip - no need for extra pieces of paper to worry about getting lost~

And if ever refilling, ask if any labeling has changed. An excellent list here...a keeper.

Good thing to add, Meredith - thanks!

Terrific, Sheryl! Your articles are always so full of great info. This could definitely save someone's life!

Thanks so much, Mindy. I do hope I am able to help by informing people of possible dangers.

What a great article, Sheryl. Makes me think of my 96-year-old father-in-law who isn't on one prescription drug. I've become far more cautious -- or is it cynical? -- about automatically agreeing to take anything.

That is absolutely incredible, Ruth! He must be very hearty. I wonder if there were meds that he said no to.

Started doing this with my mom and husband - have a list we all carry with us in the event of an ER visit.

That's good, Jane. Always good and wise to be prepared.

Try as a way to list your meds and get reminders. It is free and has iPhone and Android apps too.

Thanks for the tip, Donna. I'll check it out!

Such great tips. And I agree about the over prescribing of drugs. It's a huge problem.

Yes, Donna, overprescribing is such a far-reaching and prevalent problem. Scary, too.

Excellent advice, as usual. So many people lose track of the meds they're taking, especially if they're taking myriad different drugs. And they also may not question a physician who prescribes yet another drug in terms of potential side effects, drug interactions, etc.

Thanks, Jeanine. I agree that it's so easy to lose track or not even know enough about all the meds we take.

Excellent article. Many fail to realize the implications any medication has (including supplements)on all parts of their healthcare. Great reminder.

Thanks for reading, Marielaina. Appreciate your feedback!

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