Archives for April 18, 2003

May I Have Your Attention Please

The US now has the undivided attention of the world, (agree or not with how it happened). Most importantly, the Axis of Evil must be sweating, or whatever it is evil does (pinky-finger-to-corner-of-mouth).

A terrific graphic depiction by the cartoonists Cox & Forkum:
Iraq didn't Listen

via LGF

Medication side effects

MSNBC has a nice article about the prescriptions given to 1,202 adults in four outpatient clinics in Boston. From that they found that 1 in 4 have had a problem, either a drug reaction (including GI bleeding and low blood pressure); ‘serious’ side effects were found in 13%.

Other problems found:

-given the wrong drug 45 percent of the time,
-the wrong dose was prescribed in 10 percent of the cases
-told to take it too frequently 10 percent of the time.

The drugs that posed the greatest risk of side effects were the serotonin-reuptake inhibitor class of antidepressants, the non-steroidal anti-inflammatory drugs often given for joint pain, and calcium-channel blockers used to treat high blood pressure.

The article has a bit of editorializing about brief office interactions contributing to the problem. I have no idea whether this is a real cause or not, but I suppose it could contribute. I do see a terrific number of people on more than 10 different prescription meds, and wonder how they have room for food, let alone function on that many meds. The article does not make clear where the problem occurred, whether in the doc’s prescription, the filling or labelling of the med, etc.

Pharmacists have a tough job, and not just reading doctors’ handwriting. We get calls from pharmacists questioning prescriptions once in a while, and about 1/2 of the time it seems they’ve caught a substantive issue before it causes a problem, which is how it’s supposed to happen. (On the other hand, the patients sent back to the ED because ‘the Doctor wrote the prescription wrong’ because that one pharmacist cannot do math drives me crazy; it calls our competence into question to the patient because the pharmacist cannot figure out that Prednisone 60 mg PO QD, with a Dispense# of QS (quantity sufficient), meaning they have to multiply their 20mg tablets time three to get to the D# makes me wish we could dispense from the ED).

Anyway, I have yet to find a problem with a pill bottle brought into the ED. And, ‘side effects’ isn’t defined in this article. Headache? Indigestion? Don’t feel right? Underwear too tight? All ‘side effects’ of medications. If you want to see side effects, see the Physicians’ Desk Reference (PDR) wherein they have to list every reported side effect during clinical trials. Useless for actual side effects, it’s in there because it’s required.

As Rick says, medications are controlled poisons, and they have effects, good and bad. If you have side effects, talk to your doctor (and when he says ‘go to the ER’, just laugh and say OK).