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Drug therapy 101

Polizzi, Maureen Goodhue LPN

doi: 10.1097/01.NURSE.0000458920.95597.77
Feature: SHARING
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This nurse uses each nursing encounter as an educational opportunity to help patients sidestep common hazards associated with their medications.

Maureen Goodhue Polizzi is an LPN at Yale Health Center in New Haven, Conn.

The author has disclosed that she has no financial relationships related to this article.

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MAKING ASSUMPTIONS is usually risky and best avoided, especially in nursing. But the one thing nurses should assume is the lack of medical knowledge our patients possess. Facts that we see as common sense may be completely foreign to even well-educated patients.1,2

Experience has taught me that nurses must provide instruction in “Drug Therapy 101” for all patients—and it should be the first class we teach. The following examples from my practice illustrate how nurses can help patients avoid serious problems by educating patients about their medications, both prescription and over the counter (OTC).

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Avoiding adverse reactions

Mrs. C came to the office for an injury she sustained at work. During the intake interview, she mentioned how tired she was. She told me that her healthcare provider had prescribed a sleeping pill for insomnia, which was effective, but 2 to 3 hours after taking it, she'd have to get up to urinate. I asked what additional medications she was taking. Among others, she reported a prescription for the diuretic hydrochlorothiazide (HCTZ), which she'd also been taking at bedtime ... with the sleep aid.

We went over her entire medication list, the best time to take each medication, and why. I wrote out a schedule that we agreed would work for her and she agreed to keep it with her medications for reference. I explained the real possibility that her interrupted sleep pattern was caused by the need to void during the night, so this simple change in timing could eliminate the need for the sleep aid.1-3

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Confusing instructions

Healthcare providers usually go over new prescriptions with patients during an office visit and the pharmacist provides a list of potential adverse reactions and instructions for the prescribed drug. However, patients often forget or misunderstand verbal instructions from the healthcare provider, and the medication information provided by the pharmacy is often lengthy and too detailed to read easily. The information included on the container's label might be overlooked by a patient with difficulty reading, diminished vision, or literacy issues.3-5 Nurses can intervene by providing printed instructions that are simple and easy to understand.

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OTC dangers

Many patients believe that because a prescription isn't required, OTC drugs aren't dangerous. They don't notify their healthcare providers that they're taking them; they don't read the fine print on the packaging regarding contraindications, adverse reactions, or interactions with other drugs; and they may overlook dosage instructions.

This was the case with Mrs. N, who came in to the office complaining of back pain. When I asked how she was managing the pain, she said she was taking ibuprofen—five to six pills about every 4 hours. This dangerously high dosage was alarming. But I was even more alarmed after I explained the negative effects ibuprofen or any aspirin-like medication can have, including decreased kidney function and bleeding tendency, adding, “That's why patients are instructed to completely stop taking these medications about a week prior to any surgery.” Mrs. N looked at me wide-eyed and said, “I'm having surgery tomorrow.” The healthcare provider was immediately notified and the surgery was rescheduled once bloodwork results were stable.3,6,7

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Dangerous “leftovers”

Patients frequently keep unused, prescribed medications (especially analgesics) in case they need them in the future. Unfortunately, if they take these medications without telling their healthcare provider, they risk interactions with medications added since the “leftover” medication was prescribed.

Mr. J, who visited the office for a knee injury, is a case in point. He had a history of back pain and had been prescribed ibuprofen. During his exam he reported that he was self-treating the knee injury with “leftover” ibuprofen, three times daily, and had added OTC naproxen. He had no idea that both drugs are nonsteroidal anti-inflammatory drugs and he shouldn't be taking them together.7,8 We discussed interactions and adverse reactions at length, along with the importance of not combining medications without consulting his healthcare provider.

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Watch out for supplements

Herbal and vitamin supplements are touted as promoting good health, which some do. They're also high on the list for misuse and pose a danger for interactions with medications (both prescription and OTC) or other supplements.9 In this era of “quick fixes,” patients are apt to subscribe to the belief “more is better,” so if 500 mg of a supplement is good, 1,000 mg must be even better. Patients rarely include supplements in any list of medications or discussions with their healthcare providers, so specifically ask them about any vitamins or supplements they're taking and provide information about potential interactions.

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Antibiotic misuse

Patients who don't complete a full antibiotic course as prescribed may encounter complications.10 Once patients feel better, they often stop taking the antibiotic, possibly resulting in treatment failure and contributing to antibiotic resistance. Reinforce the importance of taking antibiotics as prescribed, even after they feel better, by explaining the consequences of improper use. If the healthcare provider discontinues or changes the prescribed antibiotic, remind patients to properly discard any remaining medication.11

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Provide rationales

The prevention of patient medication misuse starts with the presumption that none of our patients understand the possible dangers of commonly prescribed or OTC drugs. Patients who understand the rationale behind medication directions are more likely to adhere to them. Use each nursing encounter as an opportunity for patient education.12-14

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REFERENCES

1. Centers for Disease Control and Prevention. High blood pressure. 2014. http://CDC.gov/bloodpressure.
3. Sudore RL, Schillinger D. Interventions to improve care for patients with limited health literacy. J Clin Outcomes Manag. 2009;16(1):20–29.
4. “What did the doctor say?”: improving health literacy to protect patient safety. 2007. http://www.jointcommission.org/What_Did_the_Doctor_Say.
    5. National Institutes of Health. What is health literacy? 2014. http://www.nih.gov/clearcommunication/healthliteracy.htm.
    6. Whinney C. Perioperative medication management: general principles and practical applications. Cleve Clin J Med. 2009;76(suppl 4):S126–S132.
    7. American College of Rheumatology. NSAIDs: nonsteroidal anti-inflammatory drugs. 2012. http://www.rheumatology.org/Practice/Clinical/Patients/Medications/NSAIDs__Nonsteroidal_Anti-inflammatory_Drugs.
    8. Ryan G. Can you double up on pain killers? American Society of Health-System Pharmacists. http://www.safemedication.com/safemed/PharmacistsJournal/CanYouDoubleUponPainKillers.aspx.
    9. Food and Drug Administration. Avoiding drug interactions. 2013. http://www.fda.gov.
    10. Centers for Disease Control and Prevention. About antimicrobial resistance: a brief overview. 2013. http://www.cdc.gov/drugresistance/about.html.
    12. Leigh E. Teaching patients about their medications: the keys to decreasing non-compliance. 2010. http://www.communicatingwithpatients.com/articles/teaching_about_meds.html.
    13. National Institutes of Health. Clear communication. 2013. http://nih.gov/clearcommunication.
      14. National Institutes of Health. Plain language: getting started or brushing up. 2013. http://www.nih.gov/clearcommunication/plainlanguage/index.htm.
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