When a new patient comes to my clinic, I ask them to list all their medications, including any over-the-counter medications, herbal and vitamin supplements they may be taking. Often times, they don’t know.

While I understand that it’s sometimes difficult to remember everything, I cannot tell you how important it is to your health and safety for you to know what you are taking and communicate that list to your own provider, the hospital or emergency personnel.

Let’s say you suddenly show up in the ER and are unconscious. Medical personal are not going to know what kind of medication you take or what your health problems are. This could be dangerous as they will be treating you somewhat blinded. As we all know, various medications should not be combined. But how will anyone know?

In our clinic, I have cards I give out to all my patients and encourage them to write down everything, each and every medication, and carry it with them at all times.

Here is a medication list I designed for you.  It has your information, your providers information, allergies and a place for you to list all your medications, why you are taking them, and how often. Feel free to download it, fill it out and carry it in your wallet or purse at all times. Keep it updated with new medications, or remove medications you are no longer taking.

Let me know how it works for you.

I saw this recall notice today. Digiteck, a fairly commonly used medication has been recalls. You are advised to call your pharmacy and/or return the medication to them for replacement.

You can read more about it here:  http://snipurl.com/26sfo 

Are you taking the wrong medications? According to a recent study you might be. Here is some information on safe medication practices including questions to ask that may protect you are your loved ones. Wrong Medications

Chances are if you or a love one take Avandia, you have heard this news. It seems that many of my patients heard this news before I did and called in a panic wanting to stop their medication. It reminded me  of when the Women’s Health Initiative came out saying that Estrogens were dangerous. Women around the country immediately stopped their HRT (and had all sorts of side effects from the abrupt cessation of estrogen).

While no medication is free from potential side effects, let’s stop for a moment and breathe. Let’s look at what we have.

1. Researchers did a meta-analysis of several other studies looking at Avandia. For those of you who don’t know, a meta-analysis just means they looked at other studies and brought the data together into one document (more or less a simplified description).
2. In all cases, those studies (I believe) were looking at the effects of Avandia on blood sugar…not cardiovascular complications.
3. People with diabetes already have a high risk of having a heart attack or other cardiovascular events. To determine if a medication is at the route of increased heart attacks, one must design the study to be able to filter out the heart disease due to diabetes vs medication.
4. None of the studies that were looked at, included Avandia’s close relative, Actos.
5. Depending on how the numbers are “crunched”, apparently different people were coming up with different data. (One of the things I find fascinating about studies…the way you ask the question, can determine it’s outcome).

The American Diabetic Association and the American Heart Association, issued statements stating that these are questions that certainly need to be asked (effects of Avandia and Actos on cardiovascular risk), but at the present time, urge individuals taking these medications to discuss this with their providers and not just stop the medication.

Currently, already in the works, is a study (RECORD) that is looking at cardiovascular risk in those taking Avandia. That study is expected to be complete with results available by 2009.

In the meantime, if you are looking for the “magic bullet” for diabetes care, I highly recommend taking a good long look at your diet and how you can increase your activity. In most cases, taking action on diet and exercise provide maximum benefits with almost no side effects. And often, it reduces the needs for the various medications that most people with diabetes have to be in, including medication for blood pressure and cholesterol.

(c)2007 Barbara C Phillips, NP

Nearly every day, I am asked my opinion on a variety of nutritional supplements. It can be something to help them stop smoking, lower their cholesterol or lose weight. Often it will be about the various “menopausal products” that are on the market.  One of the things I frequently tell people is that whatever they buy, make sure it comes from a reputable company. Unfortunately, there are not really only standards when it comes to supplements. Or so I thought.

I recently learned that high-quality dietary supplements can be identified by the “USP Verified Mark”. It’s an optional quality standard for nutritional supplements that is set by the United States Pharmacopeia (USP). What this mark means is that product has been submitted for testing and it meets the USP standards. In other words, the product has been verified that it contains what it says it does, does not contain harmful contaminates and has undergone proper manufacturing practices.

The USP website has lots of information on how to choose a good supplement in both written format and video.  Visit  USP for further information.

Wal-mart started it, and several other companies will be following. According to the following information from Wal-Mart, almost all plans can use the $4.00 medicaitons. I’d check with your local pharmacy and perhaps your health plan – especially if you are in a closed system such as Kaiser or Group Health.

Anyway…here is the list for you to see if you could benefit and lower your medicaiton costs.

Generic Drug List from Wal-Mart

An article in todays Women’s eNews starts out with the statement: “Women are frequent targets of direct-to-consumer pharmaceutical ads, which have helped fuel a boom in drug sales over the past decade. Critics say their gender focus is often misleading and can pose a hazard to women’s health.”

As a health care provider, I’ve always been concerned about these ads. I cannot tell you how many men and women have come into the office asking for something they have seen on TV. Because I don’t watch TV, I have to figure out what the “gotta go pill” is and then explain why it is or (far more often) is not a good idea for that person. And then in most cases, these pills are not covered on this persons insurance plan or it is covered…but on the highest tier – usually 50% of the cost.

Interestingly, these direct-to-consumer ads are banned in ALL countries of the world except New Zealand and the US.
I’m all for consumer education and for consumers taking charge of their health care. It’s just not as easy and advertising a “purple” pill.

What do you really think of these ads? Feel free to leave your comment.

A recent study confirmed what many of us have known for years…those of us that are older are more at risk for medications errors.

It makes sense. Think about it. Who takes the most medications, sees the most providers, has the most test, and tend to have more health concerns? In addition to all that is the issue of how our bodies function as they get older. For example, the metabolic processes in the kidney may not be what they use to be.

This is an issue I see on a daily basis – and it confirms for me the importance of having a primary care provider. As such, I get reports from specialists and see what they have prescribed or recommended. I also request that people put ALL the medications they are taking into a bag and bring them into their appointment. This includes over the counter medication. I’m amazed at how many people take too much tylenol (which is hard on your liver) for example.

So what can you do to protect yourself and your loved ones?

1. If you don’t have a primary provider – get one. While I am biased toward Nurse Practitioners, the choice is up to you. Just find one you are comfortable with.
2. Choose a primary pharmacy. When you get all of your medications from one pharmacy, they are much more likely to detect problems before they occur.
3. Whenever you visit a health care provider – be it a specialist, the ER, etc…make sure they know what medications you are taking.
4. Create and carry with you a list of ALL medications, nutritional supplements, herbs and over-the-counter medications you take. Include in this list any allergies along with what reaction you have.
5. Unless your health condition dictates otherwise (and your provider would have told you), keep your body hydrated…drink lots of water.

Your best bet of course is to avoid unnecessary medication all together. Eat right, exercise daily, and stay healthy!

(c)2006 Barbara C. Phillips, NP

This new study is good news to my ears. I’m always worried about the possible combinations between the drugs I prescribe, but feel really uneasy sometimes with the various herbs, especially is someon is taking coumadin (warfarin) or other medications that often interact with other substances.

Even though this study is good news, one still needs to remain cautious.

• Always treat herbs with the same respect that you treat prescription medications. Remember…they are drugs too.
• Always notify your health care provider and pharmacists of the over-the-counter medicaitons and supplments you are taking.I
• If you are taking a medication such as coumadin(warfarin), please research the supplment first – before you take it. It does not take much for the INR levels to get out of wack (If you take this…you’ll know what this means).
• Write out a list of everything you take (including the dosages and how many times per day), and keep it with you. You never know when you will need it.

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May 25, 2006 St. Johns wort, ginkgo biloba, black cohosh. Just a decade ago most Americans would not have known these names. Today, these and other herbal medications are not only familiar, but the products are fixtures on drugstore shelves.

Herbal remedies are not just for health food stores anymore. The medications have gone mainstream, and as sales continue to rise, so do concerns about their interactions with prescription and more traditional over-the-counter drugs.

But new research suggests that potentially dangerous interactions may occur less often than are widely believed. Investigators reviewed the drugs taken by 7,652, mostly older Canadians, and found very few instances of such interactions.

You can read the rest of this report there – Herb-Drug Interactions Uncommon

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In Feb of 2006 a study was published showing the beneficial results that grapefruit – especially the red type – can have on one’s triglyceride level (part of your lipid panel). This study also showed that grapefruit has powerful antioxidant effects as well.

This is great news, especially for those with elevated cholesterol panels and atherosclerosis (plaque build up in the vessels). As with everything though…this does not mean you should run out and start eating tons of grapefruit.

The downside to grapefruit is that it interacts with a certain metabolic pathway (CYP3A4)…and that pathway plays a big part in the metabolism of many, many medications – including the ones you may take to reduce your cholesterol level.

What medications are involved? Think blood pressure medication, benzodiazepines (that’s the valium/xanax family), some seizure and allergy medication, many of the statins (used to lower cholesterol, think lipitor and family), anti-fungal medications, estrogens, caffeine, some antibiotics and some antidepressants. Coumadin or warfarin is also affected – as they are with most everything.

One study looked at how long grapefruit inhibits the CYP3A4 pathway and found effects even 7 days after the ingestion of grapefruit juice – in healthy individuals. This could be radically different in someone who is taking medication for a problem. They also found in order to avoid this interaction; one should take no have any grapefruit within 3 days of the medication.

If you are taking something daily…well, that means no grapefruit.

New information is coming out all the time as more and more medications are tested and as more is learned about the metabolic pathways of medication and food. If you are like me, and love grapefruit…please check with your health care provider or pharmacists regarding any potential interactions.

©2006 Barbara C. Phillips, MN, NP