Question 1

I HAVE DIFFICULTY SWALLOWING LARGE TABLETS AND CAPSULES. WHICH MEDICATIONS CAN I CRUSH?

Accepted Answer

The list of medications that cannot be broken, crushed or chewed is quite extensive and the answer is not always straightforward. One important consideration is how quickly the medication is supposed to be released in the body to have its desired effect. In general, if a tablet or capsule is designed to be released slowly throughout the day (i.e., extended-release, sustained-release, controlled-release, long-acting, etc.) it should not be broken, crushed or chewed.

You should also consider whether the medication is coated. The purpose of certain coatings is to keep the medication intact as it travels through the acid in the stomach so it can reach the area where it will be absorbed without being broken down. Another reason for coating tablets might be to protect the stomach from being exposed to medication that is irritating, such as aspirin. Other reasons that a medication should not be broken, crushed or chewed may be to prevent unpleasant taste or irritation to the lining in the mouth.

There may be other reasons your medication should not be broken, crushed or chewed. You can check the "Do Not Crush" list at the Institute for Safe Medication Practices, but please be aware that this may not be a complete list. When in doubt, ask your pharmacist! – Brandi Weller, 2018 PharmD candidate, and Jennifer Dill, Drug Information Specialist

Question 2

IS IT SAFE TO GET MY MEDICATIONS FROM AN ONLINE PHARMACY?

Accepted Answer

There are several things to consider before purchasing your prescription medication from an online pharmacy. It is important to verify the legitimacy of an online pharmacy by looking for the VIPPS (Verified Internet Pharmacy Practice Site) symbol and certification. This certification tells you the following: The pharmacy is located here in the U.S.; they dispense only FDA-approved medications; and a valid prescription is required. Without the VIPPS symbol there is great potential for you to receive counterfeit medication, substandard drug product or a generic form of a drug that is not approved here in the U.S.

Other red flags a website is unsafe include: lack of a phone number to contact the pharmacy; advertising drastically lower prices than traditional pharmacies; offers to sell the medication to you without a prescription (which is against the law); and requests for personal information such as a Social Security number without a secure connection. The best resource is to obtain prescriptions from a trusted pharmacist at your local pharmacy. If you need the convenience of an online pharmacy, stick with well-known websites of local pharmacies or inquire about home delivery options at your favorite brick-and-mortar pharmacy. – Missy Wilson, Clinical Pharmacist

Question 3

IS THERE AN OVER-THE-COUNTER PRODUCT THAT CAN REDUCE OR PREVENT MOTION SICKNESS?

Accepted Answer

The best way to prevent motion sickness is to take preventive measures before symptoms appear. A common medication class to prevent and treat motion sickness includes first-generation antihistamines. These products diminish stimulation of the area of the ear and brain that control balance, which causes motion sickness. These medications should be taken 30 minutes to one hour before travel. Dimenhydrinate and diphenhydramine are effective but can cause significant drowsiness. An antihistamine with less potency and less drowsiness is meclizine. A nonmedicated option for treatment is an elastic wristband that puts pressure on an acupuncture point on the wrist, which may be a good option for elderly patients to prevent drug side effects. Make sure to talk to your healthcare provider or pharmacist before taking any medications to ensure they are safe and do not interact with your other prescriptions or medical conditions. – Angela Miller, Clinical Pharmacist

Question 4

I AM THINKING OF TRYING A NEW HERBAL SUPPLEMENT. HOW CAN I TELL WHICH BRAND IS THE BEST PRODUCT TO USE?

Accepted Answer

Unlike prescription products, herbal and dietary supplements are not reviewed by the Food and Drug Administration with regard to quality and purity standards prior to marketing or sale. With that in mind, herbal and dietary supplements may voluntarily undergo review by the United States Pharmacopeia (USP) to verify the quality of these products. USP is a scientific, nongovernmental, not-for-profit organization that sets standards for many products manufactured in the United States. These standards include specifications for the quality, identity, purity, potency and consistency of several over-the-counter products, including herbal supplements. When interested in trying a new herbal supplement, be sure to look for the USP seal to ensure the product you purchase meets these specification standards. – Sheena Burwell, Clinical Pharmacist

Question 5

WHAT ARE HOME INFUSION THERAPY SERVICES?

Accepted Answer

Home infusion therapy involves the administration of a sterile medication through a needle or catheter in a patient's own residence. It is used when a patient's condition cannot be treated effectively by oral medications. Home infusions are safe and effective, having been provided since the 1980s.

Home infusion therapy is more convenient for patients than traditional infusion clinics, particularly for those who receive multiple treatments per day. Medications are shipped or delivered directly to the home, where nursing staff will arrive to prepare and administer the medication. – Jeff Prosch, Assistant Director of Pharmacy

Question 6

I RECEIVED ALL NECESSARY VACCINES AS A CHILD. WHY DO I NEED TO RECEIVE BOOSTER VACCINES AS AN ADULT?

Accepted Answer

Vaccines protect you from infection by essentially training your immune system how to effectively respond to a specific microbe (usually a bacterial, viral or fungal strain). Over time, this immune memory may diminish and reintroduce the risk for acquiring the infection. In these circumstances, repeating vaccination will "boost" your immune system memory to improve detection and elimination of the infectious threat. Various factors assist in determining if a booster vaccine is necessary, which may include the infection targeted by the vaccine, expert recommendations and use of blood samples to test for immune system antibodies. – Jace Knutson, Clinical Pharmacist

Question 7

WHAT IS A SPECIALTY MEDICATION?

Accepted Answer

Although there is no universal definition of specialty medications, there are two main factors that determine whether a medication is labeled as such: cost and complexity of treatment. Centers for Medicare and Medicaid Services categorize specialty medications as those having a monthly cost of at least $600. Medications acquiring additional monitoring for safety and efficacy, as well as those with special storage requirements, may also be considered specialty medications. Examples of specialty medications include: biologic agents for immune diseases, direct antiviral agents for hepatitis C treatment and enzyme replacement medications.

Specialty products are the fastest growing segment of the prescription market in the United States, accounting for nearly half of all drug spending today. Most of these prescription products are only available from specialty pharmacies, which focus on these agents to manage inventory, assist patients with access to the medications and provide comprehensive services to improve patient care. – Angelica Costanzo, Clinical Pharmacist

Question 8

WHY IS IT IMPORTANT NOT TO SHARE MY MEDICATIONS?

Accepted Answer

There are several reasons why it is a bad idea to share your medications. Not only is it against federal law to do so, it can also be very dangerous. The person you are sharing with may have an allergy to the medication or may interact with other medications the person is taking, including over-the-counter items. Medications also affect people in different ways, possibly leading to dangerous side effects.

People may also require a different type of drug to treat their condition. For example, respiratory symptoms may be caused by a virus, which would not be treated the same way as a bacterial infection.

Leftover drugs that are expired most likely have less effect or even dangerous effects if taken. Always remember that it is important your physician evaluate your condition before taking a prescription medication. Talk to your pharmacy to see if they have a drug take-back program, or ask how to properly dispose of your old medications to keep everyone safe. – Amy Faustino, Clinical Pharmacist

Question 9

WHAT ARE SOME TIPS OR TOOLS I CAN USE TO REMEMBER TO TAKE MY MEDICATIONS?

Accepted Answer

Remembering to take medications can be challenging. One tip to help patients take the right medications at the right time is sorting them into a weekly medication organizer or pillbox. Medication organizers can be bought from almost any pharmacy and help visually organize medication regimens by day and time. Setting an alarm on a watch or phone can also provide a prompt to take those medications. Smartphone and tablet users may download apps that can be programmed to alert when it is time to take a given dose.

Some companies are exploring technology to create "smart" prescription bottles. Electronic caps can record every time the bottle is opened, and a weight sensor in some models even ensures that the full dose was removed. However, one of the best methods to stay adherent to your medications is asking family members to help with reminders, which can also add support and encouragement. – Naomi Digiantonio, Clinical Pharmacist

Question 10

WHAT ARE THE DIFFERENCES BETWEEN BRAND AND GENERIC MEDICATIONS?

Accepted Answer

When a new medication is ready for approval, the manufacturer chooses a brand name under which to market the drug. This name will be used while the medication is patent-protected and usually afterward as well. Since it is chosen by the manufacturer, the brand name is often catchy, easy to say and thus easy to remember. However, each medication also receives a chemical name and generic name assigned by official councils.

When the brand's drug patent expires, other drug manufacturers can develop their own version of the medication. These would be marketed as generic products, using only the generic name. Each generic must still pass the rigorous standards established by the FDA with respect to identity, strength, quality, purity and potency. The generic product must be shown to be bioequivalent, or the same as, the brand product with only a narrow margin allowed for variation.

However, this generic approval process often requires shorter and less complex scientific trials that save development costs for the generic manufacturers. These savings can be passed on to patients and providers. Several manufacturers can develop competing generics of the same product, increasing competition and furthering savings. Inactive ingredients and the appearance of generic medications can vary from their brand counterparts, but these changes must be proven not to affect safety or efficacy. Today, generics make up 8 out of every 10 prescriptions dispensed, offering comparable quality as their brand equivalents while decreasing healthcare costs overall. – Jeffrey Pilz, former pharmacy resident

Question 11

DO I REALLY NEED TO DISCARD MEDICATIONS AFTER THE EXPIRATION DATE?

Accepted Answer

Like food in the grocery store, medications have specific expiration or beyond-use dates that inform patients of when to replace their drug supply and discard outdated medications. Over time, chemical ingredients making up medications can degrade or react with the environment, changing the potency or chemical composition. Some drugs, such as aspirin, can even degrade into harmful substances past their expiration. Other medications may simply not work as well as the active ingredient decreases. "Expiration dates on medical products are a critical part of determining if the product is safe to use and will work as intended," says Ilisa Bernstein, FDA pharmacist.

The expiration date is the latest date for which a manufacturer can guarantee the medication is safe and effective for use. This is determined from extensive chemical testing. Beyond-use dates are similar to expiration dates, but are applied to compounded or repackaged medications and are determined by both stability testing and U.S. Pharmacopeia (USP) guidelines. If your medication is past the expiration or beyond-use date, it is important to properly dispose of it. Noncontrolled substances can be dropped off at our main hospital and Westwood pharmacy locations, which participate in a drug take-back program. Patients can also throw away medications in the household trash by mixing them in a bag with kitty litter or coffee grounds. Check with your pharmacist for more information about drug disposal and expiration of medications. – Jeffrey Pilz, former pharmacy resident

Question 12

CAN I FLUSH MY UNUSED MEDICATIONS DOWN THE DRAIN?

Accepted Answer

Medications can be dangerous if taken by anyone other than for whom they are prescribed. Certain pain medications can be flushed as a safe means of disposal, but this list is limited. The FDA has a complete list of medications approved to be disposed of through flushing.

It is important to note that most medications cannot be disposed of this way. We offer safe medication disposal at some of our locations. Call 913-945-5405 or email specialtyrx@kumc.edu to find out how to safely dispose of medications at our pharmacy.

If throwing away medications at home, do not flush or pour unused medications down a sink or drain. If no take-back program is available in your area, throw the drugs in your household trash following these steps:

Remove the drugs from their original containers and mix them with used coffee grounds or kitty litter. This makes the drugs less appealing to children or pets and unrecognizable to people who may intentionally go through trash seeking drugs.
Place the mixture in a sealable bag, empty can or other container to prevent the drug from leaking out or breaking out of a garbage bag.
– Kelsey Konrardy, former pharmacy resident

Question 13

WHY CAN'T I GIVE A TODDLER OR INFANT OVER-THE-COUNTER COLD MEDICATIONS?

Accepted Answer

In 2008, manufacturers of cough and cold products for infants and children less than 2 years of age removed them from the market due to safety concerns. These safety concerns included many reports of harm, and even death in children who consumed improper doses of common over-the-counter cough and cold products. Most of those reports were in children less than 2 years of age.

If your child is less than 2 years old, consider some safe alternatives to cough and cold medications, including the use of a cool mist humidifier, saline nasal drops and a nasal suction device. If you are looking to use acetaminophen or ibuprofen to help relieve your child's fever and aches associated with the common cold, be sure to check with your pharmacist or child's healthcare provider for proper dosing instructions. – Michelle Simonsen, Clinical Pharmacist

Question 14

DO I NEED AN ANTIBIOTIC TO HELP WITH MY COLD?

Accepted Answer

No, antibiotics will not help cold symptoms. Colds are caused by viruses, and antibiotics do not fight viruses; they fight bacteria.

Taking antibiotics for viruses such as a cold will not cure the infection, prevent others from catching it or help you feel better. Taking antibiotics for viruses when they are not needed can put you at risk for getting a bacterial infection resistant to antibiotic treatment.

If cold symptoms arise, talk to your healthcare provider for information on what will help relieve symptoms and help you feel better faster. – Amber Sawyer, former pharmacy resident

Question 15

ARE ADVIL AND TYLENOL THE SAME THING?

Accepted Answer

Tylenol (acetaminophen) and Advil (ibuprofen) are both good medicines, and both provide relief from fever and pain, even though they have different chemical structures and side effects. Ibuprofen works by limiting the body's production of prostaglandins. In addition to reducing fever, body aches and pain caused by prostaglandins, ibuprofen also reduces inflammation (swelling and redness). Acetaminophen works primarily in the brain to block pain messages and reduce fever. That means it can help relieve headaches and minor pains, but it's not as effective against inflammation and the pain associated with it.

There are side effects specific to acetaminophen and ibuprofen. Taking too much acetaminophen can damage your liver, perhaps permanently. Prolonged use of ibuprofen can lead to kidney damage and stomach ulcers. Always consult your pharmacist or doctor to see which medication may be right for you. – Chris Norris, Home Infusion Clinical Pharmacist

Question 16

DOES IT MATTER IF I TAKE MY MEDICATION WITH OR WITHOUT FOOD?

Accepted Answer

Whether you should take your medication with or without food is dependent on the medication itself. Some medications bind to certain elements within the food you eat, therefore decreasing the absorption of the drug, which leads to less potency/efficacy. Other medications require food intake to increase absorption. Talk to your pharmacist to determine the best way to take your medication. – Lucy Stun, Critical Care Clinical Coordinator

Question 17

WHERE SHOULD I STORE MY MEDICATIONS?

Accepted Answer

Most medications should be stored in a cool, dry place. So, the medicine cabinet in your bathroom is not an ideal location. Be sure to keep your medications and supplies out of reach of children and pets and away from other household or food items. Refrigerated medication should be kept on a clean shelf or in a clean drawer of the refrigerator. Some medications have specific storage requirements that should be listed on the bottle. Ask your pharmacist if you're not sure. – Kiersten Williams, former pharmacy resident

Question 18

HOW DO I DISCARD NEEDLES, SUCH AS INSULIN NEEDLES, AT HOME?

Accepted Answer

Some states, counties or cities have specific guidelines for home needle disposal. In general for Kansas and Missouri, it is appropriate to use puncture-proof containers such as a laundry detergent bottle or metal coffee container. Label the exterior of the container "sharps," reinforce the lid with thick tape (duct tape) and place in the trash just prior to pickup. You can contact your local Department of Public Health agency for further instructions on how to dispose of medical waste in your area. – Kelly Robertson, HIV Ambulatory Clinical Pharmacist

Question 19

DO I REALLY NEED TO SEPARATE MEDICATIONS 12 HOURS APART IF THEY ARE ORDERED AS TWICE DAILY?

Accepted Answer

Medications are ordered twice a day to maintain a consistent level of medicine in your body; therefore, it is important to separate the doses. Most medications that are prescribed twice daily do not need to be separated by exactly 12 hours, but you should discuss this with your pharmacist or physician. If the medications do not need to be given exactly 12 hours apart, you should determine a schedule that works best for you, and is easy to remember – for example, in the morning around breakfast and in the evening around dinner. – Gina Paletta, former pharmacy resident

Question 20

SHOULD I STOP TAKING MEDICATIONS IF THEY DON'T WORK IMMEDIATELY AFTER TAKING THEM?

Accepted Answer

A lot of medications take time to start working in your body, so you should not expect to see results immediately. Often it will take a few days, or even weeks in some cases, before a medication reaches its full effect. Ask your doctor or pharmacist how long you should expect it to take for your medication to start working and contact them if you feel like it is not working after that time has passed. Additionally, many medications should not be stopped abruptly and need to be tapered off slowly to avoid adverse effects, so always contact your doctor or pharmacist before stopping a medication. – Megan Herman, HIV Ambulatory Clinical Pharmacist

Question 21

SOME MEDICATIONS HAVE SIDE EFFECTS. WILL THEY ALWAYS BE THERE OR WILL THEY EVENTUALLY GO AWAY?

Accepted Answer

This will vary greatly with different medications and between patients. You may notice side effects when starting a new medication or when a dose is changed. For many, those side effects will eventually decrease in severity or even go away, while for others those side effects may continue. The duration and severity of side effects varies depending on the medication and the patient. There are also situations in which side effects may develop suddenly when no medication changes have occurred. It is important to speak with your doctor or pharmacist about your medications and related side effects if you have concerns. – Jenny Loucks, Hepatology Clinical Pharmacist

Question 22

IF I SHOULD LOSE MY JOB, WHAT HAPPENS TO MY HEALTH BENEFITS?

Accepted Answer

You may be able to keep your coverage with your employer for 18 months, but you will have to pay the insurance company. This benefit is called the Consolidated Omnibus Budget Reconciliation Act (COBRA). It is a benefit you must purchase within 60 days after you stop working. Another option is to request coverage between jobs under a state program or short-term medical insurance policy. Get information on these from your human resources department.

Question 23

WHAT SHOULD I KNOW ABOUT PRESCRIPTION COVERAGE BEFORE MAKING ANY CHANGE TO MY INSURANCE?

Accepted Answer

Make sure your new health plan doesn’t have a pre-existing condition clause. Or if it does, make sure it's waived, consistent with the requirements of the 2010 Patient Protection and Affordable Care Act (ACA). Depending on the clause, it could mean that you’re without insurance or your insurance may be delayed 6 months or longer. For plan years beginning on or after September 23, 2010, the ACA prohibits plans from imposing pre-existing condition limits on covered persons under age 19. For plan years beginning on or after January 1, 2014, the ACA prohibits plans from imposing pre-existing limits on covered persons of any age.

Question 24

WHAT SHOULD I DO IF I HAVE AN ADVERSE REACTION TO A MEDICATION?

Accepted Answer

Contact your doctor or pharmacist as quickly as possible. If the symptom is life-threatening, call 911.

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