What Questions Should I Ask a Pharmacist in Lancaster SC?

 

I had the privilege of interviewing Hugh Mobley at Mobley Drugs in Lancaster, SC. He’s a local pharmacist that’s been in the community for over 40 years. In this podcast, Hugh answered several questions people should ask their pharmacist. I have transcribed that podcast and have provided the answers to those questions below. Every person is different. Please consult your doctor or pharmacist if you have any questions. The answers below are provided to you for informational purposes only. Enjoy!

 

Does it really matter what time of day that I take my medication?

Medication can be the best in the world but a lack of knowledge on how to use it will not create success or either cure it. Your pharmacist knowledge should be the one communication tool that you seek to achieve your goals. In regards to what time of day, with some medications, it doesn’t really matter but with some it matters a lot. Knowing which one’s matter and at what time of day is very important. Let me give you a couple examples. Medications that are fluid pills we call diuretics. Unless you’re told otherwise, should be taken in the morning. Using a little common sense, if you take it at bedtime, you’re not going to have a lot of rest. You’re going to be up a lot during the night. Conversely to that, one other heavily prescribed medication, cholesterol medicine, unless otherwise told by your prescriber, should be taken in the evening when you go to bed. That’s when your liver is most active to process those kinds of things. There are some medications, as long as you consistently take it at the same time of day, doesn’t really matter.

What vaccinations are important for seniors?

As we get older things change. One of the things that change is our body’s ability to fight off disease. When you’re young, it seems like you’re invincible. You can be exposed to certain things and in a day or so you kind of get over it, whereas, when you get older your body doesn’t respond as well. Your immune system doesn’t work as well, so the importance of vaccinations is greater in your later years. Several vaccinations come to mine that should be on the checklists. The influenza vaccine should be taken annually because influenza causes a lot of hospitalizations and death. That’s somewhat of a preventative opportunity. Now that we know a little bit more about Covid vaccinations, I believe it contributed to our ability to get where we are today or get somewhat back to semi-normal. I think we will see some sense of ongoing vaccinations for covid. It may be annual or it may not be. Another one is the pneumonia vaccine. The pneumococcal bacterium causes a lot of hospitalizations and deaths at a higher rate than influenza does. A lot of people don’t pay that much attention to it. The pneumococcal vaccination should be scheduled. The last one I would say that should be on the “to-do list” is the shingles vaccine. For over 30 years, we’ve been vaccinating our infants for chicken pox which has reduce the amount of incidental exposure, hence has created a greater sense of shingles breakthroughs in older people. In times of stress and illness, that’s when those breakthroughs happen. Some shingles can be resolved in a few days while others last for lifetime. Most pharmacies have access to a database to help someone decide what is due.

How does age increase the risk for medication side effects?

When we get older our body don’t respond or our kidneys don’t work as well as they once did. Our liver probably doesn’t work as well as it once did either. Some medications cannot work as well as others, some can work stronger than others, and some taken together can have a greater side effect than if they were taken when you were younger. So, you always have to be aware of that. In conjunction with the prescriber, make sure you talk to your pharmacist to find out what medications can affect you differently, at a different age.

What happens if I miss a dose?

For some medications, as soon as you discover you’ve missed a dose, you take a catch-up dose. Some medications you might want to wait until the next scheduled time. It depends on what it is. A lot of that information is usually included in educational information that is provided with your prescription or it’s available on the line, or contact your pharmacist. If it’s an antibiotic, I think you would probably want to go ahead and take it as soon as you realize that you missed it. Depends on how long it has been. Medications like blood pressure and cholesterol medicine. If you miss one day’s dose of your cholesterol medicine, it’s not going to be critical. You could possibly wait until the next day. Blood pressure might be a different story, based on the individual.

What if I am pregnant or breastfeeding?

Just because you take a medicine orally and you’re a female, who is breast-feeding or maybe pregnant, doesn’t mean it won’t affect or cross over and have an effect on the unborn child or subsequently the infant. Most medications do cross the placenta and become available to children, through breast milk. There’s a classification of medication based on the risk factor and it’s usually classified as “very little harm is noted”, to “great harm is noted”. You can always call and ask for that information. I always recommend that patients talk to their OBGYN, with her pediatrician because they have individual experiences. In the 40 plus years that I’ve been doing this, I only know of two instances that had an effect on a child from medication that was taken during pregnancy. So that’s pretty low but I think it is wise to find out that information.

Is there any written information about this medication that I can take home?

With the growth of technology, it has really brought that to the forefront. Usually on new medications, most of your pharmacy systems automatically print out an information sheet which is fairly detailed in regards to the medication and answers a lot of these questions we’ve been talking about. Of course, you can ask for one just by going in the pharmacy. They should be able to print it for you. I know that we have them available and a number of these things are available online. I always caution people to be careful what you read online. Some of it will scare you but there should be written information with every medicine especially the first time you receive it.

I’m taking multiple medications. What do I need to know?

Time of day, whether they’re good to be taken at the exact same time or should they be taken apart. One example is, a lot of antibiotics can cause a loss of what’s called, normal stomach bacteria, which keep things in balance. The antibiotic doesn’t choose what’s good or bad, it just kills them all. You can take probiotics with it to replace it but you won’t take them at the same time. You need to space those apart so that the antibiotic has time to clear the intestinal tract. So again, if an individual, is taking different kinds of medications, we always recommend some be taken at different times. Sometimes this applies when you go to have a test done and they are using dyes. You may need to hold off on taking the medication until the test is completed because those things can affect your health as well. Again, read the printed information and have a verbal discussion with your pharmacist.

If somebody is taking 10 medications, seeing 4 different doctors, how does one doctor know what the other doctor is prescribing so the 10 medications aren’t killing them?

We run across that a good bit. The way medicines have evolved into specialties, it’s not uncommon for a patient to have two or three or even four practitioners that they see. Even though they get a medication history from the person, a lot of times we get calls from offices or hospitals that want to know a complete medicine list. In a sense, the pharmacy should be the safety net that houses all your information and is able to look at the whole picture and be able to tell when there are multiple prescribers involved. I always try to encourage people, no matter where it is, to use the same pharmacy so that they’re seeing your information, no matter how many practitioners you see.

Is there a more affordable option for my prescription?

We will look at the medication and see if there’s an alternative that’s a lot less expensive, especially for people who are asking that particular question. Sometimes there may be a medication in the same class that has a generic alternative that may accomplish the same thing. We try to coordinate that with practitioner. If that’s not available, we try to see if there’s an online coupon to help lower the cost of it. Sometimes, believe it or not, paying cash may be cheaper than using your insurance especially if you have an insurance deductible.  We’ve had situations where certain medications are high and the practitioner will consider a different alternative and allow us to make it in our lab. It ends up saving a significant amount of money by doing that. Sometimes you have to explore those options a little bit further. Ask questions and talk with the pharmacy and find somebody to look out for your best interests.

How long can medicine be used after the expiration date?

That’s somewhat of a loaded question. That depends on what the manufacturer recommends, verses common sense verses need. A couple of examples of that is, one, the issue with Anthrax powder in the Capitol building and the fear across the country in regards to what do we do with Anthrax. At the time they stockpiled supplies of Cipro or ciprofloxacin which was an antibiotic that was specifically used to treat that, knowing that the drug would expire before the proposed need. So in regards to that, there was still some activity. A general rule of thumb that we see or I’ve seen a number of years that manufactures, per the Food & Drug Administration’s recommendation, have to label an expiration date say when it still has 90% of its activity or in other words lost 10% of its activities. Some drugs when they go past the expiration date have bad side effects. An example of that is tetracycline. Sometimes when churches go on mission trips they’ll collect expired drugs to take with them because the host country may not have access to it. The medication may still have some activity but you have to use a little bit of common sense and find out a little bit more about that specific medication and the expiration date.  That said, I always say if something is a year or 2 years past expiration date, you should really think about it.

How should medicines be stored?

I asked this question because you know I’ve heard the statement said many times, put it in the refrigerator and your medications will last. Is there any truth to that?

When you receive a medication it you usually has or it should have, storage recommendations. A couple general rules. Humidity is your worst enemy when it comes to medications. Humidity has a high level of oxygen and moisture causing those medications break down a lot faster. Two areas in your home that have the highest humidity or probably the bathroom in the kitchen refrigerator. Some medications require refrigeration like injectables for diabetics, insulin that type of thing. Always see what’s recommended by the manufacturer or the pharmacy and then try to follow those is best you can. Obviously, if the medication is refrigerated and you’re traveling for 10 days, you’ve got to think about those things. There are a number of medications that have a longer benefit when refrigerated like, probiotics, which you buy over-the-counter. You don’t have to refrigerate them but they do last longer. Read the instructions on that specific medication.

A follow-up question to this question. What about people putting medications in a freezer. Remember, all the Covid vaccines came in frozen because they will go bad really fast once they were at room temperature. Typically you probably shouldn’t freeze medications as a general rule because it’s going to change the chemical structure and medications would just falling apart so to speak. Unless specifically advised to keep in the freezer I don’t think I would.

Which foods interact with medications?

Milk and dairy have a lot of calcium. I don’t want to get too deep into chemistry but calcium is what we call a positive ion, which binds with a number of medications, like some antibiotics, tetracycline, doxycycline. It would be best to avoid those. At the same time, antiacids and certain over the counter medications that a number of people use, can interfere with how the body absorbs and uses that medication. So, a number of foods can interact with your medications. Again, we go back to the adage that your printed information is provided with your medication as a point now, usually says what foods to avoid. Some medications require you to take them with food because it requires the presence of food for them to become activated. That’s why it is important to look at the medication information that comes with it. The information provided at the point of sale is what we call user-friendly. It’s not the detailed scientific information. Most people read the scientific information online and become alarmed. I would rely on the issuer friendly information that is provided at your pharmacy.

What are my options if I can’t swallow pills?

Everybody that has a child has always had that problem at some point or another. Drink something warm or room temperature before you take it to relax your esophagus so it doesn’t spasm when you do it. Certain medications can be crushed. A lot of medications cannot be crushed. Some are available in a liquid or sometimes you have to prepare them in a compound. We’ve even had some patients who lose the ability to swallow, can rub them on the skin.

Do I need to alter my diet or activities while taking medication?

Depends on the medication but the answer is pretty much yes. You need to find out a little bit more about it because some medications just say, for instance, if you’re diabetic and you’re taking medication if you don’t change your diet, you’re still going to have the problem from a practical sense, managing your disease. Some of them require them to be taken with food or some of them require you to not drive a vehicle if they cause drowsiness or slow reaction ability. Everything we’ve talked about goes back to having a good interaction with a pharmacist who can explain things to you, provide you with information and know you and your situation.

Exactly how long will I need to use this medication

Some conditions are short-term. Poison ivy, poison oak is something that if they give you an oral medication to take usually resolves in 4 or 5 days. Cold symptoms or infections easily resolved in a specified period of time. so obviously you should take those medications until your practitioner says you no longer need to or the condition completely resolves. There are other situations where somebody with high blood pressure, they’re probably going to need to take that continually. The condition is driving the answer. What’s wrong, what am I treating and how long will this last. Knowing your medication or the information about your medication and interacting with your practitioner or your pharmacist is the best thing.

Are there any activities or food that I should avoid while taking this medication?

Medications are known to interact with each other. In today’s world, you may have multiple doctors you see. You may see a practitioner. Sometimes, you see one for your heart other times you may see a podiatrist. Another time you may see an orthopedic and they can prescribe medications and they’ll take your medication history but if they’re unaware that those medications will counteract each other or cause a problem then you do have an issue. Some of those shouldn’t be done. Back to the food issue. There are food restrictions on some. There are also food additions on some. If you’re on a fluid pill that causes you do in a reduce your fluid volume, you can also reduce your mineral volume, like your potassium, which can just wash people out and have no energy and difficulty moving. Supplementing with potassium rich foods in those cases would be really important.

Could medications interact with my vitamins and supplements?

Yes, they can. There are a number of over-the-counter medications or supplements that you buy, that even though they’re quote, “over the counter”, that doesn’t mean that it’s void of an interaction. A lot of times the printed information will tell you what to avoid or what to supplement with. There are cases where vitamins should be avoided in certain cases. If you think about it, people with kidney disease may need their magnesium adjusted. The same thing with those on heart medications. There may need to be some adjustments on that. Over the counter medications and supplements are contributors to problems with your regular prescription medication. I think everything we’ve said brings us back to what I said earlier, in the fact that if you know your pharmacist, your doctor, your lawyer, your accountant, they are the people that have your best interest at heart. They want to manage those things, knowing you as a person, they know your medical condition and know all the medications you take. There is value in that. Most pharmacists out there are attentive. I would encourage people to try to stay, as much as possible, with the same pharmacist.

 

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