September 29, 2024 • 27 mins
Taking any medication can have risks, but those risks increase when we do not know key information about the medication, do not take the medication when or how we are supposed to or take multiple medications. Dr. K and special guest Kyla Newland, Mountain Pacific pharmacist, provide tips on how to be more confident in your knowledge and routines so taking your medications is easier -- and safer.
Additional resources for this episode
Centers for Disease Control and Prevention (CDC) Medication Safety and You: https://www.cdc.gov/medication-safety/about/index.html
Johns Hopkins Medication Management and Safety Tips: https://www.hopkinsmedicine.org/health/wellness-and-prevention/help-for-managing-multiple-medications
Search for financial help for a specific medication: https://needymeds.org/
If you have a question for Dr. K, email QandAwithDrK@mpqhf.org. Your question will remain anonymous.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Beth Brown (00:10):
Welcome to Q and A with Dr. K, a podcast by
Mountain Pacific Quality Health,where we sit down with Dr. Doug
Kuntzweiler and get your healthquestions answered, because on Q
and A with Dr. K, the doctor isalways in.
(00:35):
Hello, everyone. This is yourhost, Beth Brown, and as usual
with us today is the wonderfulDr. Doug Kuntzweiler, the
knowledgeable and special chiefmedical officer from Mountain
Pacific. And we have a veryspecial guest with us. Also
joining us today is KylaNewland, who is a pharmacist
with Mountain Pacific, and she'shere because we are going to
(00:56):
take a deep dive into how to bean empowered patient when it
comes to medications. So thankyou, both, for joining today.
Good to see you. Beth, yeah.
Thank you, Beth, yeah. Thanksboth. So let's go ahead and jump
in. We are continuing with parttwo in our series about how to
help patients feel empowered,give them some confidence, let
(01:16):
them know what kind of questionsthey should be asking, which is
what we talked about last month.
And this month, we're going totalk about another way to make
sure that you are in charge ofyour health and part of your
health care team, and that'swith medications. So we're going
to talk about medication safetytoday, and medication safety,
(01:37):
that term probably sounds prettystraightforward. You know it's
being safe with medications, butwe're going to talk about what
that really means. And I thinkwe're going to start with you,
Dr K, and ask about when itcomes to medication safety, a
big factor, especially for olderfolks, is polypharmacy. What is
(01:58):
that? What do we mean when wetalk about that?
Dr. Doug Kuntzweiler (02:01):
Well, polypharmacy means taking a
number of medications at thesame time, and I've seen various
definitions, but most peopleseem to agree that if you are
taking five or more medications,your potential for adverse
interactions between themedicines goes up, your
potential grabbing side effectsgoes up, but it kind of depends
(02:24):
on the person. I mean, sometimesthree medicines is a lot, but
generally when you get up aroundfive then then you have to look
pretty carefully to make surethat they're all compatible with
each other, that they're notcausing you any side effects.
Beth Brown (02:38):
Because what are the risks there potentially?
Dr. Doug Kuntzweiler (02:41):
Well, primarily, interactions with
each other. Once you starttaking drugs, they can interfere
with the metabolism of anotherdrug that you're taking. They
can either raise or lower thelevels of another medication
that you're taking. I knowpersonally, it makes it more
difficult to keep your medicinestraight and make sure that
(03:02):
you're taking the correctmedicines at the correct dose,
at the correct time, in thecorrect way. And I use pill
minders, but even at that, Ihave to fill them, and it's
surprisingly easy to mess it up.
Beth Brown (03:16):
And once people start getting on five or more
medications, and like you said,everyone is different. How do
doctors and pharmacists -- Kyla,jump in here too, if you'd like
-- know that these medicationsare doing what they're supposed
to be doing. Or do you reallyrely on the patient talking to
you about the difference thatthey're feeling with being on
(03:37):
those medications?
Dr. Doug Kuntzweiler (03:39):
Well, I would say, and I want to hear
what Kyla has to say, too, butit depends on the medication.
Some we check levels on so youknow exactly where you're at.
But some it is by interviewingthe patient, seeing how they're
doing.
Kyla Newland (03:54):
Yeah, I mean, I think those are both good
points, and then also doing likea med review every year is a
good idea where you would meetwith either your pharmacist or
doctor, and they would match upall your medications with what
you're taking them for andmaking sure that they're
effective and that they're doingwhat they're supposed to be
doing. And then, of course, ifyou're treating something like
(04:15):
high blood pressure, diabetes,you're going to check labs to
make sure that that themedications are working how
they're supposed to be.
Beth Brown (04:22):
Perfect. And yeah, you've talked about this a
little bit, Dr. K, with theminteracting with each other, and
that's another term we're goingto throw out here really quickly
that some people may or may nothave heard before, and that's
adverse drug events. And that'ssomething that we talk a lot
about at Mountain Pacific withthe work that we do. But what
does an adverse drug eventsentail. What all does that mean?
Dr. Doug Kuntzweiler (04:44):
Well, in my mind, that means an unwanted,
harmful effect of the drug, andit could be almost anything. It
could be dizziness, it could beheadache, visual disturbance,
nausea, vomiting, those arecommon ones. Diarrhea, trouble
emptying the bladder, there'sall sorts of things, but
basically an effect of themedication that is not the
(05:06):
therapeutic effect you'relooking for, but it's something
that's that's bothersome.
Kyla Newland (05:09):
And it can either be something that we expect from
a medication that's a known sideeffect, or it could be something
that maybe we dose itinappropriately, and the patient
had an adverse reaction becauseof that. So it's kind of a
pretty broad term, and it's it'skind of hard to define exactly
what it means.
Beth Brown (05:28):
Sure, that makes sense, because everyone is
different, too, and just becausesome people respond to
medication in a certain way,there could be that one person
out there that takes it and hasa very different experience. And
that that could certainly be thecase, but we also know that
there are some medications thatare sort of on that "watch out"
list where we know they can bethe ones that tend to maybe tend
(05:51):
to cause some issues, or peopleend up having to go to the ER,
see their doctor. So let's talkabout some of those usual
suspects that we know what towatch out for, because they can
be the ones that tend to causethose adverse drug events. Kyla,
maybe can you talk about...?
Kyla Newland (06:08):
Yeah, yeah, I can absolutely speak to that. What
we've seen in the literature isthat there's three kind of drug
groups that are highest risk forcausing adverse drug events. So
that's going to be opioids,which are medications used for
pain, diabetes medicines andanticoagulants, or what we
commonly refer to as bloodthinners. So we know those are
(06:31):
the highest risk. So if you'retaking any of those medications,
you are at higher risk of havingone of those adverse drug
events.
Beth Brown (06:39):
And what do those look like, those events?
Kyla Newland (06:41):
So with our diabetes medicine, it's going to
be primarily low blood sugars. Alot of times, folks will end up
in the ED or the urgent care dueto either taking too much of
their diabetes medication ormaybe it's not adjusted
properly. With theanticoagulants, it's going to be
usually a bleed, so either astomach ulcer or some other kind
(07:02):
of bleed that's happening thatmakes it so a person has to seek
additional care, and then withthe opioids, it's going to be
mostly like respiratorydepression or dizziness, and in
the worst case scenario, I guessit would be an overdose from
opioids.
Beth Brown (07:20):
And so is it fair to say that it's the medication is
doing its job, but to an extremethat causes an issue within a
person? Or why is it that thoseare the three that tend to show
up the most when folks run intoissues?
Kyla Newland (07:35):
So if there's some drugs that they call narrow
therapeutic index, drugs, drugslike warfarin, which is a blood
thinner, it has to be monitoredwith lab values continually. And
it can be the levels of some ofthose drugs can be affected by
what you eat, even. And then ifwe look at other drugs you're
taking, it maybe you added a newdrug and there was a drug
(07:56):
interaction that maybe causedyour level to change. That's
just one that kind of comes offthe top of my head. But when we
see those drug interactions, asDr K. talked about earlier, if
you add new drugs or take awaydrugs, then sometimes the levels
of other medications willchange. And then with diabetes
medicines, I mean, when you'reusing insulin, or there's some
(08:17):
diabetes oral medicines thathave higher risk of causing you
to have low blood sugars, andthat's just kind of always,
always a battle with managingpeople with diabetes and keeping
those sugars in the right range.
Dr. Doug Kuntzweiler (08:30):
And I will say that, as a provider, I've
really benefited from thepharmacist catching when a
patient that I prescribedsomething for was on another
medication that couldpotentially interfere with it or
or have an adverse reaction, andsometimes providers don't really
have an accurate description ofall the medicines that a
patient's taking. Most of thetime when you go to a provider
(08:53):
now, when the nurse does yourintake, checks your vital signs
and your weight, they will alsoask you about your medications,
run over your medication list,so make sure that it's up to
date, because that it can changeso quickly, especially if you're
seeing more than than oneprovider, it can change really
quickly and and you won'tnecessarily recall everything
(09:15):
that you're on.
Beth Brown (09:17):
So let's talk about that then. And since we are
focusing on how to help patientsbe empowered, be more confident,
better understand their healthand their care when we talk
about medication safety, and Iwould like to hear from both of
you on this, what role does thepatient play in being safe with
(09:38):
their medications? What doesthat look like?
Dr. Doug Kuntzweiler (09:41):
I'll go first. I felt pretty strongly
about this one.
Beth Brown (09:44):
Okay, great.
Dr. Doug Kuntzweiler (09:45):
I can't tell you how many times in the
ER, I asked a patient, what,what meds are you on? But they
would say, Well, I don't know.
You've got a list of it here.
Look it up. Or they would say,Well, I'm on that little blue
pill. And I take that kind ofbigger gray pill, and then I
take this capsule and you say,right, there's only 3000 little
(10:07):
white pills. So yeah, I thinkit's patients' responsibility,
as we talked about in the past,you should have some interest in
your own health, and a big partof that is keeping an accurate
list of what you're taking andand knowing, and in general
sense, what it's for. You don'tneed to know. You know all the
(10:29):
pharmacology of a medicine, butyou might write down the
medication and that it's foryour high blood pressure, or I'm
taking this medicine it and it'sfor my thyroid. I'm taking this
medicine for whatever, keepingthat just on a little index card
and and trying to keep that upto date is is pretty viable. If
you always go to the samepharmacy, they should have a
(10:51):
pretty accurate list to whatyou're currently taking.
Beth Brown (10:54):
Yeah, we've heard that right. Use the same
pharmacist so that they can helpyou better understand your
medications.
Kyla Newland (11:01):
Yeah, and especially, as Dr K mentioned,
if you're seeing differentproviders, then the whole
picture is going to be there. Ifyou use the same pharmacy and
the same pharmacist as to what'sgoing on with your medicines.
There's also, if you aretechnologically inclined, you
can actually track yourmedications on your phone. If
you have an iPhone, I knowspecifically, there's a health
(11:23):
app on there, and you can addall your medications in there.
And you can even, I just waslooking at it this morning. You
can even ask it aboutinteractions on there as well,
which is pretty cool. And thenyou can set a timer if you have
trouble remembering you takeyour medications. You can set
reminders on there that willremind you when to take your
medication. So that's anothercool thing that you could
(11:45):
explore if you have access tothat technology.
Beth Brown (11:49):
Yeah, that's great.
I mean, there's an app for that,right? There's an app for
everything out there, so yeah,
Kyla Newland (11:55):
I'm sure there's other apps too.
Beth Brown (11:58):
So yeah, that's great for those folks who, I
mean, we live on our phones, andwe always have them with us. So
even in your example, Dr K,going into the ER or the
emergency department, odds areyou probably have your phone on
you, and so you can check thatlist and tell your doctor what
you're on and what it's for.
Kyla Newland (12:17):
Well, and, as we're talking about, like if you
go to the emergency department,or if you have a hospital stay,
is a lot of times yourmedications get changed, and so
that's a really good time tomake sure that you update that
list, that you understand themedications that you're supposed
to be taking, and also that youcommunicate with your providers
so your pharmacist and your yourdoctor about The changes,
(12:40):
because what I've seen happen,the local pharmacy, the provider
may not notify the pharmacy thatyou're not taking that anymore.
And then if you don't know whatyou're taking, and you come in
and you say, I need my bloodpressure medicine. You don't
know the name or you know thecolor, but you know whatever you
might get the wrong medicationif there's been a recent change.
So I think those instances whereyou're like either utilizing
(13:03):
specialists to add medications,or when you're have a hospital
stay or ER visit, is a good,really good time just to do that
double check on your list.
Beth Brown (13:13):
That's a great point. I appreciate that. And I
think it does really nail homethe thought that it takes a team
to manage your health, and it isthe provider who prescribed
medication, it's the pharmacistwho is helping you with that
medication, and it's you knowingwhat you're on and why you're
taking it, so that you can be apart of that team as well. And
(13:33):
so speaking of the team, let'stalk about the pharmacist,
because I feel like thepharmacist is such an
underutilized treasure as partof the healthcare team, you have
to make an appointment to get into see your doctor, unless
you're trying to get into urgentcare or emergency department. So
your doctor can sometimes bevery difficult to access. Sorry,
(13:53):
Dr K, but you know that, so youhave that pharmacist, and
pharmacies are crazy busy thesedays as well, but you can walk
in and wait in line and talk toa pharmacist. So let's talk a
little bit, Kyla, about how doesthe pharmacist play a role in
medication safety and in justbeing part of that health care
team?
Kyla Newland (14:14):
Yeah, so, we've historically been referred to as
the most accessible health careprofessional, because you can,
you can walk up to a pharmacyanytime. You can call a
pharmacy, and you can say, Iwant to talk to the pharmacist,
and we can answer a multitude ofquestions related to your
medications. And in some cases,if you have coverage on certain
(14:34):
insurance plans, we can sit downwith you and do like, a more
extensive review of yourmedications. So that's something
that you could ask about. Yeah,we do four years of training
specifically about medications,so we do have expansive
knowledge. And I encourageeverybody to utilize their
pharmacists to the highestextent that they can.
Dr. Doug Kuntzweiler (14:56):
And I would like to point out as a
provider, that I often talked topharmacists and ask them about
especially dosages, medicationinteraction and things like
which would be the bestantibiotic for this condition.
Medicine has gotten so complexand it changes so quickly. Every
(15:16):
year there are a multitude ofbrand new medications, and as a
provider, it's very difficult tokeep up, and I always found that
the pharmacists were aninvaluable resource for me to
help me prescribe accurately andcarefully.
Beth Brown (15:35):
Yeah, that's great.
You each have your own areaswhere you have to make sure
you're up to date on andobviously that's a specialty for
pharmacists. So kind of lastmonth, we met without you, but
we talked about questions thatpeople should be asking their
health care provider, and we hadsome three main ones, and then
we sort of built on those alittle bit. I wonder if you have
(15:56):
ideas on what a person should bein the routine of asking their
pharmacist. Do you have a coupleof questions there? Those are
the main ones that you shouldknow and be asking your
pharmacist, or feel comfortableasking your pharmacist?
Kyla Newland (16:12):
Yeah, I would say there is some kind of top
questions that you definitelyshould know about each of your
medications. First, you shouldknow what you're taking it for.
You should know your dose, andyou should know what time of day
to take that medication and howfrequently to take that
medication. You should also askif you need to take it with food
(16:34):
or without food, because somemedications can upset your
stomach. Some medications don'tget absorbed as well if you have
a lot of food in your system,and so those are good questions
to ask as well.
Dr. Doug Kuntzweiler (16:45):
Sometimes there are things you wouldn't
necessarily think of, like thereare a number of medications
that, if you take grapefruitjuice, that interferes with
their metabolism and theirabsorption, then you wouldn't
necessarily think about that.
Somebody needs to point that outto you, and that typically is
the pharmacist who does that.
Kyla Newland (17:03):
Yeah, that's a good point. There are some like
dietary things. Also, like ifyou take vitamins or
supplements, sometimes those canbind to medicines, and then they
don't get absorbed as well. Sothose are also good questions,
and make sure you include themedications that you are taking
over the counter, because that'simportant too, especially when
we can see those interactionswith those just as easily as a
(17:26):
prescription medication.
Dr. Doug Kuntzweiler (17:28):
I think it's important that people first
agree with their provider thatthe medication is is necessary
and that and that they agreedthat they're going to take it,
and so that means they they needa simple, understandable
explanation of what theircondition is and what the
providers proposing to treat itwith in in what what that will
(17:51):
do, and the provider should givethem, you know, at least some
basic understanding of sideeffects to watch out for and
those kinds of things.
Kyla Newland (18:01):
I mean, that's primarily when you come to the
pharmacy to get a newprescription. We can tell you
all the side effects, and we arerequired by law, actually, to
give that information to you. Sotake advantage of that and
always talk to your pharmacistwhen you pick up a prescription,
because that is a very valuableconversation.
Beth Brown (18:21):
For sure, and yeah to both of your points then,
it's not just the prescribingand even picking up the
medication, it's then taking itcorrectly. That's a big part of
medication safety as well. Andtalking about the over the
counter medications that peopleare taking, or if they're also
taking supplements or vitamins,you can see how it gets big fast
(18:46):
with all the different thingsthat people might be putting
into their bodies to help themfeel better or to function
better. So tips on that part ofit, so that people are, you
know, they agree with thedoctor, yep, okay, I'm going to
take this medication. I went tothe pharmacist, I got it. Now
I'm at home. How can I make sureI'm keeping everything sorted
(19:07):
how it's supposed to be and thenI'm taking it how I'm supposed
to take it?
Dr. Doug Kuntzweiler (19:12):
Well, I think that is a place for an
app, as Kyla talked about withmaybe the reminders, alarms with
reminders keyed into it. Or ifyou're old school, like me,
write it down, put it on therefrigerator. If you're elderly
and you know, you might havetrouble manipulating your
(19:33):
medications, or you're havingtrouble with memory, have
somebody help you set them up, afamily member, or friend to help
you set the medicines up. And ifyou add any question about what
you're supposed to be doing, youshould either ask the pharmacist
who filled it for you, or askyour prescriber, and then your
provider make sure that you gotit straight.
Kyla Newland (19:54):
Yeah, and you can also use pill boxes, and you
could do up to, like, a week'sworth of then maybe. In two
weeks. You can either do a weekor two weeks, I think, at a
time, in a pillbox. So you know,you have all your medicines you
take in the morning, all yourmedicines you take in the
afternoon, all the medicines youtake in the evening. And then
that kind of keeps you on trackas well. And like Dr K said, if
(20:15):
you're if you're needing helpwith that, definitely have
somebody help you set that upand do that for you on a regular
basis.
Beth Brown (20:23):
I mean, they really do have the day of the week,
morning, noon, evening, bedtime.
I mean, they can have all kindsof little compartments in there
to help keep all those pillsorganized.
Dr. Doug Kuntzweiler (20:34):
Another thing we should point out is
that when you are writing downall the medicines that you're
taking, a lot of people aretaking a number of over the
counter meds. And when you askthem, what medication are you
taking, they only tell you aboutthe prescription meds. You have
to ask them, Are you takinganything else? Are you taking
anything over the counter?
Sometimes it can be prettysurprising the number of things
(20:56):
people are taking that theydon't think of as, oh, that's
not what the provider wasasking.
Beth Brown (21:03):
One a day vitamins, or the whatever supplement, or
the root of whatever that you'reputting in your coffee in the
morning. Like, all of thosethings count. So another part of
that, though, is, yeah, youknow, I agree I want to take
this medication, but I justcan't freaking afford it. You
know, like, these are someinformations are expensive. And
(21:26):
for some people, depending ontheir health insurance, or if
they even have health insurance,that's where it gets sticky for
them is they would love toadhere to the treatment plan.
They would love to take thesemedications how they're supposed
to take them, but they can't gofill the prescription because
they can't afford them. Butthere are options there, right?
Kyla, like, what are some of theways that people can get help
(21:46):
paying for their medications, sothat they can take them when and
how they're supposed to.
Kyla Newland (21:52):
So there's a couple different options.
There's something called patientassistance programs, and those
are programs that are sponsoredthrough the drug manufacturer,
and so if you're taking a drugthat's expensive, you can go to
the website. It's calledneedymeds.org and you can search
for any medication on there andsee if there is what they call
(22:14):
this patient assistance program,which is an income based
assistance where in some cases,they will pay 100% of the cost
of that medication, and there,there's a lot of them out there.
And then the other thing is,there is also patient copay
cards. So say your copay, sayit's covered on your insurance,
but there's still a copay, andit's a high copay, and you still
(22:36):
can't even afford that. You canget that copay paid for with
what they call a copay card, Iguess. And that's something
usually your provider will haveand be able to distribute. Some
of the pharmacies will havethose too, and you can ask your
pharmacist if they have any ofthose for you to use. I know
with the COVID medications,since they're not covered by the
(22:58):
federal government anymore,there is a copay card because
they're pretty expensive. Sothose are a couple different
options.
Dr. Doug Kuntzweiler (23:05):
I think it's important for the providers
to have some sense of what arethe really expensive medications
and and I'm guilty of it too. Alot of times we don't really
know how much the medicines costthat we're prescribing. If you
are the patient, it wouldbehoove you to let your provider
know that cost is aconsideration, because
(23:26):
oftentimes there are cheaperalternatives. Generic forms of a
drug are usually cheaper thanthe proprietary or the name
brand.
Kyla Newland (23:38):
Yeah, that's a good point too, because you can
ask your pharmacist, that'sanother good question to ask. Is
there a medicine in this classthat would work similarly, or
the same way that I could maybehave my doctor write for
instead, so that I don't have topay this high price? And that
that is definitely a validquestion, and a lot of times
there is cheaper alternatives,and they're totally appropriate
(24:00):
and equally as effective.
Beth Brown (24:03):
I appreciate that, and that's a question, again,
that you can either ask theprovider or when the time comes
with the pharmacist, and that'salso part of asking those
questions to be an empoweredpatient, and it might take
swallowing some pride, right?
Like I don't want to admit thatI can't afford this medication.
Sometimes they really areridiculously expensive, but
sometimes it's just because ofyour situation. This is
(24:24):
expensive for me, and so I needto be able to say, but I need to
take care of my health first,and I'm just going to have to
swallow my pride a little bithere and admit I don't know if I
can afford this. And can youplease help me, whether it's
with a generic medication, orgoing to a website where I might
be able to help get somethingpaid for, or the copay card, or
(24:46):
whatever it is. So those aregreat.
Dr. Doug Kuntzweiler (24:53):
I would look at it as we're all in the
same boat too. Even if you havea high income, these medications
could still be be veryexpensive, so you don't have to
be too ashamed of it.
Beth Brown (25:04):
So I just want to end on closing thoughts from you
both about medication, safety,any thing that you want to make
sure people take away fromlistening today.
Dr. Doug Kuntzweiler (25:15):
Well, I'll start. I would say that the
important thing is to talk withyour provider and understand why
they want you to take thismedicine. What is it supposed to
do? What is the benefit to you?
Because you really should agreeto it before you walk out of
there with a prescription inyour hand, and then talk to your
pharmacist, make sure that it'sthe right medication, the right
(25:37):
dose, that you understand howand when you're supposed to take
it, and know what that littlewhite pill is when, when you go
to see a provider.
Kyla Newland (25:48):
Yeah, and I would just reiterate the fact that you
are a part of your health careteam, and medications are a huge
part of that. So be proactive.
Ask questions, and, you know,get as much information as you
can from from your health careteam, so that you can be the
healthiest that you can and getthe best benefit from the
medications that you take.
Beth Brown (26:10):
And report back with how those medications are going,
especially if they're not goinghow the prescriber and the
pharmacist hoped they would foryou. That's important to bring
up.
Kyla Newland (26:21):
Aboslultey.
Beth Brown (26:22):
Perfect. Well. Thank you both so much for being here
today. We, as always, appreciateyour experience and expertise.
Dr K and it was an absolutepleasure having you, Kyla, to
talk about your own experienceand expertise from the pharmacy
perspective. So thank you.
Dr. Doug Kuntzweiler (26:36):
Thank you.
Kyla Newland (26:36):
Thank you!
Beth Brown (26:38):
And thank you so much for listening. We'll put
some resources for you with thisepisode, including that URL that
Kyla mentioned to help out withthe cost of medications. And if
you have a question for Dr K orany of our mountain Pacific
staff who might be able to jumpon and lend their expertise,
please email us atQandAwithDrK@mpqhf.org, and that
(27:03):
email address will be includedwith this episode as well.
Thanks, everyone. Be well.
Welcome to Q and A with Dr. K, a podcast by
Mountain Pacific Quality Health,where we sit down with Dr. Doug
Kuntzweiler and get your healthquestions answered, because on Q
and A with Dr. K, the doctor isalways in.
(00:35):
Hello, everyone. This is yourhost, Beth Brown, and as usual
with us today is the wonderfulDr. Doug Kuntzweiler, the
knowledgeable and special chiefmedical officer from Mountain
Pacific. And we have a veryspecial guest with us. Also
joining us today is KylaNewland, who is a pharmacist
with Mountain Pacific, and she'shere because we are going to
(00:56):
take a deep dive into how to bean empowered patient when it
comes to medications. So thankyou, both, for joining today.
Good to see you. Beth, yeah.
Thank you, Beth, yeah. Thanksboth. So let's go ahead and jump
in. We are continuing with parttwo in our series about how to
help patients feel empowered,give them some confidence, let
(01:16):
them know what kind of questionsthey should be asking, which is
what we talked about last month.
And this month, we're going totalk about another way to make
sure that you are in charge ofyour health and part of your
health care team, and that'swith medications. So we're going
to talk about medication safetytoday, and medication safety,
(01:37):
that term probably sounds prettystraightforward. You know it's
being safe with medications, butwe're going to talk about what
that really means. And I thinkwe're going to start with you,
Dr K, and ask about when itcomes to medication safety, a
big factor, especially for olderfolks, is polypharmacy. What is
(01:58):
that? What do we mean when wetalk about that?
Dr. Doug Kuntzweiler (02:01):
Well, polypharmacy means taking a
number of medications at thesame time, and I've seen various
definitions, but most peopleseem to agree that if you are
taking five or more medications,your potential for adverse
interactions between themedicines goes up, your
potential grabbing side effectsgoes up, but it kind of depends
(02:24):
on the person. I mean, sometimesthree medicines is a lot, but
generally when you get up aroundfive then then you have to look
pretty carefully to make surethat they're all compatible with
each other, that they're notcausing you any side effects.
Beth Brown (02:38):
Because what are the risks there potentially?
Dr. Doug Kuntzweiler (02:41):
Well, primarily, interactions with
each other. Once you starttaking drugs, they can interfere
with the metabolism of anotherdrug that you're taking. They
can either raise or lower thelevels of another medication
that you're taking. I knowpersonally, it makes it more
difficult to keep your medicinestraight and make sure that
(03:02):
you're taking the correctmedicines at the correct dose,
at the correct time, in thecorrect way. And I use pill
minders, but even at that, Ihave to fill them, and it's
surprisingly easy to mess it up.
Beth Brown (03:16):
And once people start getting on five or more
medications, and like you said,everyone is different. How do
doctors and pharmacists -- Kyla,jump in here too, if you'd like
-- know that these medicationsare doing what they're supposed
to be doing. Or do you reallyrely on the patient talking to
you about the difference thatthey're feeling with being on
(03:37):
those medications?
Dr. Doug Kuntzweiler (03:39):
Well, I would say, and I want to hear
what Kyla has to say, too, butit depends on the medication.
Some we check levels on so youknow exactly where you're at.
But some it is by interviewingthe patient, seeing how they're
doing.
Kyla Newland (03:54):
Yeah, I mean, I think those are both good
points, and then also doing likea med review every year is a
good idea where you would meetwith either your pharmacist or
doctor, and they would match upall your medications with what
you're taking them for andmaking sure that they're
effective and that they're doingwhat they're supposed to be
doing. And then, of course, ifyou're treating something like
(04:15):
high blood pressure, diabetes,you're going to check labs to
make sure that that themedications are working how
they're supposed to be.
Beth Brown (04:22):
Perfect. And yeah, you've talked about this a
little bit, Dr. K, with theminteracting with each other, and
that's another term we're goingto throw out here really quickly
that some people may or may nothave heard before, and that's
adverse drug events. And that'ssomething that we talk a lot
about at Mountain Pacific withthe work that we do. But what
does an adverse drug eventsentail. What all does that mean?
Dr. Doug Kuntzweiler (04:44):
Well, in my mind, that means an unwanted,
harmful effect of the drug, andit could be almost anything. It
could be dizziness, it could beheadache, visual disturbance,
nausea, vomiting, those arecommon ones. Diarrhea, trouble
emptying the bladder, there'sall sorts of things, but
basically an effect of themedication that is not the
(05:06):
therapeutic effect you'relooking for, but it's something
that's that's bothersome.
Kyla Newland (05:09):
And it can either be something that we expect from
a medication that's a known sideeffect, or it could be something
that maybe we dose itinappropriately, and the patient
had an adverse reaction becauseof that. So it's kind of a
pretty broad term, and it's it'skind of hard to define exactly
what it means.
Beth Brown (05:28):
Sure, that makes sense, because everyone is
different, too, and just becausesome people respond to
medication in a certain way,there could be that one person
out there that takes it and hasa very different experience. And
that that could certainly be thecase, but we also know that
there are some medications thatare sort of on that "watch out"
list where we know they can bethe ones that tend to maybe tend
(05:51):
to cause some issues, or peopleend up having to go to the ER,
see their doctor. So let's talkabout some of those usual
suspects that we know what towatch out for, because they can
be the ones that tend to causethose adverse drug events. Kyla,
maybe can you talk about...?
Kyla Newland (06:08):
Yeah, yeah, I can absolutely speak to that. What
we've seen in the literature isthat there's three kind of drug
groups that are highest risk forcausing adverse drug events. So
that's going to be opioids,which are medications used for
pain, diabetes medicines andanticoagulants, or what we
commonly refer to as bloodthinners. So we know those are
(06:31):
the highest risk. So if you'retaking any of those medications,
you are at higher risk of havingone of those adverse drug
events.
Beth Brown (06:39):
And what do those look like, those events?
Kyla Newland (06:41):
So with our diabetes medicine, it's going to
be primarily low blood sugars. Alot of times, folks will end up
in the ED or the urgent care dueto either taking too much of
their diabetes medication ormaybe it's not adjusted
properly. With theanticoagulants, it's going to be
usually a bleed, so either astomach ulcer or some other kind
(07:02):
of bleed that's happening thatmakes it so a person has to seek
additional care, and then withthe opioids, it's going to be
mostly like respiratorydepression or dizziness, and in
the worst case scenario, I guessit would be an overdose from
opioids.
Beth Brown (07:20):
And so is it fair to say that it's the medication is
doing its job, but to an extremethat causes an issue within a
person? Or why is it that thoseare the three that tend to show
up the most when folks run intoissues?
Kyla Newland (07:35):
So if there's some drugs that they call narrow
therapeutic index, drugs, drugslike warfarin, which is a blood
thinner, it has to be monitoredwith lab values continually. And
it can be the levels of some ofthose drugs can be affected by
what you eat, even. And then ifwe look at other drugs you're
taking, it maybe you added a newdrug and there was a drug
(07:56):
interaction that maybe causedyour level to change. That's
just one that kind of comes offthe top of my head. But when we
see those drug interactions, asDr K. talked about earlier, if
you add new drugs or take awaydrugs, then sometimes the levels
of other medications willchange. And then with diabetes
medicines, I mean, when you'reusing insulin, or there's some
(08:17):
diabetes oral medicines thathave higher risk of causing you
to have low blood sugars, andthat's just kind of always,
always a battle with managingpeople with diabetes and keeping
those sugars in the right range.
Dr. Doug Kuntzweiler (08:30):
And I will say that, as a provider, I've
really benefited from thepharmacist catching when a
patient that I prescribedsomething for was on another
medication that couldpotentially interfere with it or
or have an adverse reaction, andsometimes providers don't really
have an accurate description ofall the medicines that a
patient's taking. Most of thetime when you go to a provider
(08:53):
now, when the nurse does yourintake, checks your vital signs
and your weight, they will alsoask you about your medications,
run over your medication list,so make sure that it's up to
date, because that it can changeso quickly, especially if you're
seeing more than than oneprovider, it can change really
quickly and and you won'tnecessarily recall everything
(09:15):
that you're on.
Beth Brown (09:17):
So let's talk about that then. And since we are
focusing on how to help patientsbe empowered, be more confident,
better understand their healthand their care when we talk
about medication safety, and Iwould like to hear from both of
you on this, what role does thepatient play in being safe with
(09:38):
their medications? What doesthat look like?
Dr. Doug Kuntzweiler (09:41):
I'll go first. I felt pretty strongly
about this one.
Beth Brown (09:44):
Okay, great.
Dr. Doug Kuntzweiler (09:45):
I can't tell you how many times in the
ER, I asked a patient, what,what meds are you on? But they
would say, Well, I don't know.
You've got a list of it here.
Look it up. Or they would say,Well, I'm on that little blue
pill. And I take that kind ofbigger gray pill, and then I
take this capsule and you say,right, there's only 3000 little
(10:07):
white pills. So yeah, I thinkit's patients' responsibility,
as we talked about in the past,you should have some interest in
your own health, and a big partof that is keeping an accurate
list of what you're taking andand knowing, and in general
sense, what it's for. You don'tneed to know. You know all the
(10:29):
pharmacology of a medicine, butyou might write down the
medication and that it's foryour high blood pressure, or I'm
taking this medicine it and it'sfor my thyroid. I'm taking this
medicine for whatever, keepingthat just on a little index card
and and trying to keep that upto date is is pretty viable. If
you always go to the samepharmacy, they should have a
(10:51):
pretty accurate list to whatyou're currently taking.
Beth Brown (10:54):
Yeah, we've heard that right. Use the same
pharmacist so that they can helpyou better understand your
medications.
Kyla Newland (11:01):
Yeah, and especially, as Dr K mentioned,
if you're seeing differentproviders, then the whole
picture is going to be there. Ifyou use the same pharmacy and
the same pharmacist as to what'sgoing on with your medicines.
There's also, if you aretechnologically inclined, you
can actually track yourmedications on your phone. If
you have an iPhone, I knowspecifically, there's a health
(11:23):
app on there, and you can addall your medications in there.
And you can even, I just waslooking at it this morning. You
can even ask it aboutinteractions on there as well,
which is pretty cool. And thenyou can set a timer if you have
trouble remembering you takeyour medications. You can set
reminders on there that willremind you when to take your
medication. So that's anothercool thing that you could
(11:45):
explore if you have access tothat technology.
Beth Brown (11:49):
Yeah, that's great.
I mean, there's an app for that,right? There's an app for
everything out there, so yeah,
Kyla Newland (11:55):
I'm sure there's other apps too.
Beth Brown (11:58):
So yeah, that's great for those folks who, I
mean, we live on our phones, andwe always have them with us. So
even in your example, Dr K,going into the ER or the
emergency department, odds areyou probably have your phone on
you, and so you can check thatlist and tell your doctor what
you're on and what it's for.
Kyla Newland (12:17):
Well, and, as we're talking about, like if you
go to the emergency department,or if you have a hospital stay,
is a lot of times yourmedications get changed, and so
that's a really good time tomake sure that you update that
list, that you understand themedications that you're supposed
to be taking, and also that youcommunicate with your providers
so your pharmacist and your yourdoctor about The changes,
(12:40):
because what I've seen happen,the local pharmacy, the provider
may not notify the pharmacy thatyou're not taking that anymore.
And then if you don't know whatyou're taking, and you come in
and you say, I need my bloodpressure medicine. You don't
know the name or you know thecolor, but you know whatever you
might get the wrong medicationif there's been a recent change.
So I think those instances whereyou're like either utilizing
(13:03):
specialists to add medications,or when you're have a hospital
stay or ER visit, is a good,really good time just to do that
double check on your list.
Beth Brown (13:13):
That's a great point. I appreciate that. And I
think it does really nail homethe thought that it takes a team
to manage your health, and it isthe provider who prescribed
medication, it's the pharmacistwho is helping you with that
medication, and it's you knowingwhat you're on and why you're
taking it, so that you can be apart of that team as well. And
(13:33):
so speaking of the team, let'stalk about the pharmacist,
because I feel like thepharmacist is such an
underutilized treasure as partof the healthcare team, you have
to make an appointment to get into see your doctor, unless
you're trying to get into urgentcare or emergency department. So
your doctor can sometimes bevery difficult to access. Sorry,
(13:53):
Dr K, but you know that, so youhave that pharmacist, and
pharmacies are crazy busy thesedays as well, but you can walk
in and wait in line and talk toa pharmacist. So let's talk a
little bit, Kyla, about how doesthe pharmacist play a role in
medication safety and in justbeing part of that health care
team?
Kyla Newland (14:14):
Yeah, so, we've historically been referred to as
the most accessible health careprofessional, because you can,
you can walk up to a pharmacyanytime. You can call a
pharmacy, and you can say, Iwant to talk to the pharmacist,
and we can answer a multitude ofquestions related to your
medications. And in some cases,if you have coverage on certain
(14:34):
insurance plans, we can sit downwith you and do like, a more
extensive review of yourmedications. So that's something
that you could ask about. Yeah,we do four years of training
specifically about medications,so we do have expansive
knowledge. And I encourageeverybody to utilize their
pharmacists to the highestextent that they can.
Dr. Doug Kuntzweiler (14:56):
And I would like to point out as a
provider, that I often talked topharmacists and ask them about
especially dosages, medicationinteraction and things like
which would be the bestantibiotic for this condition.
Medicine has gotten so complexand it changes so quickly. Every
(15:16):
year there are a multitude ofbrand new medications, and as a
provider, it's very difficult tokeep up, and I always found that
the pharmacists were aninvaluable resource for me to
help me prescribe accurately andcarefully.
Beth Brown (15:35):
Yeah, that's great.
You each have your own areaswhere you have to make sure
you're up to date on andobviously that's a specialty for
pharmacists. So kind of lastmonth, we met without you, but
we talked about questions thatpeople should be asking their
health care provider, and we hadsome three main ones, and then
we sort of built on those alittle bit. I wonder if you have
(15:56):
ideas on what a person should bein the routine of asking their
pharmacist. Do you have a coupleof questions there? Those are
the main ones that you shouldknow and be asking your
pharmacist, or feel comfortableasking your pharmacist?
Kyla Newland (16:12):
Yeah, I would say there is some kind of top
questions that you definitelyshould know about each of your
medications. First, you shouldknow what you're taking it for.
You should know your dose, andyou should know what time of day
to take that medication and howfrequently to take that
medication. You should also askif you need to take it with food
(16:34):
or without food, because somemedications can upset your
stomach. Some medications don'tget absorbed as well if you have
a lot of food in your system,and so those are good questions
to ask as well.
Dr. Doug Kuntzweiler (16:45):
Sometimes there are things you wouldn't
necessarily think of, like thereare a number of medications
that, if you take grapefruitjuice, that interferes with
their metabolism and theirabsorption, then you wouldn't
necessarily think about that.
Somebody needs to point that outto you, and that typically is
the pharmacist who does that.
Kyla Newland (17:03):
Yeah, that's a good point. There are some like
dietary things. Also, like ifyou take vitamins or
supplements, sometimes those canbind to medicines, and then they
don't get absorbed as well. Sothose are also good questions,
and make sure you include themedications that you are taking
over the counter, because that'simportant too, especially when
we can see those interactionswith those just as easily as a
(17:26):
prescription medication.
Dr. Doug Kuntzweiler (17:28):
I think it's important that people first
agree with their provider thatthe medication is is necessary
and that and that they agreedthat they're going to take it,
and so that means they they needa simple, understandable
explanation of what theircondition is and what the
providers proposing to treat itwith in in what what that will
(17:51):
do, and the provider should givethem, you know, at least some
basic understanding of sideeffects to watch out for and
those kinds of things.
Kyla Newland (18:01):
I mean, that's primarily when you come to the
pharmacy to get a newprescription. We can tell you
all the side effects, and we arerequired by law, actually, to
give that information to you. Sotake advantage of that and
always talk to your pharmacistwhen you pick up a prescription,
because that is a very valuableconversation.
Beth Brown (18:21):
For sure, and yeah to both of your points then,
it's not just the prescribingand even picking up the
medication, it's then taking itcorrectly. That's a big part of
medication safety as well. Andtalking about the over the
counter medications that peopleare taking, or if they're also
taking supplements or vitamins,you can see how it gets big fast
(18:46):
with all the different thingsthat people might be putting
into their bodies to help themfeel better or to function
better. So tips on that part ofit, so that people are, you
know, they agree with thedoctor, yep, okay, I'm going to
take this medication. I went tothe pharmacist, I got it. Now
I'm at home. How can I make sureI'm keeping everything sorted
(19:07):
how it's supposed to be and thenI'm taking it how I'm supposed
to take it?
Dr. Doug Kuntzweiler (19:12):
Well, I think that is a place for an
app, as Kyla talked about withmaybe the reminders, alarms with
reminders keyed into it. Or ifyou're old school, like me,
write it down, put it on therefrigerator. If you're elderly
and you know, you might havetrouble manipulating your
(19:33):
medications, or you're havingtrouble with memory, have
somebody help you set them up, afamily member, or friend to help
you set the medicines up. And ifyou add any question about what
you're supposed to be doing, youshould either ask the pharmacist
who filled it for you, or askyour prescriber, and then your
provider make sure that you gotit straight.
Kyla Newland (19:54):
Yeah, and you can also use pill boxes, and you
could do up to, like, a week'sworth of then maybe. In two
weeks. You can either do a weekor two weeks, I think, at a
time, in a pillbox. So you know,you have all your medicines you
take in the morning, all yourmedicines you take in the
afternoon, all the medicines youtake in the evening. And then
that kind of keeps you on trackas well. And like Dr K said, if
(20:15):
you're if you're needing helpwith that, definitely have
somebody help you set that upand do that for you on a regular
basis.
Beth Brown (20:23):
I mean, they really do have the day of the week,
morning, noon, evening, bedtime.
I mean, they can have all kindsof little compartments in there
to help keep all those pillsorganized.
Dr. Doug Kuntzweiler (20:34):
Another thing we should point out is
that when you are writing downall the medicines that you're
taking, a lot of people aretaking a number of over the
counter meds. And when you askthem, what medication are you
taking, they only tell you aboutthe prescription meds. You have
to ask them, Are you takinganything else? Are you taking
anything over the counter?
Sometimes it can be prettysurprising the number of things
(20:56):
people are taking that theydon't think of as, oh, that's
not what the provider wasasking.
Beth Brown (21:03):
One a day vitamins, or the whatever supplement, or
the root of whatever that you'reputting in your coffee in the
morning. Like, all of thosethings count. So another part of
that, though, is, yeah, youknow, I agree I want to take
this medication, but I justcan't freaking afford it. You
know, like, these are someinformations are expensive. And
(21:26):
for some people, depending ontheir health insurance, or if
they even have health insurance,that's where it gets sticky for
them is they would love toadhere to the treatment plan.
They would love to take thesemedications how they're supposed
to take them, but they can't gofill the prescription because
they can't afford them. Butthere are options there, right?
Kyla, like, what are some of theways that people can get help
(21:46):
paying for their medications, sothat they can take them when and
how they're supposed to.
Kyla Newland (21:52):
So there's a couple different options.
There's something called patientassistance programs, and those
are programs that are sponsoredthrough the drug manufacturer,
and so if you're taking a drugthat's expensive, you can go to
the website. It's calledneedymeds.org and you can search
for any medication on there andsee if there is what they call
(22:14):
this patient assistance program,which is an income based
assistance where in some cases,they will pay 100% of the cost
of that medication, and there,there's a lot of them out there.
And then the other thing is,there is also patient copay
cards. So say your copay, sayit's covered on your insurance,
but there's still a copay, andit's a high copay, and you still
(22:36):
can't even afford that. You canget that copay paid for with
what they call a copay card, Iguess. And that's something
usually your provider will haveand be able to distribute. Some
of the pharmacies will havethose too, and you can ask your
pharmacist if they have any ofthose for you to use. I know
with the COVID medications,since they're not covered by the
(22:58):
federal government anymore,there is a copay card because
they're pretty expensive. Sothose are a couple different
options.
Dr. Doug Kuntzweiler (23:05):
I think it's important for the providers
to have some sense of what arethe really expensive medications
and and I'm guilty of it too. Alot of times we don't really
know how much the medicines costthat we're prescribing. If you
are the patient, it wouldbehoove you to let your provider
know that cost is aconsideration, because
(23:26):
oftentimes there are cheaperalternatives. Generic forms of a
drug are usually cheaper thanthe proprietary or the name
brand.
Kyla Newland (23:38):
Yeah, that's a good point too, because you can
ask your pharmacist, that'sanother good question to ask. Is
there a medicine in this classthat would work similarly, or
the same way that I could maybehave my doctor write for
instead, so that I don't have topay this high price? And that
that is definitely a validquestion, and a lot of times
there is cheaper alternatives,and they're totally appropriate
(24:00):
and equally as effective.
Beth Brown (24:03):
I appreciate that, and that's a question, again,
that you can either ask theprovider or when the time comes
with the pharmacist, and that'salso part of asking those
questions to be an empoweredpatient, and it might take
swallowing some pride, right?
Like I don't want to admit thatI can't afford this medication.
Sometimes they really areridiculously expensive, but
sometimes it's just because ofyour situation. This is
(24:24):
expensive for me, and so I needto be able to say, but I need to
take care of my health first,and I'm just going to have to
swallow my pride a little bithere and admit I don't know if I
can afford this. And can youplease help me, whether it's
with a generic medication, orgoing to a website where I might
be able to help get somethingpaid for, or the copay card, or
(24:46):
whatever it is. So those aregreat.
Dr. Doug Kuntzweiler (24:53):
I would look at it as we're all in the
same boat too. Even if you havea high income, these medications
could still be be veryexpensive, so you don't have to
be too ashamed of it.
Beth Brown (25:04):
So I just want to end on closing thoughts from you
both about medication, safety,any thing that you want to make
sure people take away fromlistening today.
Dr. Doug Kuntzweiler (25:15):
Well, I'll start. I would say that the
important thing is to talk withyour provider and understand why
they want you to take thismedicine. What is it supposed to
do? What is the benefit to you?
Because you really should agreeto it before you walk out of
there with a prescription inyour hand, and then talk to your
pharmacist, make sure that it'sthe right medication, the right
(25:37):
dose, that you understand howand when you're supposed to take
it, and know what that littlewhite pill is when, when you go
to see a provider.
Kyla Newland (25:48):
Yeah, and I would just reiterate the fact that you
are a part of your health careteam, and medications are a huge
part of that. So be proactive.
Ask questions, and, you know,get as much information as you
can from from your health careteam, so that you can be the
healthiest that you can and getthe best benefit from the
medications that you take.
Beth Brown (26:10):
And report back with how those medications are going,
especially if they're not goinghow the prescriber and the
pharmacist hoped they would foryou. That's important to bring
up.
Kyla Newland (26:21):
Aboslultey.
Beth Brown (26:22):
Perfect. Well. Thank you both so much for being here
today. We, as always, appreciateyour experience and expertise.
Dr K and it was an absolutepleasure having you, Kyla, to
talk about your own experienceand expertise from the pharmacy
perspective. So thank you.
Dr. Doug Kuntzweiler (26:36):
Thank you.
Kyla Newland (26:36):
Thank you!
Beth Brown (26:38):
And thank you so much for listening. We'll put
some resources for you with thisepisode, including that URL that
Kyla mentioned to help out withthe cost of medications. And if
you have a question for Dr K orany of our mountain Pacific
staff who might be able to jumpon and lend their expertise,
please email us atQandAwithDrK@mpqhf.org, and that
(27:03):
email address will be includedwith this episode as well.
Thanks, everyone. Be well.
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