Consultant Pharmacists – A lifesaving resource for patients
Although many of those prescribing medications do well, it isn’t rare for people to be started on medications not right for them. This is particularly common with the elderly. Several factors contribute to the elderly being particularly vulnerable to medication side effects. For one thing, the liver is less able to break down drugs as quickly. Because of this, when an older person takes a dose of a medication that is normal for a younger person but too high for them, it builds up in their body, potentially reaching a toxic level. A toxic level of a drug usually brings no advantage but increases the harm to the body.
The kidneys are also less efficient with the majority of older individuals. Because of this, medications and metabolites of medications aren’t eliminated as easily. Thus these chemicals can also build up in the body and cause problems.
Another reason the elderly are more likely to get sick from medications is a practice called polypharmacy. This is another way of saying that they are more prone to be on too many medications. This is formula for an endless variety of medical problems from drug interactions. One type of such an interaction occurs when two drugs are broken down by the same liver enzyme. Because amounts of these enzymes are limited one of the medications may not be broken down as quickly as it should. This can lead to toxic levels of the drug building up.
Prescribers such as doctors, physician assistants and nurse practitioners have training to help them properly prescribe. They also have multiple guides and resources to help prevent these medication problems. Pharmacists have an important role to also provide another safety check. This system can be short circuited when an individual has more than one prescriber or gets medications from more than one pharmacy. Another problem with this system is that a given prescriber can order a medication that isn’t a good choice for a particular patient because the prescriber was ill-informed or hadn’t learned enough about the medication. Nurses and pharmacists have limited ability to stop that.
How can a patient be protected from such a potentially harmful situation? Most important is an awareness that sometimes signs and symptoms are caused by a medication rather than by germs, deterioration or some other well-known cause of illness. It might be sufficient to ask the prescriber to consider the possibility that the drug they prescribed is the cause of a new problem. Keep in mind that it’s hard for a prescriber to consider this possibility. It’s not uncommon for the prescriber to be defensive about that. After all, it’s admitting that they may have made a mistake. Another possibility is to consult with another health care provider and discuss concerns. A third choice is to find a consulting pharmacist. These specially trained pharmacists don’t prescribe or stop medications since that’s not part of a pharmacists training or work. But they are able to review medications and make recommendations to patients and/or their family. Prescribers aren’t usually eager to receive such a report. It too is usually perceived as a criticism of their work or care of their patient. It might require changing health care providers to have prescriptions reevaluated. This might seem like a lot of work and include the possibility of offending a health care provider. But the good side of this is that it may well return at least a measure of health to the patient. It may even save their life. And that is indeed worth it all.
To find a consultant pharmacist in your area, log onto this website:
This article is not intended to replace your health care provider. The intent is to inform people about this invaluable resource.
I highly recommend Dr. Armon Neel’s and Bill Hogan’s Are Your Prescriptions Killing You? This excellent book explains the role of the consulting pharmacist in much more detail. It also includes a clear discussion of a number of medication classes, and the implications for the elderly. There are numerous stories illustrating important points. There are also many resources listed.