Caregiver Guide: Using Medicines Safely

A drug reaction can be an emergency. The following is a list of serious symptoms that could be caused by a drug reaction. These drug reactions often begin shortly after starting a new medicine or when the dosage (amount and frequency) of a drug is changed.

Call the healthcare provider during office hours to discuss the following problems

While some side effects from medicines happen immediately, others happen slowly over a period of days or weeks, or even months.  What may seem to be a new health problem or a worsening of an existing condition may be a reaction to a medicine. 

The following symptoms may develop over time as a result of taking certain medicines and should be reported to the healthcare provider by calling during office hours:

• Moderate shortness of breath (If sudden or severe, call immediately)
• Fatigue (If sudden or severe, call immediately)
• Confusion or being "out of it" (If sudden or severe, call immediately)
• Incontinence or problems urinating (If sudden or severe, call immediately)
• Depression, feeling "down," or taking no interest in previously enjoyable activities
• Constipation
• Persistent cough
• Insomnia
• Sexual problems
• Sensitivity to sunlight
• Feeling jittery or fearful
• Increased lower leg swelling

Know the answers to the following questions before calling the healthcare provider

Symptoms

• What is the symptom? (Try to be accurate and specific.)
• When did the symptom start?
• Is it a new symptom or an ongoing problem that is now worse?
• How severe is the symptom? Does it interfere with usual activities (such as preparing meals or dressing)?

Medicines

• What medicines are being taken? (Include prescription and non-prescription.)
• Is the older person following instructions for prescription medicines? If not, what is being taken and how much?
• Has a day or two been skipped in taking prescription medicine?
• Does the older person have any allergies?

There are many things that you can do to help safely manage medicines in the home.

Keep a current record of all medications taken

Make a list of all the medicines that the older person takes.  Include prescription and nonprescription medicines.  (Personal medication record books, sometimes called 'medication passports' are available at no cost at some pharmacies.) 

Write down

• the name of each medicine
• the healthcare provider who prescribed it
• what it is for
• the amount taken
• the possible side effects
• the times of day it is taken

The older person should keep a copy in the medicine cabinet and in a wallet or pocketbook.  You should keep a copy too.  This record should be reviewed with the healthcare provider at every visit and whenever a healthcare provider prescribes a new medicine.

Ask about drug allergy and medicine bracelets and necklaces

Drug allergy bracelets can be bought in many pharmacies.  These are small metal bracelets that can be worn over the wrist or hung on a necklace.  For example, a bracelet might say "allergic to penicillin." 

Custom medical identification bracelets or necklaces are also available, for a fee, by mail.  Some pharmacies will have the application forms.  Customized bracelets can tell medical personnel, such as ambulance workers, about the person's medical conditions, allergies, medicines, and special needs, such as blood type and if the person has a living will.  In some instances, this information will be provided to health care workers after they call a telephone number imprinted on the bracelet.

At least once a year, ask the healthcare provider or the staff to review all medicines and explain the reason for taking each medicine

As new medical problems occur, new medicines will be prescribed.  Sometimes this is done without a complete review of medicines that have already been prescribed.  Also, new information about side effects may become available about medicines the older person is taking.  Therefore, it is important that medicines be reviewed regularly.

If possible, use only one pharmacy

This way, the pharmacy will have all of the prescription medications and drug allergy information on their computer.  This will be helpful when the pharmacist checks for drug interactions as new prescriptions are filled.  Tell the pharmacist the medical problems that the older person has. Medicines taken for one problem may make another problem worse and the pharmacist may notice this, if it has escaped the healthcare provider's attention.

Make sure you understand the label that the pharmacy attaches to the medicine

Labels can be hard to read and difficult to understand.  Ask the pharmacist to explain the information on the label including expiration date, number of refills (if any), and directions for use. 

If the information is vague, ask for an explanation.  For example, if a label says "take 3 times a day" does that mean every 8 hours?  Does the older person need to be awakened promptly to take the medication?  Should the medicine be taken with meals or an hour before meals?  What should you do if a dose is skipped? Can it be taken with other medicines?

If there are no children in the home, refuse child safety caps on bottles

Child safety caps have helped prevent child poisonings, but they can be difficult to open.  If it is too much of a struggle to open the bottle, the older person may not take the medicine. If children live in the house or sometimes visit, keep medicines locked up or on a shelf they cannot reach.

Store medicines in a cool, dry place

Although many people keep their medicines in the bathroom, its high moisture content makes it a poor place to keep them.  Many tablets and capsules lose their strength if exposed to moisture or strong heat or light.  The bedroom is usually a better location. 

Store medicines in the refrigerator only if instructed to do so by the pharmacist or if they are labeled "refrigerate."

If you do not know how to store the medicine, ask a pharmacist.

Keep medicines in their original containers

Mixing different pills in one bottle can be confusing and even dangerous. Since many medicines look alike, this can confuse the patient, caregivers, or people who may help in an emergency.

Do not keep medicines at an older person's bedside

An older person can wake up in the middle of the night and take an additional dose of medicine without realizing it.

Have the older person sit up or stand when taking pills, and use a half cup of water to wash them down

Water will help prevent the medicine from sticking in the throat and causing irritation.  If the older person has difficulty swallowing, ask your pharmacist if the medicine is available in liquid form, or if it is all right to crush the tablet and mix it with applesauce or other soft food.  Some tablets or capsules should not be crushed or chewed.

Use a pillbox

You can buy a pillbox with many compartments at your pharmacy.  Some pillboxes have compartments for 7 consecutive days and for times of day the medicine has to be taken: early morning, noon, evening, and bedtime.  "Mediset™" is a popular brand of this type of pillbox. There are also pillboxes with alarms to notify you when the next dose should be taken (this is useful for medicines that require precise timing, such as medicines for Parkinson's disease.) For medicines that cannot be placed in a pillbox - such as liquids, cream, and patches - a reminder note placed on the refrigerator may be helpful.  Keeping medicines on the kitchen table with a note saying when to take them may also be helpful.

Use reminders

A checklist or markings on a calendar may be helpful to show when medicine should be taken and when it was taken.  Alarm clocks can be helpful, or you personally may have to remind the older person when to take medicines.

Ask about other ways to take medicines

Few people, young or old, can remember to take a medicine three or four times a day.  If the older person has trouble taking the prescribed medicine, or has trouble remembering to it, tell the healthcare provider or pharmacist.  They may know of a similar medicine that is easier to take, or one that only needs to be taken once a day.

Some medicines are available in the form of patches that are placed on the skin and need to be changed only every few days; however, they are usually more expensive than the same medicine in pill form.

Throw away old medicines

Check the expiration dates on medicine bottles, and throw medicines away if the date has passed. It's usually a good rule of thumb to discard medicines after a year. It is natural to want to hold onto unused medicines ("just in case"), but stockpiles of medicines can be confusing and even dangerous. Some pharmacists highlight the expiration date with a yellow marker; you can do the same thing at home. 

This is especially important for nitroglycerin tablets. Some communities have laws about how drugs can be disposed of.  For example, it is illegal to flush medications down the toilet in some communities.  Ask your pharmacist if it is OK to flush medications down the toilet or if you can return the expired medicines to the pharmacy for disposal.

Problems you might have carrying out your plan

You may have some beliefs that might get in the way of carrying out your plan.  Here are some examples and responses.

The medicines your aunt takes are an important part of her care.  Her healthcare provider needs to review them with you.  If you have trouble bringing it up at the appointment, tell the office staff in advance that you would like the healthcare provider to review all of her medicines at the next visit.

There are lots of things that can be done to make the medicine-taking routine simpler and easier for her to remember.  Pillboxes like Mediset™ can contain all the medicines your mother needs for 7 days, counted out and organized by day, time, and dose.  Medicines that can be taken once a day instead of three times a day might also be helpful. Ask the healthcare provider or pharmacist for suggestions. 

You shouldn't stop giving a prescription medicine unless the healthcare provider says it's okay. It may be helping in ways that you're not aware of. It may also be the type of medicine that should be stopped gradually, taking smaller and smaller doses until the older person is off it completely.  Some drugs, if stopped suddenly, may cause adverse effects.

The high cost of medicines is a major concern for many older people.    Medicines are not generally covered under Medicare, and many older people don't have the insurance coverage to pay for them.

If the price of medicines is a problem, tell your healthcare provider or pharmacist. Your healthcare provider may be able to prescribe a less expensive medicine, or substitute a generic medicine that does the same thing as the brand name.  Generics are generally just as good as the brand names but usually much less expensive. Also, many drug companies have programs that supply their medicines free to patients who have no insurance and cannot afford them.  Your physician will have to provide the company with information about your medical condition and inability to pay.  Ask your healthcare provider or pharmacist for more information. Also, social workers can tell you about programs or agencies that can give you financial help for medicines.

Think of other problems you might have carrying out your plan

What additional roadblocks could get in the way of helping the older person safely manage medicines?  For example, do you have the time and energy to carry out these responsibilities?  You need to develop plans for getting around these problems.

To manage medicines effectively, you have to be organized, persistent, and constantly asking questions.  When you see changes in the older person, always keep in mind that the medicines they are taking may play a part.

Managing medications and making sure that they are used safely is an important part of caregiving.  If you do a good job, you can prevent many problems. Getting the older person on the right medication schedule can improve their life dramatically.  Changing or stopping medicines can sometimes improve quality of life including becoming more active, thinking better, and improving sexual functioning. 

If your plan isn’t working

Improperly managed medicines can be dangerous.  If medicines are not being managed properly, in spite of your best efforts to use the ideas in this section, you should get help. You may need the help of a home health nurse, or to bring someone into the home to help manage the medicines.  Or perhaps this is a time to consider moving the older adult to a setting with more structure where someone is paid to be responsible for managing medicines.  These range from assisted living settings to nursing homes - depending on the person's needs.