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Managing someone else's medicines

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					MedicinesTalk
Information for consumers and consumer groups about using medicines wisely
 Spring 2008       Quick        Reporting when       What to do with       Should I stop my      Medicines
 No. 27            quiz    3    things go wrong 4    unwanted meds 5       medicines? 6          Line      7




Managing someone else’s medicines
Carers are family members or friends
who provide regular unpaid support
and care at home for an older person
or a person with a disability, chronic
condition or mental illness. Carers may
care full time or for a few hours a week.
Managing the person’s medicines is often
part of the role. There are several things
that can make the role easier.

This article is most relevant if you are
looking after a person who is unable
to make decisions about their health or
manage their medicines. If they can make
decisions, you will need their consent to
become involved in such decisions.           In turn, you will need the GP and
                                             pharmacist to give you clear information
Get to know their GP and                     and instructions about the person’s
pharmacist well                              medicines, and how and when to
Good two-way communication with the          administer them.
person’s GP, pharmacist and community        If you find it difficult to remember
nurse (if relevant) is essential.            everything you need to ask or tell the
Let the GP and pharmacist know that          GP or pharmacist, write down the
you are the person’s carer, and that         information or questions, and give it to
you are responsible for managing their       them at the start of the appointment.
medicines.                                   Don’t hesitate to ask the GP or
The GP and pharmacist will need you          pharmacist to write down any
to tell them about the health and well-      information or instructions you may
being of the person you are caring for,      forget. Also, feel free to ask them if they
any changes in their condition, and how      can give you any written information or
they are responding to their medicines.      refer you to other sources of information. cont >




Spring 2008 MedicinesTalk                    Managing someone else’s medicines       
          If you feel uncomfortable saying some        when to seek help. Keep the leaflets in a
          things in the presence of the person,        safe place, so you can refer to them later
          consider asking if you can speak to the      if necessary.
          doctor without them being present. This
                                                       Consider asking the GP to organise a
          may also be a good opportunity to raise
                                                       Home Medicines Review. This involves
          any concerns you may have about their
                                                       a specially trained pharmacist coming
          health and what may happen in the
                                                       to your house to discuss the person’s
          future.
                                                       medicines with you and the person you
                                                       are looking after. The pharmacist will
          Know their medicines                         explain what each of the medicines is
          Understanding what medicines the             for and anything else you need to know
          person you are caring for needs and why      about them. They can also answer any
          they need them will help them get the        questions you may have.
          best out of their medicines.
                                                       Keep track of their medicines
                                                       Keeping track of the medicines of the
Don’t hesitate to ask questions if you
                                                       person you care for will help to ensure
       are uncertain about anything.                   that they get the right medicine at the
                                                       right time, and help to prevent medicine-
                                                       related problems.
          Ask the GP to make a list of all the
          person’s medicines: prescription,            If the person takes several medicines,
          over-the-counter, herbal and natural         consider using a medication organiser.
          medicines. Take the list with you when       These are containers that store a day’s or
          the person sees a doctor or pharmacist,      a week’s supply of medicines in a series
          or goes into hospital.                       of small compartments.
          The list should include                      Medication organisers make it easier
          • the active ingredient and the brand        for you to give the person each of their
            name of the medicine                       medicines at the right time. They also
          • what it is for                             make it easy to see if a dose has been
                                                       given already. This is particularly helpful if
          • how and when to take it
                                                       several people are involved in giving the
          • side effects to look out for
                                                       person their medicines.
          • other medicines, including any
            over-the-counter, herbal and natural       Your pharmacist can put a week’s supply
            medicines, it may interact with.           of medicines in a medication organiser
                                                       (eg Webster-pak) that stores each dose in
          Read the medicine labels, and don’t          a separate sealed compartment. All you
          hesitate to ask questions if you are         have to do is remove each dose from its
          uncertain about anything.                    compartment and give it to the person.
          You can also ask the pharmacist for the      If more than one family member is
          Consumer Medicine Information (CMI)          involved in giving medicines that are
          leaflet (see back page) for each medicine.   not in a medication organiser, get each
          CMI leaflets contain comprehensive           person to write down on a chart (eg in
          information about how the medicine           an exercise book) what medicine they
          works, how to take it, side effects and      gave, how much they gave, and when


              Managing someone else’s medicines                     Spring 2008 MedicinesTalk
they gave it. If each carer checks the
chart before giving a medicine, you will
minimise the risk of missing doses or
giving doses twice.

In some situations, such as if you suspect
that the person is experiencing a side
effect, it may help to keep a diary of the
person’s symptoms to give to the GP. This
will help the GP determine whether the
symptom is a side effect or a part of their
health problems.

Look after yourself
Caring for another person is stressful
and tiring. It is vital that you look after
yourself and your health, because you
can’t look after someone effectively if
you are not in good health yourself.
                                              • Carer Advisory and Counselling
Some suggestions that have helped other         Service 1800 242 636
carers include
                                              • your state or territory Carers
• try to continue doing at least some of        Association 1800 242 636.
  the activities and outings you enjoy
• take respite breaks from caring from
  time to time
• try to get some regular exercise
                                               Quick quiz
• eat regular healthy meals                    Test your knowledge of the quality
• get enough rest and sleep                    use of medicines issues covered in
                                               this edition of MedicinesTalk. Are the
• ask for help when you need it.
                                               following statements true or false?
                                               Answers on back page.
Other sources of help
Many services exist to help carers and         1. Carers can ask their GP to
the people they are caring for. Such              organise a Home Medicines
services include help with showering              Review in their home.
and dressing the person, help with
                                               2. The Adverse Medicine Events Line
housework, support groups for carers,
and respite care at home, at a day centre         (AME Line) is for doctors to report
or in a nursing home.                             problems with medicines.

                                               3. You can take unwanted medicines
To find out about the services in your
                                                  back to the pharmacy you bought
area, talk to
                                                  them from for safe disposal.
• your GP, local council, local health or
  community workers                            4. You should stop taking all your
• Commonwealth Respite and Carelink               medicines before going in for an
  Centre 1800 052 222                             operation.


Spring 2008 MedicinesTalk                     Managing someone else’s medicines         
Reporting when things go wrong
Your doctor or pharmacist is obviously
your first port of call if you think you
may have experienced a side effect from
a medicine. They can tell you if it is a
recognised side effect of that medicine,
give you advice about what to do, and
suggest other treatments if necessary.

But, what if the side effect is not a recog-
nised side effect and you want to make
sure the right people find out about it?

You have two choices: you can ask
your doctor to report the side effect          The AME Line pharmacist will ask you
for you, or you can report it yourself to      questions about the side effect, the
the Adverse Medicine Events Line, also         medicine you suspect of causing the
known as the AME Line.                         side effect, the other medicines you are
                                               taking, your medical history, and any
Adverse Medicine Events Line                   recent changes to your medicines. These
                                               questions will help them to determine
The AME Line enables you to report
                                               whether the side effect could be related
suspected side effects of your medicines
                                               to your medicine.
to a specially trained pharmacist. The
pharmacist will collate the information        If the side effect could be related to your
and pass it on to the right authorities. The   medicine, the pharmacist will record all
pharmacist can also give you up-to-date        the relevant details and pass them on to
information about the medicine suspected       the Therapeutic Goods Administration
of causing the problem.                        (TGA), which is the Australian Govern-
                                               ment authority responsible for medicine
To report suspected side effects, call
                                               safety.
the AME Line on 1300 134 237 from
anywhere in Australia for the cost of a        The TGA will examine your report to
local call (mobile calls cost more). The       determine if anything needs to be done
service is open Monday to Friday               to prevent other people experiencing the
9 am–5 pm Eastern Standard Time.               same side effect, or to warn doctors and
                                               consumers.
You can report a suspected side effect
of any medicine, be it a prescription          Your personal details will remain
medicine, over-the-counter medicine,           confidential and will not accompany the
or complementary medicine (vitamins,           report.
minerals, herbal and natural medicines).

Ideally, it is best to ring the AME Line       More information
when you are experiencing the side             A free AME Line brochure with a fridge
effect or immediately afterwards, so the       magnet is available from the National
details are fresh in your mind. You can        Prescribing Service. Visit them at
also call the AME Line to report side          www.nps.org.au/consumers or ring
effects that happened some time ago.           them on 02 8217 8700.


    Reporting when things go wrong                          Spring 2008 MedicinesTalk
What to do with unwanted medicines
How many out-of-date or unwanted
medicines are lying in the cupboards
in your house? Where are the left over
tablets you stopped taking last year?

Dangers
We all understand the dangers that
unwanted medicines in the house
pose to children because of the risk of
accidental poisoning. However, few of us
think about the dangers they can pose
to the community as a whole. Medicines
past their use-by date may slowly
deteriorate and become less effective.
Medicines used by someone other than
the person for whom they were intended
may be unsuitable for that person,
or they may interact with their other
medicines and cause a harmful reaction.         Do your bit
                                                Gather all the medicines in your
Return Unwanted Medicines
                                                house.
Project
So, what should we do with our                  Check the expiry dates on all the
unwanted medicines?                             medicines.
                                                Check which medicines you still
Simply putting them down the toilet
                                                need. If in doubt, check with your
or sink or in the rubbish bin is not the
                                                pharmacist or doctor.
answer. Medicines disposed of via the
toilet or sink may go through the sewage        Take all the expired and no longer
treatment process unchanged, which              needed medicines to any pharmacy
can pollute our waterways. Medicines            for disposal.
disposed of via the rubbish bin usually
end up in landfills, which can pollute our    The pharmacy will place the medicines
soils and air.                                in a special yellow container. When
                                              the container is full, the pharmacy will
The Return Unwanted Medicines (RUM)           arrange for it to be transported to a
Project is an Australia-wide scheme,          disposal depot where it will be destroyed
funded by the Australian Government,          in a high temperature incinerator.
that enables each of us to dispose of our
unused medicines safely by taking them
                                              Further information
to a local pharmacy.
                                              To obtain a brochure about the RUM
To dispose of your unwanted medicines,        project, ring Simon Appel, the Project
simply take them to any pharmacy (it          Manager, on 03 9583 8699 or
doesn’t have to be the one you got them       1300 650 835, or visit the RUM Project
from). There is no charge for the service.    website (www.returnmed.com.au).

Spring 2008 MedicinesTalk                    What to do with unwanted medicines      
Should I continue or stop my medicines?
                                             • increase the chances of bleeding
                                             • increase the chances of other
                                               problems occurring
                                             • change the effect of the anaesthetic
                                             • change the effect of drugs given after
                                               the operation.

                                             Some of these medicines should
                                             be stopped completely before your
                                             operation. Aspirin, warfarin, anti-platelet
                                             medicines such as Plavix or Iscover, anti-
                                             inflammatory arthritis medicines (NSAIDs)
                                             such as ibuprofen, and herbal medicines
                                             such as gingko and ginseng are examples
Most people know it’s important not to       of medicines that you will usually be told
eat or drink for several hours before an     to stop.
operation. But, what do you do about
                                             Some other medicines should
your medicines? The answer to this
                                             be continued as normal, but the
question depends on several things: the
                                             anaesthetist needs to know about them,
medicines you are taking, your health
                                             so they can adjust the amount or type
conditions, and the type of operation
                                             of anaesthetic they give you. Medicines
you are having.
                                             for anxiety, sleeping, depression and
                                             some pain medications are examples of
Continue as normal                           medicines in this category.
Most medicines should be taken as
normal before an operation, so you           Tell your surgeon and
don’t interrupt their beneficial effects.    anaesthetist
This will help ensure that your operation
                                             It is vital that your surgeon and
and recovery go as smoothly as possible.
                                             anaesthetist know about all the
Unless told otherwise by the surgeon,
                                             medicines you are taking, so they can
anaesthetist or pre-admission clinic, take
                                             ensure that your operation goes as safely
your regular morning medicines with a
                                             and as successfully as possible.
few sips of water up to two hours before
the operation. Medicines for high blood      When you agree to have your operation,
pressure, angina, asthma, stomach ulcers     give the surgeon a list of all your
and epilepsy are examples of medicines       medicines, or tell them about all the
that are usually continued as normal.        medicines you are taking. This includes
                                             any prescription, over-the-counter, herbal
Exceptions                                   and natural medicines, as well as any you
                                             might not think are important, such as
However, there are exceptions. Some
                                             aspirin, supplements and vitamins.
medicines may increase your chances
of having problems during or after           Ask the surgeon if you should stop
the surgery, or they may hinder your         taking any of your medicines before the
recovery, because they                       surgery. If advised to stop, ask cont >


    Should I stop my medicines?                          Spring 2008 MedicinesTalk
when you should stop it — it could be
anything from 1–2 days to 2–3 weeks          Key points
beforehand. Also, ask when you can           Tell your surgeon and anaesthetist
re-start it after the operation.             about all the prescription, over-the-
If you are concerned about stopping a        counter, herbal and natural medicines
medicine you feel you rely on, ask your      you are taking.
doctor if there is another medicine you      Continue taking your prescribed or
could take during this time. For example,    recommended medicines, unless
people who normally take NSAIDs for          advised to stop.
arthritis may be advised change to           If advised to stop a medicine, ask
paracetamol (eg Panadol) to minimise         when you should stop and restart it.
their joint pain and stiffness.
                                             At the pre-admission clinic and when
You also need to have details of your        you are admitted, tell the hospital
medicines on hand at the pre-admission       about all the medicines you take.
clinic and when you go into hospital or      Best of all take a list.
day surgery for the operation. Therefore,    If you have any questions about
it will pay to make a list of all your       continuing or stopping medicines,
medicines. The list should include any       contact your surgeon or anaesthetist.
you have temporarily stopped.



Medicines Line answers your questions
Each day, scores of people ring the         medicine for diabetes. His advice will
pharmacists at Medicines Line (see          depend on the medicines you take.
back page) to ask questions about their
                                            Many commonly used arthritis medicines
medicines. Here’s Roger’s question.
                                            including meloxicam (eg Mobic),

Q     I’m due to have a hip replacement
      operation next month. My doctor
mentioned that I may need to stop some
                                            ibuprofen (eg Nurofen) and diclofenac
                                            (eg Voltaren) can increase the chances of
                                            excessive bleeding during surgery, so are
of my medicines beforehand, but I’m not     usually stopped for a short period.
sure which ones he wants me to stop.
                                            Some diabetes medicines such as
I’m taking six medicines for high blood     metformin (eg Diabex) may need to be
pressure, arthritis and diabetes.           stopped for a couple of days before the


A
                                            surgery due to increased side-effect risks
     This is an important question.
                                            during surgery. However, other diabetes
     You need to check back with your
                                            medicines such as insulin should be
surgeon at least two weeks before the
                                            continued and not stopped.
surgery to get clearer instructions about
which ones he wants you to continue         Be sure to follow any instructions about
and which ones he wants you to stop.        when to stop your medicines. Stopping
                                            them too early could mean that you
The surgeon will probably advise you
                                            become unwell or suffer unnecessary
to continue taking your medicines as
                                            pain. Stopping them too late could mean
normal, with the possible exception
                                            that your surgery has to be postponed or
of the medicine for arthritis and the
                                            cancelled.

Spring 2008 MedicinesTalk                           Should I stop my medicines?      
                                                                                                                                Useful information
                                                                                                                                CMI leaflet                                                  NPS Medicines List
                                                                                                                                Consumer Medicine Information (CMI)                          Use an NPS Medicines List to keep an
                                                                                                                                leaflets have been written for most                          up-to-date record of all your medicines.
                                                                                                                                prescription and many non-prescription                       Keep it with you at all times for
                                                                                                                                medicines. The leaflets explain how                          emergencies, and take it whenever you
                                                                                                                                the medicine works, how and when                             go to a doctor, pharmacist, health centre
                                                                                                                                to take it, common side effects and                          or hospital. The list is available in English,
                                                                                                                                potential interactions. Obtain the CMI                       traditional and simplified Chinese, Greek,
                                                                                                                                for your medicine from your pharmacist,                      Italian and Vietnamese. Order a copy free
                                                                                                                                Medicines Line or the NPS website                            of charge from the NPS website
                                                                                                                                (www.nps.org.au/consumers).                                  (www.nps.org.au/consumers).

                                                                                                                                Home Medicines Review                                        Medicines Line
                                                                                                                                A Home Medicines Review (HMR)                                Ring Medicines Line on 1300 888 763
                                                                                                                                involves a pharmacist visiting your home                     to talk to a pharmacist about your
                                                                                                                                to check and discuss all your medicines.                     prescription, over-the-counter and
                                                                                                                                The visit is organised in consultation                       complementary medicines for the cost of
                                                                                                                                with your GP, who receives a report                          a local call (calls from mobiles may cost
                                                                                                                                afterwards. Talk to your GP or pharmacist                    more). The service is open
                                                                                                                                if you want to find out more about                           9 am–6 pm Monday–Friday (EST).
                                                                                                                                HMRs.
                     system for doctors. 3. True. However, it doesn’t have to be the pharmacy you bought them from. 4. False.




                                                                                                                                                                                             Questions to ask about your
                     general public, so they can report problems with medicines to the government. There is another reporting

                     It depends on the medicines, your health and the type of operation, but in most cases, no. Make sure you
                     find out from your surgeon, well ahead of time, whether you need to stop any of the medicines you take.
                     1. True. This can be a good opportunity to learn more about the medicines taken by the person you are




                                                                                                                                Medication organisers                                        medicines (new)
                     caring for. Ask your GP or pharmacist for more information. 2. False. The AME Line is specially for the




                                                                                                                                Medication organisers are plastic boxes                      A reminder list of questions to ask your
                                                                                                                                with compartments that hold a day’s or                       doctor or pharmacist is available in
                                                                                                                                a week’s supply of medicines. Some, you                      English (as a fact sheet) and in traditional
                                                                                                                                fill yourself. Others, eg Webster-paks,                      and simplified Chinese and Italian (as a
                                                                                                                                are filled by the pharmacist. To find out                    wallet-sized list). Order a copy free of
                                                                                                                                more, ask your pharmacist.                                   charge from the NPS website
                                                                                                                                                                                             (www.nps.org.au/consumers).


                                                                                                                                 Who writes MedicinesTalk                                    ing decisions. Opinions expressed in MedicinesTalk are not
                                                                                                                                 MedicinesTalk is written and edited by Ros Wood and         necessarily those of the editors or NPS.
                                                                                                                                 Sarah Fogg, and overseen by an Editorial Committee          Spread the word
                                                                                                                                 comprising consumer representatives, health professionals   You are welcome to reproduce articles from MedicinesTalk
                                                                                                                                 and the National Prescribing Service (NPS).                 provided that you reproduce the whole article and
                                                                                                                                 MedicinesTalk is sponsored and published by NPS, an         acknowledge MedicinesTalk and the National Prescribing
                                                                                                                                 independent non-profit organisation for the Quality Use     Service.
                                                                                                                                 of Medicines (QUM) funded by the Australian Government      Get your copy of MedicinesTalk
                                                                                                                                 Department of Health and Ageing.                            Medicines Talk is published quarterly free of charge on
Quick quiz answers




                                                                                                                                 ISSN: 1447-3208 (print) and 14447-3216 (online)             paper and online. Visit www.nps.org.au/consumers to
                                                                                                                                 All due care is taken to provide accurate and reliable      subscribe to the paper version or view the online version.
                                                                                                                                 information. However, the information in MedicinesTalk is   You can also write to MedicinesTalk, NPS, Reply Paid 1980,
                                                                                                                                 not medical advice, so seek professional help before mak-   Strawberry Hills NSW 2012 or ring 02 8217 8700.


                                                                                                                                     Useful information                                                         Spring 2008 MedicinesTalk

				
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