Sunday, February 17, 2019

Some common mistakes in taking medicines

·         Prescribing liquid medications in teaspoons and tablespoons: A teaspoon (tsp) can be confused with a tablespoon (tbsp). Their sizes may vary. Hence, all liquid medications should be prescribed in millilitres (mL) and they should be taken with a dosing device such as a small cup which should have mL markings.

·         Pill splitting: Tablets that are not scored should not be split into two. They can crumble or are divided into unequal halves affecting the dose strength. Sustained or extended-release tablets and enteric- or film-coated tablets are generally not considered appropriate for tablet splitting. Film coating masks taste; therefore splitting film-coated tablets may unmask the taste.

·         Sound-alike drugs can cause confusion e.g. a hypertensive patient called up his family physician who asked him to take Amlopress AT but the patient took amlopress 80 mg. After sometime he developed dizziness, flushing, palpitation, nausea, abdominal pain. Another example of sound-alike drugs is the patient received Isoprin IV in place of Isoptin and nearly died.

·         Misinterpreting decimal points: Using a trailing zero after a decimal point e.g. do not write 5.0 mg. There are chances that the patient may get 50 mg; 5.0 mistaken as 50 mg if the decimal point is not seen. Lack of a leading zero before the decimal point, if the dose of a drug is less than one, may cause a decimal point to be missed. E.g. writing .25 mg may result in the patient taking 25 mg instead, so write 0.25 mg.

·         Mistaking “U” as zero. Do not write ‘U’ for units; always write the complete word ‘units’. E.g. 4U insulin may be mistaken to be 40 units of insulin when the doctor meant 4 U (4 units).

·         8-2-8 mistake: The time interval should be written more clearly as 8am 2pm 8pm. Or, the patient may consider it to be the number of tablets to be taken 8 in the morning, 2 in the afternoon and again 8 at night.

·         Taking medicines with inadequate quantity of water or lying down immediately after taking the drug can cause pill esophagitis by direct esophageal mucosal injury. It is commonly seen with drugs such as nonsteroidal anti-inflammatories (NSAIDs), tetracycline, doxycycline, alendronate, antiviral drugs, iron supplements.

·         Some medicines need to be taken “before meals” or “on an empty stomach” because food can prevent absorption of some medicines and reduce their effectiveness. E.g. Levothyroxine and rifampicin should be taken on an empty stomach.

·         Taking medicines with fruit juices: Grapefruit, orange, and apple juices decrease the absorption of many drugs such as fexofenadine, cancer chemotherapy (etoposide), antibiotics (ciprofloxacin, levofloxacin), itraconazole, antihypertensives (atenolol), immunosuppressant (cyclosporine)

·         Skipping doses: This may be dangerous especially with antiepileptic drugs or anticoagulants.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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