Experts on drug therapy, interactions and side effects, pharmacists are now also taking on expanded professional advisory roles. Following the lead of their colleagues in Alberta, pharmacists across Atlantic Canada are in the process of receiving limited prescribing rights. Pharmacists may not diagnose or prescribe new medications, but are recognized as primary health-care providers and drug experts who may be able to provide you with refills of certain prescriptions.
We asked two pharmacists to answer questions often asked by patients. Glenn Rodrigues, president of the Pharmacy Association of Nova Scotia, teaches at the Dalhousie University College of Pharmacy and works in a Dartmouth, NS, in a community pharmacy. Erin Farrell MacKenzie is executive director of the PEI Pharmacists' Association and a community pharmacist in Charlottetown.
I seem to be experiencing a side effect that isn't included in the pharmacy handout. What do I do?
Erin Farrell MacKenzie: Call me. The first thing I'd do is research to find out what the repercussions are and if you need to see your physician. I generally do patient follow-up on day five or six of drug therapy to see how the patient is making out. That is fantastic for being able to nip things in the bud like making sure someone doesn't stop taking their medication. Patients can absolutely request that follow-up and sometimes pharmacists just do it proactively. We'll do anything we can do to improve adherence to your medication therapy. Often it just takes a bit of reassurance that yes, you can expect that, and that's all you need to hear.
Glenn Rodrigues: Contact your pharmacist. If it's just a nuisance thing, I'll try to figure out if there is anything I can do to manage it, like recommending sunscreen if it makes you sensitive to the sun, taking it with food if it makes you nauseous, lozenges if it gives you dry mouth, or drops for dry eyes. Sometimes someone will have an uncommon adverse reaction and Canada Vigilance, a program that monitors side effects, needs to know. If you have a serious side effect like a severe allergic reaction or you're hallucinating and it's the middle of the night, go to emergency.
Why do some medications have an immediate effect that I can feel, but others take so much longer to have an effect?
EFM:It comes down to pharmacology and how the drug works in your body. Antidepressants need time to change chemical pathways in the brain, whereas Tylenol blocks your pain receptors as soon as it reaches them. This is where counseling can really help. If you're on antidepressants it can be weeks or months before you begin to feel better. In the meantime, there can be side effects like drowsiness or nausea. People who already are feeling down are now feeling worse. They may not be in a good state of mind to deal with this kind of thing and may quit the therapy in a week or two if they're not forewarned.
Can I flush my expired medication down the toilet?
GR: No. In Nova Scotia you can take them back to the pharmacy. It's really an environmental concern. We don't want drugs in the water supply or in the landfill.
EFM: In PEI we have a province-wide program whereby patients are educated to take their medication back to the pharmacy for safe disposal.
Why do I have to take some medications on an empty stomach?
GR: "Empty stomach" means take your medicine an hour before or two hours after you eat. Some drugs need to be taken on an empty stomach to absorb or you will lose the benefits of the drug. You can take these with a full glass of water and that helps them dissolve.
What does "take with meal" mean? How much food do I need to eat?
EFM: Taking a drug with food can help with absorption, but usually the food is more of a cushion to prevent stomach upset or irritation to the stomach lining. The amount of food depends on how much you need to stave off stomach upset or diarrhea. This could be a snack or a full meal.
If I run out, where can I get an emergency supply?
GR: If I know you and it is a refill of a prescription on which you have a history, I can give you an emergency supply. For example, it's nighttime and you run out of your heart medication and I'm worried about your blood pressure spiking overnight, or you run out of your puffer and can't breathe, then it makes sense. For narcotics or controlled drugs, you have to go to a walk-in clinic that prescribes them (not all do, so call first) or to a hospital emergency department.