Jennifer Gold

Jennifer Gold

Monday, 23 May 2011 18:11

High-Alert Medications - Methotrexate

Extra care is needed because methotrexate is a high-alert medicine.

High-alert medicines have been proven to be safe and effective. But these medicines can cause serious injury if a mistake happens while taking them. This means that it is very important for you to know about this medicine and take it exactly as directed.

 

Top 10 List of Safety Tips for Methotrexate

When receiving a prescription
1. Look for the reason. Ask your doctor to put the reason for your medicine on all prescriptions. You might take a medicine like methotrexate daily for a week at a time if you have cancer, but just once or twice a week if you have arthritis or psoriasis (or certain other conditions). If the pharmacist knows your condition, he or she will make sure the directions for taking your medicine are correct.
2. Ask for special packaging. Ask your doctor if the medicine comes in a special package designed for weekly use. For example, Rheumatrex, one brand of methotrexate, comes in a weekly dose pack. Never leave the doctor’s office unless you clearly understand how to take your medicine.
3. Disclose all medicines. Tell your doctor about all prescription, nonprescription, and herbal products you take, particularly ibuprofen (Motrin, Advil), aspirin, echinacea, and vitamins.
4. Avoid during pregnancy or breastfeeding. Tell your doctor if you are pregnant or trying to get pregnant. Methotrexate may cause birth defects or death of the unborn fetus if taken during pregnancy. Avoid pregnancy for at least 3 months following treatment with methotrexate. Do not take this medicine while breastfeeding, as it may reduce your infant's ability to fight infections.
When dropping off a prescription
5. Pick a day(s). Pick the day(s) of the week that you’ll be taking your medicine, and ask your pharmacist to include that in the instructions.
When picking up your prescription
6. Ask for education. Ask the pharmacist to go over the directions for taking the medicine. Be sure it agrees with what the doctor told you.
7. Take weekly, not daily. Never take the medicine daily for more than 1 consecutive week.
When taking your medicine
8. Never take extra doses. Do not take extra doses for symptom relief. Relief of symptoms is gradual and begins in 3 to 6 weeks after starting the medicine. Continued improvement occurs during the first 12 weeks of taking the medicine.
9. Avoid direct sunlight. Methotrexate causes an abnormal skin reaction if you are exposed to sunlight. You could develop severe redness, pain, and peeling of the skin. If you are in the sun, use sunscreen on your skin and wear eye protection and a hat.
10. Report side effects. Let your doctor know about any side effects you experience, particularly a rash, fever, chills, trouble breathing, cough, racing heartbeat, bleeding, and changes in how often you urinate.

 

Methotrexate is a cancer medicine. However, it is also used to treat other conditions like rheumatoid arthritis and psoriasis. It works well for these conditions if you take the medicine just once or twice a week, and in smaller doses. But if you take the medicine every day by accident, you could be harmed. Sadly, some people have even died.

In several instances, this happened because people misread the directions on the prescription bottle.

In one case, a man with arthritis mistakenly took one tablet each morning, but the directions said to take one tablet each Monday. In another case, the prescription label said to take the medicine every 12 hours for just three doses. But a woman took the medicine every 12 hours for 6 days in a row. Another man took many extra doses to help relieve arthritis pain—something that should never be done.

Harmful mistakes may happen because you, your doctor, and your pharmacist are more familiar with medicines that are taken daily. Serious harm, even death, could occur if you take methotrexate daily for conditions other than cancer.

See the Top 10 List of Safety Tips to help you avoid mistakes when taking methotrexate less often than daily.

 

 Topics Fast Facts
Generic name
  • methotrexate (pronounced meth o TREKS ate)
Common brand names
  • Rheumatrex and Trexall
Generic available
  • Yes
Common uses
  • Cancer, psoriasis, rheumatoid arthritis
Other uses
  • Crohn's disease, ectopic (tubal) pregnancy
Safe dose limits
  • No more than three tablets (each taken 12 hours apart), or a total dose of 20 to 25 mg each week for treatment of psoriasis and arthritis
  • Higher doses are used only if treating cancer
Special instructions and precautions
  • Typically taken once or twice each week
  • Do not take daily for more than 1 consecutive week
  • Avoid alcohol
  • Do not take any new medicine unless approved by your doctor
  • Causes sun sensitivity, so use sunscreen and protective eyewear and clothing
  • Do not take with milk-rich foods
Safety during pregnancy/breastfeeding
  • Do not take during pregnancy; may cause birth defects
  • Do not take while breastfeeding
  • Avoid pregnancy for at least 3 months following treatment
This medicine should not be taken if you have:
  • Liver or kidney disease, AIDS, certain blood or bone marrow disorders
Also tell your doctor if you have:
  • Peptic ulcer disease or ulcerative colitis
Storage and disposal
  • Store at room temperature and protect from light
  • Avoid touching the tablets with your hands as much as possible
  • Dispose of the medicine securely in the trash
Side effects
  • Minimal side effects occur with low doses to treat psoriasis or rheumatoid arthritis
  • Possible side effects include: nausea, vomiting, drowsiness
  • Low-dose methotrexate has been associated with the rare development of cancerous lymphomas (tumors in lymph nodes)
Side effects to report to your doctor immediately (usually seen when taking high doses)
  • Rash, excessive fatigue, mental confusion, fever, chills, mouth sores, shortness of breath, dry cough, rapid heartbeat or palpitations, unusual bleeding or bruising, black stools, persistent stomach disturbances, change in how often you urinate
Nonprescription medicines/herbals/vitamins to avoid when taking methotrexate
  • Nonsteroidal anti-inflammatory agents (e.g., ibuprofen [Motrin, Advil]) or aspirin
  • Vitamins that contain folate, echinacea
Prescription medicines that should not be taken with methotrexate
  • Check with your doctor; some of the medicines that may be a problem include: acitretin, cyclosporine, sulfonamides, trimethoprim, vaccines, clozapine, carbamazepine
Special tests your doctor may prescribe
  • Blood tests may be prescribed every 1 to 4 months to make sure your kidneys and liver are functioning well and your body is making enough blood cells

This information does not replace the need to follow your doctor's instructions and read the drug information leaflet provided with your prescription.

This project was supported by grant number R18HS017910 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.

Extra care is needed because fentanyl is a high-alert medicine.

High-alert medicines have been proven to be safe and effective. But these medicines can cause serious injury if a mistake happens while taking them. This means that it is very important for you to know about this medicine and take it exactly as directed.

Top 10 List of Safety Tips for Fentanyl Patches

Before you use the patches
1. Use for long-term chronic pain only. Fentanyl patches should ONLY be used to treat long-term chronic pain by people who have previously taken high doses of prescription pain medicine (opioids) for 7 or more days without relief. Otherwise, the medicine can cause serious breathing problems.
Use intact patches.
2. Use intact patches. Never cut the patches or use damaged patches (could result in an overdose).
3. Avoid broken skin. Apply patches only on skin without cuts or sores.
When picking up the prescription
4. Talk to your pharmacist. Tell your pharmacist the type of pain you are experiencing and any other pain medicines you have been taking and for how long.
While wearing a fentanyl patch
5. Follow directions. Use the patches exactly as directed to prevent serious side effects. Do not use more patches than prescribed. Take off the old patch before applying a new patch.
6. Do not warm your patches. While wearing a fentanyl patch, do not expose the site to heat from a heating pad, electric blanket, sauna, hot tub, heated waterbed, or excessive sun exposure, or hot climate. Also, avoid tight coverings over the patch and strenuous exercise, which can heat the body. The body absorbs too much medicine with excessive heat.
7. Take care around children. Don’t let children see you apply a patch. Don’t apply the patch where children can see it or on areas with frequent movement. Used patches still contain medicine, so check often that the patch has not fallen off, especially after exercising, bathing, and sleeping. Consider taping the patch to your skin so it doesn’t come off your body. Children have found patches that have fallen off or removed patches on sleeping adults and put them in their mouths or on their bodies with deadly results. If a patch is chewed, sucked on, or ingested, seek immediate medical attention.
8. Report signs of an overdose. Signs of fentanyl overdose include: trouble breathing, shallow or very slow breathing; tiredness, extreme sleepiness; inability to think, talk, or walk normally; and feeling faint, dizzy, or confused.
Storing and discarding the patches
9. Store patches safely. Keep new patches far away from the reach or discovery of children. Do not let children see you apply patches or call them stickers, tattoos, or Band-Aids. This could attract children and encourage them to mimic your actions.
10.

Dispose of patches safely. Safely discard used or unneeded patches by folding the sticky sides together and flushing them down the toilet. Some of the medicine remains in each patch even after use, which could harm others who come into contact with it. The US Food and Drug Administration recommends flushingpatches to quickly and effectively make sure a child or pet can't get to them and be harmed by the leftover medicine.

Used fentanyl patches still contain some medicine after you take them off. This is why it is important to always take off the old patch before placing a new one on your skin. If you don't, you could receive an overdose of the medicine.

Both new and used patches can also be dangerous to children or pets. In a tragic accident, a 4-year-old child died after placing a fentanyl patch on his body. His mother had been using fentanyl patches to treat pain from Crohn's disease, a digestive tract disorder. After she found her son dead, she also found a torn fentanyl patch wrapper in an overturned trashcan in her bedroom. A 2-year old child and a 15-month-old baby died recently after they found used fentanyl patches, put them in their mouths, and swallowed them.

Children have also been exposed to medicine patches that have fallen off a family member. One child sat on a fallen patch and it stuck to her thigh. Another child removed a patch while his grandmother was sleeping and put it on himself. In these cases, the patches were noticed quickly and the children were not injured.

See safety tips # 7, #9 and #10 for safe ways to keep children safe

 

 Topics Fast Facts
Generic name
  • fentanyl (pronounced FEN ta nil) transdermal system patches (generic available)
Common brand names
  • Duragesic
Common uses
  • Management of persistent, moderate-to-severe, long-term (chronic) pain when around-the-clock pain control is needed for an extended period of time
  • ONLY used if patients have previously taken high doses of opioids for more than 1 week
Usual dose
  • Doses vary widely, from 12.5 mcg per hour to 100 mcg per hour or more
  • The initial safe dose is determined by the amount of pain medicine that has been previously required in a typical 24-hour period
  • The dose should not be increased more often than every 3 days after the initial dose or every 6 days thereafter
What to do if you miss a dose
  • Apply the patch as soon as remembered after removing the old patch
  • Do not use more than the prescribed dose (just one patch at a time unless your pharmacist tells you that two patches are needed for your prescribed dose)
Special instructions and precautions
  • Prior to application, clean the skin with water (no soap), allow it to dry completely, and clip hair if necessary (do not shave the area)
  • Apply the patch to unbroken skin on the chest, back, flank, or upper arm; do not apply to areas getting radiation therapy
  • Firmly press the patch in place and hold for 30 seconds
  • Change the patch every 72 hours (or 48 hours if directed by your doctor)
  • Remove the old patch and clean the site; apply a new patch to a different site
  • Do not use damaged or cut patches (could result in an overdose)
  • If gel leaks from the patch, serious effects are possible; thoroughly wash the affected skin with lots of water (not soap or alcohol, just water)
  • Avoid heat on the site of the patch (e.g., heating pad, electric blanket, hot tub, sun)
  • Avoid drinking grapefruit juice or eating grapefruit while taking this medicine
  • Have a family member watch you closely for side effects during the first 24 hours of wearing the first patch or if your doctor increases your dose
Safety during pregnancy/breastfeeding
  • Do not use during pregnancy; may result in newborn having withdrawal symptoms
  • Enters breast milk, so not recommended while breastfeeding
Tell your doctor if you have:
  • Lung diseases such as asthma or sleep apnea, liver or kidney disease
  • Been using recreational drugs or consuming alcohol
Storage and disposal
  • Do not store in temperatures above 77° (F)
  • Dispose of patch by folding the sticky sides together and flushing it down the toilet
Side effects
  • Shallow or slow breathing, confusion, dizziness, drowsiness, poor coordination, headache, blurred vision, sweating, nausea, vomiting, constipation
Side effects to report to your doctor immediately
  • Shallow or very slow breathing, significant dizziness, chest pain, slow or rapid heartbeat, bad headache, confusion, swelling of extremities or unusual weight gain, temperature of 10° (F) or higher, vision changes
Nonprescription medicines and herbals to avoid when using fentanyl patches
  • Alcohol, St. John's wort, kava kava, gotu kola, sleep aids, antihistamines, other pain medicines unless directed by your doctor
Prescription medicines that should not be taken when using fentanyl patches
  • Check with your doctor; some of the medicines that may be a problem include: ritonavir, indinavir, nelfinavir, erythromycin, clarithromycin, fluconazole, ketoconazole, itraconazole, nefazodone, verapamil, some heart medicines, many antidepressants

This information does not replace the need to follow your doctor's instructions and read the drug information leaflet provided with your prescription.

This project was supported by grant number R18HS017910 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.

Monday, 23 May 2011 18:11

High-Alert Medications - Warfarin

Extra care is needed because warfarin is a high-alert medicine.

High-alert medicines have been proven to be safe and effective. But these medicines can cause serious injury if a mistake happens while taking them. This means that it is very important for you to know about this medicine and take it exactly as directed.

Top 10 List of Safety Tips for Warfarin

When taking warfarin (blood thinner)
1. Take exactly as directed. Take your medicine at the same time each day. Do not take extra doses or skip any doses.
When the doctor changes your dose
2. Keep a record of telephone calls. When your doctor, nurse, or pharmacist calls to change your dose: write down the dose and any other instructions; read the dose and instructions back to him or her to make sure you understand them; and date the instructions so they won't be mixed up with older instructions.
3. Know your dose. Always tell your doctor the strength of warfarin tablets that you have on hand. Then ask him or her how much warfarin to take, and how many tablets in that strength to take to equal the dose. If you are running low on tablets, ask for a new prescription.
4. Keep instructions nearby. Keep the dated instructions near the medicine, and read them every time before taking your warfarin.
5. Restart your medicine. If your doctor told you to stop taking warfarin until your next blood test, call him or her if you don’t hear anything within 24 hours of the test to find out your new dose or when to restart your prior dose.
To avoid serious side effects
6. Keep to your regular habits. Keep your eating habits and exercise regular. Know the foods high in vitamin K to avoid or eat consistently. Tell your doctor if there has been a recent change in your level of exercise, diet, or how often you smoke.
7. Take precautions. Because serious bleeding can occur, take precautions. Use an electric razor, avoid sharp objects, and keep away from fall risks (climbing ladders, for example).
8. Get regular blood tests. Keep all appointments for regular blood tests (called INR). Call your doctor for your test results if you are not contacted within 24 hours of the test.
When you should call your doctor
9. Signs of bleeding or clot. Call your doctor immediately if you experience any signs of bleeding or clot formation, which are listed on the other side of this paper.
10. New medicines. Do not start or stop any prescription or nonprescription medicines, herbals, or vitamins without telling your doctor. Common nonprescription medicines to avoid can be found in the Fast Facts table.

 

Signs of bleeding

  • Unusual pain, swelling, discomfort (may also be a sign of a clot)
  • Unusual or easy bruising
  • Pink or brown urine
  • Prolonged bleeding of gums or cuts
  • Persistent, frequent nosebleeds that don't stop within 7 minutes
  • Unusually heavy/long menstrual flow
  • Coughing up blood
  • Vomit that is bloody or looks like coffee grounds
  • Severe dizziness, weakness, headache, fainting, unusual or persistent tiredness
  • Bloody or black stools
  • Pain in joints or back

Signs of a clot

  • In the lung: chest pain, fast heart rate, coughing, shortness of breath, fever
  • In the arm or leg: sudden leg, arm, or back pain, swelling, redness, warmth, tenderness
  • In the brain: headache, vision changes, seizure, slurred speech, weakness on one side of body, dizziness
  • In the heart: chest pain, shortness of breath, sweating, nausea and vomiting
  • In the abdomen: abdominal pain, vomiting, diarrhea

 

Some foods high in vitamin K

Avoid

  • Cranberries/cranberry juice

Avoid or eat in consistent amounts

  • Beef or pork liver
  • Green tea
  • Broccoli and Brussels sprouts
  • Chickpeas
  • Green leafy vegetables, such as spinach, kale, turnip greens, Swiss chard, cabbage
  • Parsley, basil, thyme
  • Many cooking oils
  • For more: www.ismp.org/sc?k=foods

 

 Topics Fast Facts
Generic name
  • warfarin (pronounced WAR far in) (generic available)
Common brand names
  • Coumadin and Jantoven
Common uses
  • Prevent and treat blood clots in certain conditions that increase the risk of clots: surgery, heart attack, heart rhythm problem, heart valve replacement, immobility after an accident
  • Prevent transient ischemic attacks (mini strokes, brief episodes of low oxygen to the brain)
Usual dose
  • Up to 10 mg daily for adult patients; your dose may be based on a lab test that shows how sensitive you are to the medicine
  • Doses are periodically adjusted based on INR blood test results
What to do if you miss a dose
  • If it is still the same day, take the dose as soon as you remember it
  • If it is the next day, skip the missed dose and take your normal dose
  • Do not double the dose to catch up
  • Contact your doctor if you miss two or more doses in a row
Special instructions and precautions
  • Take exactly as prescribed, the same time each day
  • Avoid alcohol, keep eating habits and exercise regular
  • You will have a tendency to bleed easily, so use a soft toothbrush, waxed dental floss, electric razor; avoid sharp objects and fall risks, such as climbing a ladder
  • Do not start or stop any medicine, including nonprescription medicines, herbals, and vitamins, without letting your doctor or pharmacist know
Safety during pregnancy/breastfeeding
  • Do not take when pregnant, may cause fetal bleeding or abnormalities
  • May take while breastfeeding, but let the infant's doctor know for proper monitoring
Tell your doctor if you have:
  • Diseases: bleeding disorders, kidney disease, liver disease, thyroid disease, severe high blood pressure, diabetes
  • Conditions: surgery, history of falls or if you are at risk for falls, open wound
Storage and disposal
  • Store at room temperature, protect from light and moisture (do not store in bathroom)
  • Dispose of tablets securely in the trash; do not flush down the toilet
Side effects to report to your doctor immediately
  • Signs of bleeding or clot (see top of page), skin irritation, painful red-purple patches on skin (toe, breast, abdomen), unusual fever, unhealed wounds, yellowing eyes or skin
Other conditions to report to your doctor
  • Accidents or falls (even if you feel fine), new or stopped medicines (including antibiotics, nonprescription drugs, herbals, vitamins), changes in smoking/eating habits, infection
Nonprescription medicines/herbals/vitamins that should not be taken with warfarin
  • Aspirin (unless prescribed by your doctor), nonsteroidal anti-inflammatory drugs (ibuprofen [Advil, Motrin], naproxen [Aleve]), most herbals (particularly cranberry, fenugreek, garlic, ginkgo biloba, glucosamine, American ginseng, ginger, goldenseal, coenzyme Q10, St. John's wort, alfalfa, anise, bilberry), cimetidine (Tagamet), vitamins A or E
Prescription medicines that should not be taken with warfarin
  • Check with your doctor, as many prescription medicines interact with warfarin
  • Tell your doctor and pharmacist about all the medicines you take
Special tests your doctor may prescribe
  • You must have blood tests (called INR) checked regularly
  • Your doctor will determine the right INR level (usually between 2 and 3.5) for you

This information does not replace the need to follow your doctor's instructions and read the drug information leaflet provided with your prescription.

This project was supported by grant number R18HS017910 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.

Durezol is a steroid eye drop prescribed to reduce swelling and pain after eye surgery. Unbelievably, there’s a wart remover with a very similar name called Durasal. The wart remover is a strong salicylic acid (26%) solution. Both products come in small applicator bottles. You can guess what can happen, especially since patients who undergo eye surgery often have difficulty reading medication labels.

Friday, 02 September 2011 15:21

Hot Topic Testing Area

This is the Hot Topic Testing Area. I am trying to see how I can put other articles in the Hot Topic Area!!! This has color on the page? Why?

All medicines have one generic name, and perhaps one or more brand names. For example, Advil and Motrin are brand names for the generic medicine ibuprofen. When you are taking medicine, it is important to know both the generic and the brand names. This information will prevent you from taking too much of the same medicine, which can lead to an overdose.

Electronic prescribing (e-prescribing) is becoming an increasingly popular way for doctors to prescribe medicines for their patients. This method involves using a special computer program. Using a handheld device or computer terminal, the doctor selects the medicine he wants to prescribe for the patient.

One of the medication errors reported recently to the Institute for Safe Medication Practices (ISMP) through this website involved a patient who dropped off her doctor's prescription for Prilosec (omeprazole), a drug for acid reflux, at a local pharmacy. After she picked up the prescription and got home, she opened the bottle.

It should never happen, but it's not unheard of for another patient's medication to somehow slip into your bag before you pick it up at the pharmacy. Bagging errors can happen when more than one patient's medications are in the pharmacy work field at the same time, often during the prescription packaging process. Pharmacists are well aware of this and most pharmacies do require that staff work on only one patient's medications at a time. Nevertheless, since bags containing prescription medications are not routinely opened at the point-of-sale, if an error does happen it may not be captured before the patient leaves the pharmacy.

Inhalers are devices that contain medicines used to treat asthma and several other diseases that affect the lungs. By inhaling the medicine from the device, asthma sufferers and people with other lung diseases can breathe easier. It is important to learn how to properly use an inhaler and when to use it. This is especially true for people with asthma. Asthma is a breathing condition that affects both children and adults. Many people often need more than one medicine/inhaler to treat their asthma.