Medication Safety Articles

 

A recent warning was issued by the US Food and Drug Administration (FDA) to parents and caregivers about feeding infants homemade formula. Babies require adequate nutrients to help them grow and develop. The best source of these nutrients comes from human breastmilk. However, some families may not be able to, or may choose not to, breastfeed their baby; others may need to supplement breast feedings. In these situations, commercially available infant formula is best.

Consumers sometimes have allergies to certain medicines. In some cases, the allergy may not be related to the medicinal ingredient in the medicine. Instead, it may involve one of the other ingredients in the medicine, such as a preservative or a dye. These are called “nonmedicinal ingredients.”

A concerned veterinarian reported a potential risk with a medicine that is fatal to our furry family members, even after just licking their owners! The topical chemotherapy medicine, fluorouracil (CARAC, EFUDEX, FLUOROPLEX), is a cream or solution that is often used to treat skin disorders such as actinic keratosis or basal cell carcinoma. But it is extremely toxic to dogs and cats. Despite receiving emergency veterinary treatment after coming into contact with fluorouracil, the rate of death within 24 hours is high for dogs and cats. Even when small amounts of fluorouracil are eaten or licked, the dog or cat can build up high levels of ammonia in their body, which can be deadly. The problem happens when a pet licks the owner’s skin where the medicine has been applied or chews the fluorouracil container or tube of medicine. Soon after this, the pet may vomit, have diarrhea, start shaking (tremors), become unsteady and fall over, and have seizures. Currently, nothing can be done to stop the effects of fluorouracil once it has been licked or eaten (www.ismp.org/ext/574). Sadly, no warning label appears on fluorouracil products to alert pet owners about this risk. Please be sure to store fluorouracil products safely if pets (or children) are nearby, and to prevent dogs and cats from licking the owner’s skin if the cream or solution has been applied.

Ibuprofen is s an over-the-counter (OTC) medicine that parents might give their child to relieve minor aches and pains or reduce a fever. For children, it is available in chewable tablets (100 mg each) and an oral suspension (liquid). But parents may not be aware that there are two different concentrations of the oral suspension. Ibuprofen for infants contains 50 mg per 1.25 mL (40 mg per mL) and is often called “infant drops.” This medicine is for 6- to 23-month-old babies who weigh 12 to 23 pounds (5.5 to 10.5 kilograms [kg]). Babies may not be able to swallow a large amount of medicine. So, ibuprofen for infants is more concentrated than ibuprofen for children.

Some contact lens cleaning solutions contain hydrogen peroxide, which should never be used directly in the eye or as a rinsing solution for lenses. When these solutions are used as a cleaning and soaking agent, the lenses must be placed in a special lens case provided with the solution to neutralize the hydrogen peroxide gradually over 6 hours. The lenses can be safely placed back in the eyes only after soaking for 6 hours in the special case, not in a typical lens case. If the hydrogen peroxide is not neutralized, or if the solution is used only to rinse the lens or put directly in the eye, it will cause severe burning and pain. It may even result in severe eye injuries.

In October 2020, the US Department of Health and Human Services (HHS) gave permission to qualified pharmacy technicians and pharmacy interns to administer childhood vaccines and the new coronavirus disease 2019 (COVID-19) vaccines. HHS determined that, during the COVID-19 public health emergency, pharmacies can help consumers access lifesaving vaccines, particularly in areas that have too few pediatricians and other primary healthcare providers.

Are you (or is someone you know) scheduled to have wisdom teeth removed? Pain after wisdom teeth removal is common, so dentists and oral surgeons may prescribe strong medicines that combine a common non-opioid pain medicine (such as acetaminophen, ibuprofen, or aspirin) with a stronger opioid pain medicine (such as codeine, hydrocodone, and oxycodone). Examples of such combination medicines are Lorcet Plus, Vicodin ES, Norco, Endocet, and Percocet, or generic equivalents of them. Opioids are effective in treating pain, but even short-term prescriptions can lead to dependence or addiction.

A pharmacist recently heard from two people who mixed up their insulin pens and gave themselves the wrong insulin. First, a 67-year-old man with type 2 diabetes had been taking the long-acting insulin, Tresiba (insulin degludec), 70 units once daily. Because his blood sugar remained high, the man’s doctor also prescribed a rapid-acting insulin, Humalog (insulin lispro) to take with the first bite of dinner. Both of these insulins came in pens. One day, he accidentally took 70 units of the rapid-acting Humalog (which is a very large dose of rapid-acting insulin) instead of the long-acting Tresiba. He immediately realized the mistake and called the Poison Control Help line (1-800-222-1222). He had to check his blood sugar every 15 minutes for several hours and eat and drink sugary foods and beverages during this time to keep his blood sugar from dropping too low (hypoglycemia).

Confusion between the medicines Wakix (pitolisant) and Lasix (furosemide) was reported. Wakix is used to treat adults with narcolepsy (sleep disorder) for excessive daytime sleepiness. Lasix is a diuretic (or “water pill”) which increases the flow of urine to rid the body of excess fluid and salt. Using an online secure messaging system, a man was asking his doctor about a change in his dose of “Wakix” and whether he should get blood tests drawn. The man was also taking Lasix, and the dose had been changed several times over the years. The man had made several spelling errors when typing messages to his doctor. The doctor assumed the man had made a spelling error when typing “Wakix” and was instead talking about Lasix. Further questioning revealed the man actually was asking about Wakix.

Heading home after a hospital stay can be overwhelming. An important part of going home safely is understanding your medicines before you leave the hospital. The medicines you were taking before being hospitalized may have been changed or stopped, or new medicines may have been added during your hospital stay.

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