Healthcare: Not Consulting Pharmacists Cause Grave Error


By Dr Charles Nwaora Nwako

Some Nigerian patients are still unaware that the cycle in their health-seeking behaviour is incomplete if they fail to consult with their pharmacists especially during their drug refill.

Most patients feel that their health challenges are solved once they consult their physicians, but fail to realize that the success of any health journey or outcomes depends greatly on their drug usages.

Drugs are not ordinary items of trade, but are potential poisons that could treat or harm if wrongly taken. The pharmacist is the health professional and legal authority that acts as the learned intermediary who produces, imports, distributes, and clinically audits any prescription for its appropriateness and safety, among others.

Any other personnel who assumes such roles is a usurper. As a consequence of patients not consulting with their pharmacists, many innocent clients have suffered both economic, health and other setbacks while trying to refill or administer their drugs.

Wrong choice in sourcing for drugs.

Many patients wrongly source their drugs in non-pharmacies or unregistered pharmacies. An adage says that it is not the size of the church building that makes a cathedral, but the presence of a Bishop. Once any drug outlet is without a pharmacist, getting your prescription refilled there is tantamount to taking a risk. The patient stands the risk of either buying a substandard/fake drug or robs himself of the salient drug information/disease education necessary for the appropriate intake
of the drugs.

Wrong drug administration timing

Some drugs must be taken at a particular time before they work. If taken at the wrong time, they may not work optimally. For example; some Antibiotics are time or
concentration dependent in order to work optimally. Examples of sometime-dependent drugs include penicllins like ampicillin/cloxacillin; cephalosporins like cefuroxime; macrolides like erythromycin; lincosamides like clindamycin, among others.

These drugs must maintain their concentrations above the minimum inhibitory concentration of the pathogens for up to or above 50 per cent of their dosing intervals to work optimally. Some concentration dependent drugs must have their concentrations
up to or greater than 10times that of the minimum inhibitory concentration of the microbes.

Nature of liquid used during drug administration

Many patients wrongly use very cold or hot water, tea, milk , soft drinks, alcohol and fruit Juices to administer their drugs. These liquids could affect the chemical nature of some drugs. For instance, cold water could slow the dissolution and disintegration rates of some drugs; hot water could hasten their dissolution and disintegration rates of these drugs; Coca cola, being acidic could interact with some basic drugs and form a neutral water and salt. This will automatically alter the drugs’ original state.

Fruit juices like grape, cranberry, orange and apple juices could alter the alkalinity or
basicity of these drugs or even hinder the activities of some metabolising enzymes in the liver.

Use of food in drug administration

Administration of food with some drugs could increase or reduce the bioavailability of those drugs.

Drugs like artemisinin based combined anti-malarials have enhanced absorption if taken with fatty meals. Cefuroxime antibiotic has enhanced absorption if taken with meals;
presence of food could reduce the intensity of GIT irritating properties of some drugs,etc. However, presence of food could reduce the bioavailability of some drugs like iron builders, ciprofloxacine, proton pump inhibitors like omeprazoles, among others.
The truth is that your pharmacist remains your best guide in drug administration

Drug storage

Many patients poorly store their drugs leading to rapid degradation. Some drugs are temperature, moisture or light sensitive and may be destroyed if not properly stored.

Drugs like Insulin should be stored in a cool and dry place like the door casing of fridges and not in the freezer. Very cold or hot environments denature them as protein. Eye drops must be kept in cool and dry places. Patients should avoid freezing their drugs except instructed otherwise by their pharmacist.

No drug that is to be stored in the fridge or freezer should be allowed to be there if there is long power outage. Drugs should be kept in the proper container, sealed and in an
aseptic condition. Your pharmacist will properly guide you on the best storage condition for each type of drug.

Crushing and scoring of drugs

Not all drugs are crushable or scored. Only drugs that are scored are crushable. It is wrong for patients to try to break or crush their drugs without first getting approval from their Pharmacist.

The pharmacist knows the best in terms of drug properties. Some drugs have a narrow margin of safety and unequal division could lead to toxicities. Most uncoated drugs could be crushed just like paracetamol. Coated drugs should not be crushed.

The essence of coating could be to mask the bitter taste, reduce acidic degradation in the stomach, etc. Entericoated drugs like low dose aspirin should not be crushed to avoid degradation by acid in the stomach.

Concurrent administration of two or more drugs

It is not always proper to take many drugs at the same time. Some could interact with each other and alter their properties. For example, antimalarials generally called ACTs
interact with vitamin C or antioxidants like selenium and this renders the ACT ineffective.

Antacids destroy the action of most drugs if taken together. Iron preparations and proton pump inhibitors like rabeprazole interact. However, drugs like Vitamin C and
Iron preparations are best co-administered to improve blood drug absorption. Only your pharmacists know the best for every circumstance.

Using a different container for drug storage

It is always wrong for patients to use another container to store their drug. This
could lead to drug interactions or accidental poisoning of drugs. Some particles of a drug could chemically react with a drug packaging if stored in a wrong container.

Also, there could be misinterpretation of labels and subsequent consumption of the wrong drug. Every drug must be properly labelled in the right container to avoid confusion and the incidence of poisoning and toxicity.

Using another patient’s prescription

Some patients go as far as borrowing copies of prescriptions from another patient to treat cases with similar signs and symptoms. It must be clearly stated that many
ailments look alike in terms of signs and symptoms and have different treatments.

It is a suicidal attempt for patients to use prescriptions prescribed for another person for
their personal cases. Patients must consult with their healthcare provider for better advice and guidance.

Discarding of drugs after use

Most patients are unaware that what they call medicine could actually poison the same patient. Some antibiotic penicillin powders turn to a toxic product once exposed to moisture. This toxic product could kill the patient if consumed.

This means that antibiotics, especially the powders should be discarded after the recommended duration. Other drugs should also be discarded if stored after some durations, otherwise they become poisonous to the patients. Patients must always ask their pharmacist(s) about how long their opened product could last.

Most products could expire earlier than their expiry dates if poorly stored. Always consult your pharmacist on all drug related issues to guide you properly. Consult a Clinical Pharmacist in the case of advanced pharmaceutical care and medication therapy management.

…Dr Nwako is a clinical pharmacist and he writes from Lagos