MEDICATIONS

medication/medical assistance

Anyone taking prescription medication or even over-the-counter medication or herbal preparations really needs to understand just a few things about how the body uses medication and how some medications or supplements can cause problems. I can understand that most of you may be saying to yourself that you don't really understand pharmacology and you want to leave that up to your prescriber or your pharmacist. But you really should understand just a little bit about how medications work and why some supplements or even alcohol may prove problematic.

Let's just begin with a few terms that will help you to understand the language that people in healthcare may use. They shouldn't be the only ones using this language and leaving you out of the discussion and that's the reason why I'm offering this information to you.

Terms You Need to Know

Bioavailability: this indicates how much of the drug which you took is actually going to get into your blood supply. If you take 10mg of a medication, 10mg will not get into your blood because two things will get involved in that process. The two areas that will cut back on the available amount of medication are located in the gut and the liver. This is where the body begins to try to eliminate the drug.

As much as 50, 60, or even 70% of the original dose of medication may be eliminated and you may only be getting as little as 30% of the medication dose you took. Everyone in healthcare knows this and there is really no way around it. Your body is trying to protect you even as you take medication to maintain your health. Taking higher doses of a med, however, is never a good idea because that can lead to dangerous levels of the medication or even toxic levels in your blood. The dose ordered by your prescriber is the dose you take unless it is changed by that prescriber.

An additional point regarding bioavailability needs to be made here. While many people in healthcare will tell you that there is absolutely no difference between a brand name medication and a generic medication of the same type, there is a difference and it is in the bioavailability.

According to FDA regulations, generic medications may have a 15% difference in bioavailability vis-à-vis a brand medication. So the end result is that generics don't necessarily put the same amount of medication into circulation in the blood in your body. This is not to say that generics are not good or that they don't save money for you, but if you are taking a generic and you find it's not really working as well, it may be because of this bioavailability difference. You need to discuss this with your prescriber.

Sequestering: when you take medication your body, depending on the medication you take, may store some of it in your bones or in your body fat. For this reason, even after you stop taking a medication there may actually be medication in your blood because it is slowly coming out of the bones and the fat and going into your blood supply.

Half-life: half of the drugs that you have taken will be available after a certain number of hours. When will the drug be totally out of your body? We usually consider a simple multiplication; 4–5 half-lives is usual. So if the half-life of a medication is 4 hours, it can take up to 20 hours for almost all of it to be metabolized and disposed of. But remember that sequestering and that can account for some trace amounts to remain.

Research videos on the internet and watch the basic ones. Yes, you can understand it and it doesn't have to be difficult. You may have to watch the videos a few times but that's normal because you are, in fact, learning an unfamiliar language. Give yourself time and you will become a better informed medication consumer.

Mode of administration: Of course not all meds are taken by mouth (the abbreviation for medications taken by mouth is PO) and there are several other ways that a medication may be introduced into the body such as IV (into a vein), IM (intramuscular), rectally, subcutaneous (otherwise known as sub Q), and transdermal (through the skin). Each of these has its own advantages and uses for the disorders or problems being treated with the medication. Newer approaches to medication administration include intranasally where a spray is used to quickly put the medication into the bloodstream via the nose and inhalants taken via the mouth as a gaseous spray for administration to the lung.

Products that cause problems: One thing that people often forget is that some OTC products, fruit juices and alcohol can cause problems with medication action. How does this happen? Simply put these products may block areas of the gut or liver where a medication must be broken down and this can lead to a build-up of medication to unsafe levels in the blood. On the other hand, they may also prevent much of the medication from getting to the liver and this means a lower level of the medication reaches the blood circulation.

In addition to alcohol, problems are caused by St. John's Wort, antacids and grapefruit juice and, I suspect, that wonderful fruit known as a Tangelo which is a cross between a grapefruit, a tangerine and a pomelo. The result is probably the same as grapefruit juice.

I recommend that you read up on all of this. This list is not complete by any means because there can also be drug-drug problems that lead to ineffective or overly high blood levels of medications.

A blog everyone MUST have on their “favorites” list in their web browser is: The Carlat Psychiatry Blog

Not everyone has health insurance and some who have it don’t have sufficient coverage or are not able to purchase their medications. With this thought in mind, the uninsured or underinsured, we will add to this page as we uncover more resources.

Some of the resources will be for assistance with prescriptions, others will be groups that offer help of some type in the area of healthcare services. If you wish to have a resource included, please send an email to me and we will consider it for inclusion.

DR. PATRICIA A. FARRELL

the need to know has never been greater

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