by Glenn Rodrigues, Community Pharmacist

Every year, Canadians fill millions of prescriptions. The process of taking a medication is often complicated. Do you take it with food or on an empty stomach? What about vitamins, alcohol, or dairy products? When should you take it? How do you manage the side effects? Was that three or four times a day? The process is even more difficult for those who take several medications to treat multiple conditions, such as diabetes, depression, heart disease, arthritis, and high blood pressure. People who take 5, 10, 15, or more pills a day may equate success in drug therapy to being able to take all the medications correctly. Focusing on how to take medications can cause people to lose sight of what the medications are, what they are supposed to do, and how well they are working.

Fortunately, Canadians are becoming more knowledgeable about their medications. People want to know if a drug therapy will achieve its desired benefit or outcome. Your pharmacist as a medication manager can work with you and other members of your health care team to help you evaluate your treatments. Helping you to find the answers to the following six questions can usually accomplish this.

1. What is the name of the medication? Knowing the names of your medications is the first step. It is difficult to memorize complex drug names, but aim to be familiar with them so that you can relate them to their purpose and reduce the risk of confusing multiple drug therapies. Your pharmacist can assist you with a written medication record.
2. What benefit should I expect by taking it? Understanding the benefits of taking a medication is the second and most important step. People are more likely to skip doses and to stop helpful treatments, or alternatively, to continue to take treatments that are not giving the best results, if they do not know why they are taking them. Sometimes the answer is simple. If you have pneumonia, you want your antibiotic to clear the infection. If you have asthma, you want your medication to improve breathing, prevent attacks, and enable you to perform your daily activities.Sometimes the benefits are less straightforward. You might be surprised to learn that the ultimate goal of taking cholesterol medications is not to lower blood cholesterol. The motivation for dieting, exercising, and taking these medications is to avoid the heart attacks and strokes that are more likely to occur in people with high cholesterol. Preventing complications and prolonging life are the much more meaningful goals for people with diabetes, high blood pressure, glaucoma, osteoporosis, and many other conditions. Talk to your pharmacist if you are unsure of the full benefits of a medication.
3. What should I monitor to determine if I am receiving this benefit? If changing cholesterol levels is not the ultimate goal of cholesterol medications, are they important? Absolutely! We use cholesterol readings to monitor how successful we may be at reducing the risk of heart attacks and strokes. It is important with any therapy that you have a way to measure your level of success. It is easy to see how blood glucose levels, thyroid levels, a fever, bone density, blood pressure, or even a persistent cough are all characteristics that can be monitored to determine if a medication is working.Some treatments may require a more creative approach to gauge success. Patients taking medications for arthritis may rate the intensity of their pain and keep a diary of how easily they are able to perform daily activities. People taking asthma medications may use a peak flow meter, keep a record of how easily they are able to exercise, or keep track of how often they use their rescue medication. Someone taking an antidepressant may record sleeping and eating patterns or use tools to help measure mood and keep track of social activities. Your pharmacist can assist you with ideas on how to monitor the effectiveness of any medication in accomplishing your personal goals.

   The final three questions allow you to be specific in evaluating your drug therapy.

4. What is my current condition? Once you have determined the characteristics you wish to monitor, you should try to determine your current condition and a specific, realistic target that you hope to achieve. A patient at risk of a heart attack with an LDL cholesterol reading of 3.6 may wish to lower it to 2.5. Someone with asthma may wish to decrease the use of a rescue inhaler from 12 times a week to 3 times a week. Someone who consistently rates arthritis pain as a 7 out of 10 may wish to lower it to a 3 out of 10. People with redness and swelling from a skin infection wish to completely eliminate their symptoms.
5. What target should I hope to achieve? You may have to consult with your health care team to determine your current condition and targets. It is important to recognize that targets may vary from one person to another based upon individual circumstances. Once you know your targets, you will be in a position to properly evaluate the effectiveness of your medication.
6. When should I reach my target? It is essential to set a time frame for reaching your targets. Some therapies may provide rapid results, while others may work more slowly. Nitroglycerin to relieve heart pain should start to work within five minutes. An antibiotic for an ear infection should reduce pain, fever, and discharge within two to three days. The effect on mood for antidepressants may not be noticeable for four to six weeks. Some arthritis treatments may take up to six months before the full benefit is realized. Find out when you should notice the desired result for any medication. If the targets are not achieved by then, you may have to consider changes in dose, alternate medications, additional medications, or even re-examination of your targets. Without a time frame, you may put yourself at risk by continuing treatments that are not effective. If you reach your targets, plan to routinely reassess the safety and effectiveness of the medication and make sure your targets continue to serve your health needs.

By learning the answers to these six questions, you allow yourself to play a much more active role in managing your health. With our health care system facing rising costs and limited resources, Canadians want results from their treatments. As a medication manager, a pharmacist can help you develop strategies to evaluate your medications and make sure you are getting the benefits you deserve.

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