 Hello, my name is Kevin Shibilski and I'm a pharmacist at Michigan Health. I help provide medication information for all of our patients. Today, I am here to provide you with medication management information. Today, we'll be discussing more life, more health, more knowledge about medication management. I'd like to first start with the definition of medication. A medication is a substance used for medical treatment, especially a medicine or a drug. There are two kinds of medicine, prescription and over-the-counter or OTC. For prescription medications, a prescription is needed from your physician and you get it filled at a pharmacy. For over-the-counter medications, no prescription is needed. The Food and Drug Administration, or FDA for short, is a federal entity that determines what medications become prescription and then which ones end up as over-the-counter. When a medication becomes over-the-counter, it is no longer really considered a drug by the FDA, it is deemed safe enough to basically be considered a food. The FTC, or Federal Trade Commission, regulates advertising for over-the-counter medications. The FTC has much less stringent standards than the FDA for what manufacturers have to reveal. Now looking at the difference between generic and brand name drugs. Starting with brand name drugs. Brand name drugs are researched by a specific pharmaceutical company. That company holds a patent on the medication and the patents are usually good for up to 20 years. It takes on average 12 years for a new drug to come to the market. There's one in 5,000 chance that a new drug will come to the market. It has to be researched for side effects, safety and efficacy. So why do brand names medications cost so much? The brand name medications can cost up to 3 times the price of the generic version. This is because brand names take years of extensive research and advertising is needed to introduce a new product which of course is costly. As far as generic drugs, it's basically a copy of the brand name. It has the same active ingredient as the brand name medications. But they cannot use the same brand name as the original but sell it as a generic chemical version. The cost is much less because less research, testing and advertising is involved. More companies are able to produce a medication with market forces driving down the cost. Most insurance companies require or prefer generic medications to help reduce the cost. So changing gears some, let's briefly discuss how to recognize how changes in our aging bodies affect medications. For medications to be effective, they have to be absorbed which is usually through the intestine. They then have to be distributed which is through the bloodstream to get to the area of the body which they need to be effective. And they need to be metabolized and removed from the body which usually occurs via the liver and or kidneys. As far as the effects of the normal aging process, a number of things happen as we age. There's an increase in the percentage of our body fat. There's a decrease in body fluid. There's a decrease in digestive system function. A decrease in our liver function and also our kidney function. Of course there's a decrease in our memory, a decrease in vision and hearing, and a decrease in dexterity. I'm sure that everyone is not happy to hear all of these things that worsen as we age. But I'm also sure there's no surprises to anyone regarding this. And because of all these changes that occurs in our body as we age, this affects how medications work. For example, with worsening liver and kidney function as we age, this affects how medications are metabolized. So as we age, the doses of medication usually needs to be decreased. Now we'll discuss how to distinguish between allergic reactions, side effects, and adverse drug events. Let's start with allergic reactions. These are sensitivities to substances called allergens. They can be mild, which includes rash and itching, up to severe, which is anaphylaxis. And of course, anaphylactic reactions are life-threatening and needs emergency treatment. As far as side effects of medications, it's an adverse effect of a medication. Some examples include the nonsteroidal medications or NSAIDs, such as ibuprofen. This can lead to bleeding or ulcers. Anticoagulants, such as warfarin or coumadin, can lead to bleeding problems. Benadryl or diphenhydramine, which you can get over the counter, can lead to drowsiness. And many antibiotics can cause diarrhea. Again, these are all side effects of medications. And then when patients start to have side effects from medications, these side effects may be treated with more medications, which can lead to polypharmacy and even more side effects. It can basically turn into a vicious cycle. So allergic reactions plus side effects leads to adverse drug reactions or ADRs. As far as adverse drug events, this is an injury resulting from the use of a medication. It's usually a serious event such as falls leading to injury. Narcotics and antidepressants used in the elderly population lead to greater risk of falls. Since narcotics, such as Norco or Tylenol-3 or morphine, and antidepressants such as Zoloft or Paxil can cause drowsiness, which can then lead to a fall. So moving on to how to avoid common drug-drug and drug-food interactions. Interactions occur when a drug or food interacts or interferes with another drug. This alters the way medications act in the body or cause unexpected side effects. Medications involved can be prescription medications, over-the-counter medications, and even herbal products. This can be an interaction affecting how a medication is absorbed or how a medication is metabolized by the liver or kidneys. Some common drug-drug interactions and examples include aspirin and warfarin or kumadin. Aspirin and warfarin both increase the risk of bleeding, so putting them together really increases the risk of bruising and bleeding. However, many of our patients need to be on both warfarin and aspirin to prevent a stroke, so the bleeding and bruising may occur. Another example of drug-drug interactions includes anacids and certain antibiotics. Anacids may not allow antibiotics to be absorbed in the gut, and therefore the antibiotic becomes less effective or not effective at all. Another interaction can be gingko-beloba and warfarin or kumadin. Gingko-beloba may affect how warfarin is metabolized by the liver, which can therefore increase the risk of bleeding. Cotmin-drug food interactions include calcium-rich dairy products, anacids, and vitamins containing iron can all decrease the effect of antibiotics, especially tetracycline. Again, they don't allow the antibiotics to be absorbed. Grapefruit juice, I'm sure you've heard of, and certain medications can cause an interaction. Grapefruit juice can inhibit enzymes in the liver involved in drug metabolism and thereby increase the effect of these medications. Some examples of interactions with grapefruit juice include the statin medications that are used for cholesterol, such as lovastatin, atorvastatin, and simvastatin. Also, the calcium channel blockers for hypertension can be affected by grapefruit juice. Also, the calcium channel blockers for hypertension can be affected by grapefruit juice. These include verapamil and nicartapine. Some aniorhythmic agents, such as amiodarone, may also interact with grapefruit juice. So please ask your pharmacist or physician. Foods high in vitamin K, such as green leafy vegetables, decrease the effectiveness of warfarin or kumadin. So our patients that take warfarin or kumadin, we always tell these patients to maintain a consistent diet with leafy green vegetables. We don't tell the patients to avoid these foods. Again, just be consistent. So what can you do to help avoid an interaction? You want to thoroughly read the labels of all your medications, again, both prescription and over-the-counter. You want to make sure you know the benefits as well as the potential risk of all of your medications. Look specifically for the section warnings on the labels of over-the-counter medications. Talk to your physician or pharmacist before taking any new medications, again, whether prescription or over-the-counter. Find out if they are safe with any of the medications you are currently taking. Again, prescription, over-the-counter, herbal products, or vitamins. You also want to try to keep an accurate list of all the medications you take, including dose and frequency of both prescription and over-the-counter medications. Use one pharmacy for all of your family's prescriptions and over-the-counter medication needs. You want to keep your medications in their original prescription bottles and you want to be an active participant in your healthcare. Please ask questions against your physician and or pharmacist. So some key takeaways for medication management. You want to be an active participant in your healthcare. You want to practice the what can I do to help avoid an interaction tactics that we provided in this presentation. And also discuss your medication questions with your primary care provider and your pharmacist. If you don't have a primary care provider, please call them in Michigan Healthline at 800-999-3199. I hope you found the information I provided today on medication management helpful. At MidMichigan Health, we celebrate the power of health throughout life with you.